Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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On Aug 2018

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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
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Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : FC08 - FC12 Full Version

A Novel Approach in Understanding and Retaining the Subject Concepts among Medical Undergraduates using Treasure Hunt Competition as a Tool: A Quasi-experimental Study

Published: May 1, 2022 | DOI:
Shyamjith Manikkoth, B Deepa, Prajna V Raj, Bheemesh Vangalapati, Rathnakar P Urval, Suresh Vadakedom, Sajith Kumar Radhakrishnan

1. Associate Professor, Department of Pharmacology, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India. 2. Assistant Professor, Department of Pharmacology, K S Hegde Medical Academy, Mangalore, Karnataka, India. 3. Assistant Professor, Department of Pharmacology, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India. 4. Assistant Professor, Department of Pharmacology, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India. 5. Professor and Head, Department of Pharmacology, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India. 6. Associate Professor, Department of Paediatrics, Government Medical College, Kottayam, Kerala, India. 7. Chief and Nodal Officer (Telemedicine), Department of Infectious Disease, Government Medical College, Kottayam, Kerala, India.

Correspondence Address :
Dr. Bheemesh Vangalapati,
Assistant Professor, Department of Pharmacology, Kanachur Institute of
Medical Sciences, Natekal, Mangalore-575018, Karnataka, India.


Introduction: There is a need to incorporate innovative teaching methods other than conventional didactic lectures to generate interest of medical undergraduates in learning Pharmacology. Game-based Learning (GBL) is a new strategy in medical education that can create a fun based atmosphere for learning.

Aim: To assess the effectiveness of GBL as a tool in learning process and in memory retention of the knowledge acquired in pharmacology using treasure hunt competition.

Materials and Methods: The quasi-experimental study was conducted on 4th semester MBBS students of Kanachur Institute of Medical Sciences, Mangaluru, Karnataka, India, from February to March 2019, as a part of the Advanced Course in Medical Education (ACME) project work, Medical Council of India. Entire phase II students (N=150) were included in the study. Students were divided into the GBL group and the Facilitated Learners (FL) group. Both groups were exposed to their respective GBL and FL based learning. Before and after the respective GBL and FL sessions, a pretest and two post-test multiple choice questions based tests were conducted. The second post-test was conducted one month later as a surprise one. Thereafter, a questionnaire was given to pen down the perceptions about GBL. Pretest and post-test marks were analysed by one-way Analysis of Variance (ANOVA) followed by the Tukey-Kramer test. Perceptions about GBL were entered in percentage.

Results: The mean scores of the GBL group were significantly more (p-value <0.001) as compared to the FL group in both the post-tests. In their feedback about GBL, the students appreciated the usefulness of this innovative way of learning pharmacology.

Conclusion: The GBL is an effective tool to teach pharmacology to medical undergraduates.


Innovative, Learning tool, Pharmacology, Team-based learning

The subject pharmacology serves as a backbone in medical science curriculum as well as research based biomedical programs in higher education. It mainly deals with drugs and their interactions with living systems. A good grip over this subject is essential for any clinical practitioner. It is included as a para clinical subject in the medical course in India (1),(2). The most important purpose of teaching pharmacology is to facilitate undergraduate medical students to take logical therapeutic decisions in clinics. Teaching pharmacology to a second year medical undergraduate is a challenging task. The resemblance in drug names, their clinical uses, pharmacodynamic and adverse drug effect profile, always confuse the students and finally they forget the taught contents. Conventional lecture centered teaching emphasises more on theoretical aspects of drugs with less importance on their clinical application (3),(4),(5). Recently for teaching pharmacology, small group discussions are included. This is done with a goal to increase student’s active participation and to deal with clinical conditions, thereby enabling the students competent enough to solve clinical problems (5),(6).

In the conventional pharmacology practicals, apart from prescription writing and clinical problems solving exercises, dispensing pharmacy exercises and experimental pharmacology topics are included to impart knowledge. However, relevance of these practical exercises in clinical utility is always been debated and criticised (5),(7). Students have pointed out in many questionnaire based studies that, even though pharmacology is an essential part of the medical curriculum, the subject is boring and volatile. The basis of this perception could be the vast nature of the subject and difficulty in memorising the details of many drugs at a stretch [6-10]. Even though, attempts are made all over India to make the training in pharmacology more exciting and relevant with the impartation of competency based medical education, it is hard to mend student’s perception about traditional methods in pharmacology teaching (5),(11),(12).

Failure to converge knowledge and skill by an effective method made this basic science subject less appealing and tough for most of the medical undergraduate students. It is high time for the pharmacology faculties to change their perception that subject pharmacology is a dull one. Faculty should keep in mind the learning can be an effective, long-lasting experience if it is driven by fun-loving approaches and worth memorising experiences (13).

