Conclusion
This study investigated a competitive e-learning quiz application to “cure” medical students’ statistical illiteracy, aiming to increase students’ intrinsic motivation to engage with EbM in the long term. We found no evidence of the tested simple gamification programme increasing medical students’ risk competence. Changes in test scores can be attributed to chance. There was no indication that it improved their intrinsic motivation. Even though students valued EbM as a major skill in curriculum and profession, they perceived their own risk competence as poor. On the one hand, more than half of the participants enjoyed using MC-Duell and assumed, it would improve their risk competence. On the other hand, they especially rejected the competitive approach and showed low time investment. Nevertheless, we learned a valuable lesson for upcoming studies. When developing prospective longitudinal learning interventions in medical education, the use of competitive gamification must be carefully evaluated. Instead, a collaborative approach may be contemplated. To increase time investment and lower dropouts, it appears promising to increase usability, for example by avoiding real-time matches. In addition, it can be beneficial to increase the complexity of the applications. By incorporating these principles, we hope to design effective learning applications in the future that intrinsically motivate students to become risk competent health professionals.