Virulence: A cooperative educational tabletop game for high school students to improve their knowledge retention, understanding and application of immunology

Immunology is a complex subject, and students often find it difficult to grasp key concepts through conventional pedagogical methods. Educational tabletop games offer a promising and interactive alternative; however, evidence of their impact on cognitive learning outcomes and past games in the cooperative genre are limited, with few frameworks available to guide their development. To address this, the POV3D framework (Problem, Objectives, Vision, Design, Debrief, Development) was developed by the researcher and applied in the creation of Virulence, a cooperative board game to teach immunology. To evaluate Virulence’s effectiveness, 30 Year 12 students from an international school in Bangkok participated in small-group sessions. A 36 -item test was completed by participants before and after gameplay, with immunology questions categorized by Bloom’s taxonomy to assess knowledge retention, understanding and application. A separate questionnaire collected participant feedback. Data normality was checked using the Shapiro-Wilk Test, followed by analysis using Paired T-Tests and the Wilcoxon Signed-Rank Test. Results showed a statistically significant improvement in short-term knowledge retention and understanding ($\mathrm{p}\lt 0.05$), though gains in application were statistically insignificant ($\mathrm{p} \boldsymbol{\gt } {0 . 0 5}$). The questionnaire feedback indicated that participants found Virulence to be useful, motivating and replayable, but also not as technical as lessons. This study’s limitations include the lack of a control, the effect of the participants’ subject history and of the facilitator in the sessions. Even with these limits, Virulence helped students learn immunology, the cooperative genre for board games shows merits, and the POV-3D framework has promising utility for educators, but should be tested further.