In the present scenario, teaching trends in medical education also exhibit some form of a shift from the conventional classroom teaching methods to incorporating unconventional teaching methods. A bit of creativity and unconventional thinking is needed to produce this interest (2),(3),(4),(13).

It’s heartening to see that many pharmacology faculties in India have tried diverse teaching-learning methods to generate interest in students on this volatile, boring subject. A number of innovations such as crossword puzzles, jigsaw active learning, E-learning modules, drug models, prelecture assignments, poetry, Case Based Learning (CBL), role-plays, seminars, simulations are tried as an adjuvant to conventional teaching methods to arouse interest in the subject and for knowledge retention (1),(4),(5),(12),(13),(14),(15),(16),(17).

The concept of conducting treasure hunt competition in understanding and retaining the concepts of pharmacology is novel. It is a part of Game-based Learning (GBL). Games offer a wide opportunity to complement traditional teaching methods and infuse teaching with vigour, ignite innovative thinking and offer diversity in teaching methods. Through GBL, learners are prompted to combine knowledge and skills from different areas for a solution. They can observe the outcome of the game, based on their judgment and actions. Plus they are forced to get in touch with other team members, converse and adjust the steps in finding an answer, thus recuperating their social skills. Psychologists have proposed that GBL could help children to master cognitive skills and expand their imagination. In a safe learning environment without the distractions of a complex clinical setting, game-based learning offers many advantages as it nurtures better and more effective understanding which in turn helps to retain information for a long time. GBL is extensively utilised in various fields such as the military, education, marketing and advertising (5),(11),(18),(19),(20),(21),(22),(23),(24).

Considering all the above facts, this study was done to explore the effectiveness of GBL as a tool in learning process and in memory retention of the knowledge acquired in pharmacology using treasure hunt competition.

Material and Methods

The quasi-experimental study was conducted on 4th semester MBBS students of Kanachur Institute of Medical Sciences, Mangaluru Karnataka, India, February to March 2019, as a part of the Advanced Course in Medical Education (ACME) project work, Medical Council of India. The entire 4th semester MBBS students (N=150) were enrolled for the study, after obtaining Institutional Ethics Committee Clearance (2/FEB/IEC/2019; dated 13th February 2019). Informed consent was obtained from participants.

Inclusion and Exclusion criteria: All the 4th semester MBBS students who were willing to take part in the study were included and students who quit before the completion of the study were excluded from the study.

Study Procedure

They were not compelled or forced to take part in the study. Even though, the students were informed that taking part in the study was not compulsory and they were free to quit the study at any point of time, all 150 students willingly joined the study and took part in all the sessions. In brief, the study was done as follows

1. After theory topics on a particular system were taken, Multiple-Choice Questions (MCQs) test of five marks, i.e. pre game test, was conducted.
2. Treasure hunt competition was organised after the test.
3. For conducting the treasure hunt competition, students were divided into small groups comprising of less than ten. Each group was assigned a group captain. There were different stations for this game. In each station, a set of questions/clinical problem/chart was kept. An answer to each station was a part of the clue, where the treasure is kept. The main attraction of this game was that participants could refer to standard medical textbooks in pharmacology for solving the questions in a stipulated time of one hour. The group captain reported to the game co-ordinator about the clue his/her group had solved, enabling them to locate the hidden treasure. When a wrong clue was reported, the game co-ordinator conveyed to the group members of the particular group members to search for the correct one. The group which solved all the clues first were able to find the hidden treasure. Irrespective of a group winning the treasure, the other groups were also asked to solve the clues.
4. After the game was played, another MCQ test of five marks (GBL postgame test 1) was conducted on the same topic. Moderate to tough questions were asked.
5. Exactly after a month, a surprise MCQ test of five marks (GBL post-game test 2) was conducted on the same topic. Moderate to tough questions were asked.
6. After GBL post-game test 2, students were given a peer validated questionnaire to pen their perceptions about GBL. The questionnaire was prepared by referring to published articles of studies on other teaching-learning methods like computer-based learning and team-based learning. Further, the prepared questionnaire was validated by peers within and outside the institute. This was approved by the scientific and Ethics Committee of the institute. Students were given a time of 15-20 minutes to pen their perceptions about GBL.
7. Altogether, three treasure hunt competitions were conducted during the February 2019 to March 2019 study to validate the efficacy of game-based learning. In the first GBL, entire students, i.e., all 150 students, were exposed to a treasure (topic-cardiovascular system). Pretest and post-test 1 and 2 were conducted. In the second and third GBL, 150 students were divided into two groups:
• Total 75 were exposed to GBL, and
• The rest 75 were exposed to Facilitated Learning (FL).

