This randomized controlled trial will compare three innovative teaching methods-Massive Open Online Courses (MOOCs), simulation, and escape games-among newly recruited medical interns at Ibn Sina University Hospital in Rabat, Morocco. The study aims to evaluate their effectiveness in improving knowledge of diabetic ketoacidosis management, retention of knowledge after 4 weeks, and learner motivation. Fifty-one interns will be randomly assigned to one of the three groups. Outcomes will be assessed using multiple-choice knowledge tests at baseline, immediately after training, and 4 weeks later, as well as the Intrinsic Motivation Inventory questionnaire. The results will provide evidence on the most effective and engaging approach to support induction training of new medical interns.

The induction period for newly recruited medical interns represents a critical stage in their professional training. On arrival at the hospital, interns must rapidly acquire clinical knowledge, technical skills, and adaptive behaviors to ensure patient safety and integration into the healthcare team. Innovative teaching strategies, including Massive Open Online Courses (MOOCs), high-fidelity simulation, and gamified approaches such as escape games, have been increasingly adopted in medical education, but comparative evidence of their effectiveness in this context remains limited.

This study is a prospective, randomized controlled trial conducted at Ibn Sina University Hospital, Rabat, Morocco. A total of 51 newly recruited medical interns will be randomly assigned to one of three intervention groups:

MOOC group: A structured online course hosted on Canvas, including four short video modules (4-5 minutes each) covering diagnosis, pathophysiology, precipitating factors, and therapeutic management of diabetic ketoacidosis (DKA). Interactive quizzes are included between modules.

Simulation group: Participants engage in a high-fidelity simulation scenario of DKA secondary to urinary tract infection, using a mannequin in a controlled training environment. Each session is followed by a structured debriefing.

Escape game group: Interns participate in a 30-minute collaborative escape game consisting of 10 puzzles designed to guide them through the diagnostic and therapeutic steps of DKA management, encouraging teamwork and problem-solving.

All interventions focus on the same clinical case to ensure content comparability. A single faculty member oversees all sessions to maintain consistency in delivery and evaluation.

Outcomes: Knowledge acquisition is assessed using a validated 10-item multiple-choice questionnaire administered at baseline (pre-test), immediately after the intervention (post-test), and 4 weeks later (late post-test) to evaluate both immediate learning and short-term retention. Motivation and satisfaction are assessed immediately after the intervention using the Intrinsic Motivation Inventory (IMI), focusing on interest/enjoyment, perceived competence, perceived choice, and pressure/tension.

Analysis: Scores will be compared within and between groups using repeated-measures ANOVA and appropriate non-parametric tests. The study is designed to test whether one teaching method provides superior short-term knowledge gains, improved retention, or greater learner motivation.

This trial addresses an important gap in medical education by directly comparing three pedagogical approaches during the induction training of new interns. Results are expected to guide educational policy and support the development of blended learning strategies that combine the strengths of digital, experiential, and gamified methods.

Inclusion Criteria:

• Newly recruited medical interns at Ibn Sina University Hospital (CHU), Rabat
• Voluntary participation with signed informed consent
• No prior formal training specifically focused on diabetic ketoacidosis

Exclusion Criteria:

• Refusal to participate
• Previous advanced training on diabetic ketoacidosis management