Gamification in Action: Theoretical and Practical Considerations for Medical Educators

Underground nursing students' experiences in a face-to-face, hybrid, and online escape room model: a comparative analysis in Serbian context

Educational escape rooms (EERs) are gamified teaching and learning tools increasingly used in nursing education. This study aims to compare undergraduate nursing students' gameful experiences (GEs) across three EER models: face-to-face, hybrid, and online. A cross-sectional study was conducted with 136 first-year students in a Serbian undergraduate nursing programme. All models EERs had the same narrative, which included several topics from the Fundamentals of Nursing course. Face-to-face and hybrid EERs were implemented in faculty skills laboratories, while the online model used the Zoom® platform. Face-to-face EERs were conducted in 2021/2022. and hybrid and online in the 2022/2023 school year. Immediately after the EER activity, the Gameful Experience Scale (GAMEX) assessed students' GE across six dimensions (Enjoyment, Absorption, Creative Thinking, Activation, Absence of Negative Effects and Dominance). All students solved the puzzles in the allotted time and 'escaped from the room.' Median escape time from face-to-face EER was 39.2 (IQR = 2.1), from online 37.4 (IQR = 4.1), and hybrid 37.2 (IQR = 3.5) minutes. By comparing GE students in three EER models, significant differences were found in five dimensions of the GAMEX scale. Students in face-to-face EER enjoyed significantly more (p < 0.001) and thought more creatively (p < 0.001), while the GE of online model students indicated significantly higher levels of activation (p < 0.001), dominance (p < 0.001), and negative effect (p < 0.001). In the face-to-face and hybrid models, students' GE were more moderate in these dimensions. All EER models can generate positive emotions with moderate negative effects, aligning with the goals of EERs as educational games. Further research is needed to identify the most effective EER model for different areas of nursing education.

Motivation Theories and Constructs in Experimental Studies of Online Instruction: Systematic Review and Directed Content Analysis

BACKGROUND

The motivational design of online instruction is critical in influencing learners' motivation. Given the multifaceted and situated nature of motivation, educators need access to a range of evidence-based motivational design strategies that target different motivational constructs (eg, interest or confidence).

OBJECTIVE

This systematic review and directed content analysis aimed to catalog the motivational constructs targeted in experimental studies of online motivational design strategies in health professions education. Identifying which motivational constructs have been most frequently targeted by design strategies-and which remain under-studied-can offer valuable insights into potential areas for future research.

METHODS

Medline, Embase, Emcare, PsycINFO, ERIC, and Web of Science were searched from 1990 to August 2022. Studies were included if they compared online instructional design strategies intending to support a motivational construct (eg, interest) or motivation in general among learners in licensed health professions. Two team members independently screened and coded the studies, focusing on the motivational theories that researchers used and the motivational constructs targeted by their design strategies. Motivational constructs were coded into the following categories: intrinsic value beliefs, extrinsic value beliefs, competence and control beliefs, social connectedness, autonomy, and goals.

RESULTS

From 10,584 records, 46 studies were included. Half of the studies (n=23) tested strategies aimed at making instruction more interesting, enjoyable, and fun (n=23), while fewer studies tested strategies aimed at influencing extrinsic value beliefs (n=9), competence and control beliefs (n=6), social connectedness (n=4), or autonomy (n=2). A focus on intrinsic value beliefs was particularly evident in studies not informed by a theory of motivation.

CONCLUSIONS

Most research in health professions education has focused on motivating learners by making online instruction more interesting, enjoyable, and fun. We recommend that future research expand this focus to include other motivational constructs, such as relevance, confidence, and autonomy. Investigating design strategies that influence these constructs would help generate a broader toolkit of strategies for educators to support learners' motivation in online settings.

TRIAL REGISTRATION

PROSPERO CRD42022359521; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022359521.

Gamification to enhance clinical and technical skills in surgical residency: A systematic review

OBJECTIVE

Gamification has emerged as an adjunct to traditional teaching methods, however, literature on its application in surgical education is limited. We sought to explore the prevalence and impact of gamification techniques among surgical trainees.

DESIGN

A systematic review was performed to identify studies using gamification in surgical training, where gamification was defined as the use of game elements to foster competition.

PARTICIPANTS

Surgical residents.

RESULTS

Twenty-two studies, including 1283 participants, described the use of gamification in surgical education. Thirteen studies focused on knowledge-based games and ten on technical skills. Gamification was associated with improvements in technical performance, knowledge acquisition, and overall engagement among surgical trainees. Additionally, satisfaction surveys indicated a positive reception of gamification as an educational tool.

CONCLUSIONS

Gamification presents a promising approach to enhancing the performance of surgical trainees in an engaging learning environment.

Emerging trends in gamification for clinical reasoning education: a scoping review

BACKGROUND

Clinical reasoning is a fundamental skill in healthcare education, crucial for diagnosing and managing patient care effectively. Traditional pedagogical techniques often fall short in fully engaging students or simulating real-life medical decision-making complexities. Gamification, which applies game-design elements in educational settings, has emerged as a promising strategy to enhance learning outcomes by making the educational process more interactive and engaging. This scoping review aims to comprehensively map the existing literature on gamification techniques used to enhance clinical reasoning education, identifying trends, gaps, and opportunities for future research.