During the one hour period of facilitated learning, the first 15 minutes were utilised to summarise the important points in the particular topic by the faculty and for the rest of 45 minutes, students were asked to read the textbooks. They were encouraged to ask to clarify doubts with faculty whenever required. In short, this facilitated learning is a modified way of conventional lecture. Pretest, post-test 1 and 2 were done like that in GBL-1 for both the groups. This facilitated learners group was added as per the recommendations suggested by the institutional ethics committee.

8. The total marks for each MCQs were five. It was taken care that the participants who were not exposed to treasure hunt in GBL-2 were given a chance in GBL-3.

Treasure hunt design: A brief word about how this game was played.

In this game, a treasure (chocolate) was kept near ROTAROD apparatus. The clue about it was gained after solving all the questions/charts kept at various stations. For example answer of question 1 was a drug name starting with letter R, for other questions the drug name started as follows

S2: O
S3: T
S4: A
S5: R
S6: O
S7: D

That is, when they solved all questions at various stations and when they combined the first letters of all answers it was read as ROTAROD, name of an apparatus which is kept in the experimental pharmacology lab. The participants were informed initially that the first letters of the solved answers will lead to a clue where treasure is hidden. That means treasure is near ROTAROD apparatus. Solving the questions was done by referring standard text books in pharmacology.

The above clue was kept for one of the treasure hunt competition. Different clues were kept for other treasure hunt competitions. After the treasure hunt competitions and subsequent tests were conducted, a feedback was collected from the participants to know their perceptions and opinion about GBL.

Statistical Analysis

All the data procured from the study i.e. pre test and post test marks are expressed as mean±standard deviation, they are analysed by one-way Analysis of Variance (ANOVA) followed by Tukey-Kramer test. The p-value<0.05 was considered significant. Analysis was carried out using Graphpad Prism software. The questionnaires were scrutinised and student’s perceptions about GBL are depicted in percentage.


GBL helped students in conceptualising and memorising a topic from the cardiovascular system: From (Table/Fig 1), it is clear that students’ performance after undergoing GBL has significantly (p<0.001) improved compared with their pre game test marks. It is also noted that their knowledge retention was significantly high (p<0.001) after undergoing GBL, as evidenced by their post game test-2 score.

GBL is effective than FL in conceptualising and memorising the topics in Pharmacology: From [Table/Fig-2,3], it is clear that students performances after undergoing GBL in two topics of pharmacology (GIT and autacoids) have significantly (p<0.001) improved on comparing with their pre-GBL test marks. It is also noted that their knowledge retention was significantly high (p<0.001) after undergoing GBL, as evidenced by their post GBL test-2 score, compared with pre GBL test marks. It is interesting to see that post GBL test-1 scores were significantly higher (p<0.05) than post FL test-1 scores in the topic of autacoids. Another important thing observed was that the post FL test-2 marks were considerably reduced (p<0.01) compared with the post-FL test-1 score in the topic of autacoids. It is noteworthy to mention that the post GBL test-2 scores were extremely (p<0.001) higher than the post FL test-2 scores in both the topics of GIT and autacoids.

Perceptions and opinions about GBL: Questionnaire results and the student’s perceptions clearly showed that more than 90% of the participants liked this new way of teaching in pharmacology (Table/Fig 4).

Other important points mentioned by students:

“GBL contributes more to understand theoretical concepts and memorising the topics”
“Interesting and help to gain knowledge”
“I was motivated to read text books like K D Tripathi”
“GBL is fun based learning, obviously add to long run memory”
“GBL should be conducted more often”
“GBL helps to cover more topics in a very short time”


Pharmacology, like any other branch of medicine, is evolving year by year. Usually, in India, the pharmacology teaching in medical colleges depends on a lecture-based approach. This type of teaching is not an effective method in prompting higher order thinking. As a result, the knowledge of basic pharmacology is less among medical practitioners and students consider it to be a very complex, volatile and dry subject with minimal relevance. Restructuring in undergraduate teaching must be made regularly to improve the standard of teaching. Reassessing the teaching methods periodically and modifications in the various methodologies in teaching schedule is a must to match up with the global standard of teaching. Therefore, to accomplish both the learning demands and National Medical Commission (NMC)’s requirements, new strategies are necessitated in Competency Based Medical Education (CBME) based pharmacology teaching (7),(8).

It is a fact lectures will remain as the essential part of teaching methodology for next few years as they are a part of curriculum in India. There is a need for innovative teaching methods to adjuvant the usefulness of lectures and at the same time make the learning more interesting and stress free (8),(9),(12).

Game-based learning is an innovative tool in teaching method to impart knowledge in the field of pharmacology. So, a game-based learning was conducted in topics from cardiovascular system, gastrointestinal system and autacoids. These topics were selected based on student’s request.

The reported use of games in pharmacology teaching is uncommon. The slow implementation of games in pharmacology teaching may be because of ambiguity and confusion of how games could have a role in medical education and how they can do well to both students and educators (15),(21),(23).

