Lee et al. Anesthesiology and Perioperative Science (2023) 1:14 https://doi.org/10.1007/s44254-023-00016-4 ORIGINAL RESEARCH Open Access © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Anesthesiology and Perioperative Science A serious video game—EmergenCSim ™ — for novice anesthesia trainees to learn how to perform general anesthesia for emergency cesarean delivery: a randomized controlled trial Allison J. Lee 1* , Stephanie Goodman 1 , Beatriz Corradini 1 , Sophie Cohn 2 , Madhabi Chatterji 2 and Ruth Landau 1 Abstract Purpose We developed EmergenCSim ™ , a serious game (SG) with an embedded assessment, to teach and assess performing general anesthesia for cesarean delivery. We hypothesized that first-year anesthesiology trainees (CA-1) playing EmergenCSim ™ would yield superior knowledge scores versus controls, and EmergenCSim ™ and high-fidelity simulation (HFS) assessments would correlate. Methods This was a single-blinded, longitudinal randomized experiment. Following a lecture (week 3), trainees took a multiple-choice question (MCQ) test (week 4) and were randomized to play EmergenCSim ™ (N = 26) or a non- content specific SG (N = 23). Participants repeated the MCQ test (week 8). Between month 3 and 12, all repeated the MCQ test, played EmergenCSim ™ and participated in HFS of an identical scenario. HFS performance was rated using a behavior checklist. Results There was no significant change in mean MCQ scores over time between groups F (2, 94) = 0.870, p = 0.42, and no main effect on MCQ scores, F (1, 47) = 1.110, p = 0.20. There was significant three-way interaction between time, gender and group, F (2, 90) = 3.042, p = 0.053, and significant two-way interaction between gender and time on MCQ scores, F (2, 94) = 107.77, p = 0.036; outcomes improved over time among males. There was no group difference in HFS checklist and SG scores. Both instruments demonstrated good internal consistency reliability but non-signifi- cant score correlation. Conclusions Playing EmergenCSim ™ once did not improve MCQ scores; nonetheless scores slightly improved among males over time, suggesting gender may impact learning outcomes with SGs. Keywords Serious games, Multiple-choice test, General anesthesia, Emergency cesarean delivery 1 Introduction Anesthesia-related maternal mortality has decreased with reduced use of general anesthesia for cesarean deliv- ery [1], however, general anesthesia -related complica- tions in pregnancy remain high [2, 3]. Tis has raised concern about inadequate readiness of anesthesia train- ees to manage such cases, which are usually emergencies *Correspondence: Allison J. Lee al3196@cumc.columbia.edu 1 Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th St, PH5, New York, NY 10032, USA 2 Columbia University Teachers College, New York, NY, USA