METHODS

The review followed the Joanna Briggs Institute (JBI) methodology and the Arksey and O'Malley framework for scoping reviews. A systematic search of Medline, Scopus, and Web of science, complemented by hand-searching reference lists. Studies published between 2014 and 2023, focusing on gamification applied to clinical reasoning education for healthcare professionals and trainees, were eligible for inclusion. Two independent reviewers screened and selected studies, and data were extracted using a pre-defined tool. Findings were synthesized using both quantitative summaries and qualitative thematic analysis.

RESULTS

Fifty-three studies met the inclusion criteria, representing research from 20 countries, with the United States contributing the largest proportion (28.3%), followed by Germany (9.4%) and France (7.6%). The majority of studies were cross-sectional (28.3%) or pilot studies (22.6%). Gamification was most frequently applied in university and academic settings (37.7%), followed by clinical and hospital-based training (18.9%), and digital platforms and simulations (17.0%). Medicine (28.3%) and nursing (22.6%) were the most targeted disciplines, with pharmacy (13.2%) following. Serious games were the most common gamification technique (45.3%), with additional strategies including escape rooms (11.3%), board and card games (7.5%), and branching case-based games (5.7%). Most studies (88.7%) referenced at least one theoretical framework, predominantly game-based learning theories (34.0%), followed by constructivist learning (13.2%) and experiential learning theories (13.2%). However, cognitive theories, directly relevant to clinical reasoning, were referenced in only 11.3% of studies, highlighting a theoretical gap.

CONCLUSIONS

Amification offers diverse and flexible strategies for enhancing clinical reasoning education across healthcare disciplines and settings. However, significant gaps remain, including limited longitudinal evidence, inconsistent use of validated reasoning assessments, underutilization of cognitive reasoning theories, and a lack of standardized design and reporting frameworks. Moreover, research predominantly focuses on medicine and nursing, with limited attention to interprofessional reasoning and underrepresented fields such as dentistry, rehabilitation, and allied health. Future research should prioritize theoretically informed gamification design, apply robust reasoning outcome measures, and explore emerging technologies such as AI-enhanced adaptive gamification and immersive virtual reality simulations to support clinical reasoning development. Addressing these gaps will ensure that gamification evolves from a promising innovation into a rigorously evidence-based strategy for enhancing clinical reasoning competence in healthcare education.

Gamifying anatomy outreach: An underexplored opportunity

This article explores the underutilized potential of incorporating gamified approaches into anatomy outreach initiatives. While gamification and game-based learning approaches have been widely adopted in formal educational settings, there is a surprising lack of research on their application for community-based public engagement with anatomy. We emphasize the importance of involving community partners from the outset to co-design gamified outreach activities. A collaborative approach tailors the final products to the needs, preferences, and resources of the target audiences. By actively involving end users, co-design fosters a sense of ownership, relevance, and long-term sustainability for the educational resources. This article also presents a practical guide for evidence-based implementation of gamified anatomy outreach, drawing on key learning theories. We discuss strategies for supporting participant motivation and fostering an optimal "flow" state, as well as principles of cognitive load theory and social learning. We also apply each of these theoretical frameworks to illustrative examples, demonstrating how gamified learning can enhance the accessibility, engagement, and retention of complex anatomical concepts. We conclude by presenting practical distinctions between implementing gamified approaches in academic versus community settings, highlighting considerations around technology, resources, and audience diversity. By bridging the gap between gamified learning research and public engagement principles, this article aims to provide practical guidance for anatomy educators, outreach coordinators, and game designers seeking to create more accessible, equitable, and impactful experiences for their communities.

The pit crew card game: a novel gamification exercise to improve EMS performance in critical care scenarios

BACKGROUND

Gamification can be defined as the use of game design elements in non-game contexts, in this case, education. As such, gamification seeks to augment the interactive approach of adult learning theory which promotes ongoing motivation and engagement. The objective of this study was to develop and implement a gamified learning module to teach the pit crew approach to Emergency Medical Services personnel in an interactive, engaging format. We created a game-based simulation scenario, an introductory video, and a post-session survey to assess the effectiveness of our educational innovation. We hypothesized that gamification would strengthen classroom engagement and attitudes toward clinical education as assessed in the post-session survey.

METHODS

This was a pilot study to assess the characteristics of a novel, gamified educational session. We created teams of 5 personnel with various experience and levels of training. Our educational session began with an introductory video and the Pit Crew Card Game, a novel, interactive card game where the facilitator leads teams through a verbal scenario and administers task cards to the team leader based on interventions and other tasks the group verbalizes. After the game, teams were engaged in an interactive critical care simulation scenario where they were expected to perform tasks based on their pre-assigned roles. After the exercise, we administered a brief survey to assess learners' perceptions about the effectiveness of this novel educational session as well as whether participating in this activity would change their behaviors in future real-life critical care scenarios.