In this study, the majority of students opined that the GBL to be fun and motivating. From the results it was observed that students who were exposed to GBL excelled in both the post game tests, when compared with the students who underwent facilitated learning. It is to be noted that both types of learning were done after the didactic lecture on the particular topic was delivered. The most important point to mention is GBL students were able to recollect more points during the surprise post test-2 sessions on comparing with FL students. Even though, both the teaching methods were done in a stress free, friendly environment, the major reason for the improved performance and improved retention of knowledge by GBL students can be because of two key factors motivation and enthusiasm. These factors were missing in facilitated learning sessions.

Similar with other studies, where different games like jigsaw puzzles, cross word puzzles, quizzes were utilised to improve learning in medical undergraduates (7),(8),(12),(13),(15),(17). The present study using treasure hunt as a tool to impart knowledge and retaining memory in pharmacology was also found effective.

With these game-based sessions in the present study, the students were able to observe directly how their learning and judgment skills can be applied to solve the problems in front of them for getting the clue of place where treasure is hidden. This made the sessions exciting, interactive and enthusiastic. Above all they were motivated to read textbooks and grab the knowledge in a quick span of time to beat their peers in other treasure hunting groups. The internal motivation and enthusiasm for learning is proved to have a positive influence on the learning process all through the medical career of a student (8),(21).

The students reported that GBL enhanced their ability to understand the concepts and incorporate the knowledge in an effective manner, that too in a fixed time period. Furthermore, GBL also helped in applying the knowledge in these topics, as was evident from the higher test scores in post game sessions as compared to the test scores in facilitated lecture-based sessions. During the study, students were actively interacting with their peers while playing to find the correct clue for the hidden treasure. In other words, GBL promoted Team-based Learning (TBL).

Team based learning is a novel and effective strategy of teaching methods that encourages peer interaction and self directed learning (4). Team-based interaction and learning skills are necessary for a good health care delivery in the future. Education experts emphasise that students gain more knowledge through discussions with instructors and other classmates (19),(23).

Games and gaming elements create fun and enthusiasm in stressful environments. Well planned games are cognitively challenging. They make learners occupied and aid progression through difficult tasks. The tasks in a well structured game engage learners in diverse aspects of serious play, such as planning, interacting, decision making, proof gathering, competing, reviewing feedback and self improving (19),(20),(25).

Game-based learning can be useful as an adjuvant option to classroom lecturing. Games can provide the motivation to learn, increasing the probability that the required learning outcomes can be attained (18).

Game-based learning is a tool which makes use of the game as a medium for learning. The success of GBL techniques is obliged to energetic participation and communication. GBL is a trending topic amongst human resource and education fields internationally. The game and its game plan are enabling the students to master the concepts. Through, a game, a player can increase the skills, ability, and art of applying knowledge when required. Through GBL, we can not only generate an outlook that push students to go for new things, but also an environment where the student is no longer worried of failing (20).

The more pleasurable an educational game is, the more actively students will continue in playing it. However, the teacher must make sure that educational information is not mislaid in the enthusiasm and competition of the game. Further, the complexity level of the game should be modest as complex games dispirit students from participating. To be successful, the educational game needs to strike equilibrium between instructive contents and gaming rudiments. It is feasible to develop educational games, without much funding and sophisticated technological expertise (21),(23).

To summarise, this study shows that a properly planned educational game can successfully engage pharmacology students with greater motivation and enthusiasm, and it can be developed as an offline or online based module to support classroom teaching in the blended learning approach.


one of the drawbacks of GBL was, not all students wished to gain knowledge by this method. It was echoed in their feedback. From the faculty’s perspective, for planning a GBL an extensive time has to be invested. More over once used, the game material (clues) cannot be reused. For every game new clues and new places to hide treasure has to be ensured. This is likely to be a tedious one, when GBL has to be conducted frequently. The MCQ tests conducted before and after the respective learning sessions were only of five marks. The effectiveness of this treasure hunt based teaching has to be proved by conducting MCQ tests of more marks or by conducting essay based questions. Further, the effectiveness of this game-based learning has to be proved by conducting it in other medical institutes.


In conclusion, any game-based learning can be a great tool to boost the effectiveness of conventional lecture-based sessions in pharmacology by creating an atmosphere of fun, enthusiasm and motivation.


Authors acknowledge the help of Medical Education Units of Kanachur Institute of Medical Sciences, Mangaluru and Government Medical College, Kottayam, India, for successfully carrying out this medical education research work.


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DOI and Others

DOI: 10.7860/JCDR/2022/55777.16365

Date of Submission: Feb 19, 2022
Date of Peer Review: Mar 13, 2022
Date of Acceptance: Apr 24, 2022
Date of Publishing: May 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Feb 22, 2022
• Manual Googling: Feb 28, 2022
• iThenticate Software: Mar 13, 2022 (7%)

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