# Investigation of the psychometric properties of the German System Thinking Scale in an interprofessional learning setting using the game “Friday Night at the Emergency Room®”: a cross-sectional study

## TL;DR

This study tested a German version of a system thinking scale in a healthcare education game and found it reliable and effective in improving students' system thinking.

## Contribution

The study validates the German System Thinking Scale and demonstrates its effectiveness in an interprofessional educational game setting.

## Key findings

- The German System Thinking Scale showed high internal consistency (Cronbach’s α = 0.876) and good psychometric properties.
- Nine out of 20 items on the scale significantly improved after students played the simulation game.
- The game positively impacted students' attitudes toward system thinking across various healthcare professions.

## Abstract

System thinking is recommended as a necessary component in health education. However, it is not yet regularly addressed in medicine and health care professions. Therefore, the simulation game “Friday Night at the Emergency Room®” was used to teach system thinking in an interprofessional setting. The aims of this study were to evaluate (a) the psychometric properties of the translated German version of the System Thinking Scale in an interprofessional workshop and (b) the effect of the game on the students’ attitudes toward system thinking.

The translation of the game and the System Thinking Scale involved independent forward translation, the creation of a consensus version in an interdisciplinary team, cultural adaptation, and a backward translation. Descriptive item analysis and confirmatory factor analysis, internal consistency and reliability of the German System Thinking Scale were calculated. The Interprofessional Socialization and Valuing Scale as well as the evaluation of the effect of the simulation game “Friday Night at the Emergency Room®” on the German System Thinking Scale were used for external validation.

The translation of the game and the System Thinking Scale was successful without major cultural adaptations. A total of 97 students (response rate: 37%) from medicine, applied nursing sciences, midwifery, health and health care sciences, physical therapy and occupational therapy, on average 23.3 years old and 67 females (72.8%) participated in the workshop and the overall evaluation. The German System Thinking Scale showed a high internal consistency (Cronbach’s = 0.876) and high level of acceptance. The game had a positive impact on the students’ system thinking, as nine of the 20 items increased significantly after the game.

The German version of the System Thinking Scale is a reliable instrument in measuring system thinking of medical and health care students and it revealed good to moderate psychometric properties. The measured system thinking could be significantly improved by using the game “Friday Night at the Emergency Room®” in educational programs.

The online version contains supplementary material available at 10.1186/s12909-025-07564-2.