Assessment of the impact on learning

A 9-point Likert scale from 1 (very, very low mental effort) to 9 (very, very high mental effort) [29] was used to evaluate the cognitive load related to the review of the teaching content, the performance of the game tests, and the use of Second Life, at the end of the three blocks corresponding to anatomy and semiology. The test scores of each stage made it possible to measure the short-term knowledge profile of the participants. The correct answers were not provided during the game. One month after the game ended, all the students in the course were invited to a review seminar in the classroom, where the certificates and prizes of the participating teams were publicly given. The 180 questions of the game were reviewed except for 60 questions (10 randomly selected from each stage) that integrated a post-exposure test with 30 s to answer each question. Additionally, course scores were recorded to correlate with game scores. The results of participants and non-participants were compared.