Both the experimental and comparison groups will receive a reminder lecture from the researcher on ethical principles and codes prior to the applications. Participants in the experimental group will simultaneously play digital games and participate in classroom group work after the reminder lesson.

They will only participate in in-class group work.

Digital Game:

The developed digital game aims to enhance medical students' ethical awareness and decision-making skills. The digital game first provides students with reminders about ethical principles.

The game covers a four-week process, focusing on a specific ethical principle each week. Each weekly module presents two cases supported by animated visuals written by the researcher, reviewed by experts, and created by the software company. After watching and reading the cases, students answer related questions.

The modules and principles covered are as follows:

Week 1 (Do No Harm/Beneficence): Cases related to treatment refusal and palliative care compliance.

Week 2 (Autonomy/Respect): Cases related to organ donation decisions and chemotherapy refusal.

Week 3 (Justice/Equity): Cases related to resource (air mattress) allocation and patient prioritisation.

Week 4 (Confidentiality/Privacy): Cases related to HIV diagnosis confidentiality and psychiatric service confidentiality.

This scale determines the ethical sensitivity levels of nursing students.

The 7-point Likert-type scale (1=Strongly disagree, 7=Strongly agree) consists of 30 items and six subscales. Items 8, 24, and 29 are reverse-scored. The total score ranges from 30 to 210; a high score indicates high ethical sensitivity.

Item averages are evaluated as 7-5.9 (very important), 5.8-5 (important), 4.9-3.1 (neutral), and below 3.1 (unimportant).

The scale developed under the name 'Nursing Dilemma Test' aims to identify ethical issues in nursing and consists of six scenarios.

Each scenario has three sections (A, B, C):

Section A (Action): Measures the decision to be made in the face of an ethical dilemma (to act/not to act/to be undecided).

Section B (Thinking Style): Determines the 'Principled Thinking' (NPT - importance given to ethical principles) and 'Practical Thinking' (PT - importance given to environmental factors) scores by ranking six statements based on Kohlberg's theory.

Section C (Familiarity): Calculates the 'familiarity' score by questioning the case experience.

Scoring:

NPT Score: ranges from 18 to 66. PT Score: ranges from 6 to 36. Familiarity Score: 6-17 (familiar), 18-30 (unfamiliar).

Reliability (Turkish Version):

Cronbach's Alpha: NPT (0.59), PT (0.50). Test-Retest: NPT (0.77), PT (0.73).

This scale assesses students' satisfaction with education and their attitudes towards self-confidence in learning.

The 5-point Likert-type scale (1=Strongly disagree, 5=Strongly agree), consisting of 13 items in total, has two subscales:

Satisfaction with Learning (5 items) Self-Confidence (8 items)

Items are reverse-coded. The total score ranges from 13 to 65; a high score indicates high satisfaction and self-confidence. The Cronbach's alpha coefficients of the original scale were found to be Satisfaction (0.94) and Self-Confidence (0.87).

The Cronbach's alpha values for the Turkish form were found to be Satisfaction (0.89), Self-Confidence (0.83), and Scale Total (0.90).