Purpose
A conceptual understanding of the process of tumorigenesis is important for clinicians, yet students can struggle to integrate cancer biology topics from different learning events and apply them to a wide range of cancer types. To support integration and application of these topics, I developed a “choose your own adventure” style game based on the Hallmarks of Cancer framework using Twine. The game stimulates a normal cell on its way to becoming a cancer cell. Students select appropriate genetic modifications to overcome obstacles and then answer multiple-choice questions to acquire the associated hallmark. Students win by acquiring all 8 hallmarks. The game’s value to students was assessed using a post-game survey and game tracking data.

Methods
This game was introduced in November 2023 during the M1 Hematology and Oncology course at WMed. The 2024 game incorporated feedback from a 2023 feedback form. In November 2024, students were invited to complete a post-game survey using a 5-point Likert scale and free-response questions to evaluate 1) student-reported confidence and knowledge of cancer biology topics and 2) student perceptions of the game’s effectiveness and enjoyment. The paths taken through the game and when it was accessed were also tracked.

Results
In 2023, students accessed the game 111 times. They won 61 times (55.0%), 33 attempts (29.7%) terminated in a “Game Over” ending, and 17 attempts (15.3%) ended when students exited the game. Initial feedback on the game in 2023 was mostly positive with minor suggestions for improvement. Data collection for the 2024 game is currently underway.

Conclusions
Overall, the “Hallmarks of Cancer” game has been well-received by students. While students mostly utilized it during the week it was assigned (Week 3), many also accessed it during their Summative Exam week (Week 5), suggesting they found it to be a useful study tool.