RESULTS

96 participants completed the post-session survey. The Pit Crew Card Game was heavily favored over traditional lecture-based learning sessions, with 84% of respondents indicating agreement. 77% agreed that the game improved their understanding of how to utilize the pit crew approach for critical care scenarios and that it was an effective teaching, teamwork, and communication tool.

CONCLUSION

Based on these results, we conclude that gamification has potential as a preferential and feasible learning method for critical scenario training among prehospital personnel. Participants reported that the Pit Crew Card Game increased their understanding of pit crew concepts, promoted effective communication and teamwork, and was an overall effective teaching tool. We recommend further expansion of gamified teaching strategies to the prehospital education realm and support for future research in this domain.

Use of game-based learning strategies for dermatology and dermoscopy education: a cross-sectional survey of members of the International Dermoscopy Society

BACKGROUND

Dermoscopy is a valuable tool in the diagnosis of various skin conditions. It increases sensitivity and specificity in skin cancer diagnosis, as well as in infectious, inflammatory and hair diseases. However, mastering the intricacies of dermoscopy can be challenging. In this context, innovative educational methods are sought, including game-based learning (GBL) strategies.

OBJECTIVES

To describe current perceptions, knowledge and use of GBL strategies in dermoscopy education, and identify strengths and challenges to enhance their use.

METHODS

A web-based cross-sectional survey with 25 questions was distributed to members of the International Dermoscopy Society -between October 2022 and April 2023. Responses were collected and analysed using frequency analysis and graphical representation.

RESULTS

In total, 801 responses were received. Of these, 46.6% of respondents were unfamiliar with gamification and serious games. Among those acquainted with these concepts, 56.3% reported using GBL strategies for education. Younger participants were more likely to use GBL strategies (P = 0.02). Participants familiar with GBL believed it enhanced medical education (78.5%) but should not entirely replace traditional teaching methods (96.0%). For dermoscopy education specifically, 22.1% of respondents had used GBL strategies, with Kahoot! (35.5%) and YOUdermoscopy (24.1%) being the most commonly used platforms. Respondents found gaming strategies to be fun (95.5%), motivating (91.0%) and valuable for e-learning (94.4%).

CONCLUSIONS

Results from this survey demonstrate a favourable perception of GBL strategies in dermatology education, including dermoscopy. While there are ongoing challenges in validation, GBL strategies are promising and valuable tools that can aid the learning and teaching experience. Addressing implementation barriers and validating existing games could optimize the impact of GBL on dermatology education.

The Impact of Audience Response System in Changing Students' Attitudes Towards Lectures During Training Courses; A Before-After Study

Background and Aims

The primary teaching approach known as "traditional lecture" has drawbacks, including being dull and reducing student participation, which has made students feel negatively about it. It seems that by implementing certain changes, active learning techniques like the "Audience Response System" could alter students' perceptions of lectures. The purpose of this study is to find out how employing "ARS" throughout a course has affected nursing students' perceptions of traditional lectures.

Methods

In present research, 44 nursing students participated in quasi-experimental study (Pretest-Posttest Design). A 5-item, 5-point Likert questionnaire and a pre-test question regarding the degree of participation during lecture were used to gauge the students' attitudes towards lectures. Following that, a six-session pharmacology course including "Lectures + ARS" was held. Following the completion of the course, the original questionnaire, a posttest question regarding attitudes, and four 3-point Likert items regarding students' opinions regarding the use of ARS going forward were used to assess changes in the students' attitudes towards lectures. SPSS Ver. 26 was used for the data analysis. p < 0.05 was taken into consideration as the significance threshold.

Results

In comparison to before the course, the students' attitudes towards lectures had changed in a positive and significant way, specifically in items such as learning quality improvement, decreasing boredom, increasing participation and class activity. However, in the domain of "decreasing the use of lecture," the ARS had failed to change the students' attitudes. 79.6% of students stated that the ARS had changed their attitudes towards lectures. More than 90% of students agreed with continued use of ARS in the future.

Conclusion

Lecturing could transform from a passive position to an active position by implementing ARS. Lecture + ARS could lead to improvement in students' class participation and activity, both of which are essential factors of an optimal education.

Gamification in medical education: identifying and prioritizing key elements through Delphi method

BACKGROUND

Gamification has gained popularity in medical education, but key elements have not been formally identified. This study aimed to generate and prioritize a list of key elements of gamification in medical education.

METHODS

This study utilized a two-stage approach, including the Delphi method and qualitative interview. Nineteen medical educators with expertise in gamification participated in the Delphi method stage. Experts who had more than three years of experience with gamification in medical education constituted the expert panel. The experts were then asked to rate the gamification elements using the Likert five-point scale through at least two consensus-seeking rounds. Consensus for key elements was predefined as ≥ 51% of respondents rating an element as 'important' or"very important." In the qualitative interview stage, 10 experts provided feedback on the application of these key gamification elements.

RESULTS

Eighteen participants (11 males and 7 females) completed the entire Delphi process for this study. After two rounds of surveys, the consensus was reached on all elements. Thirteen elements scored more than 4 points (37%) and reached the criteria of key elements of gamification in medical education. The top five key elements were integration with instruction objectives, game rules, rapid feedback, fairness, and points/scoring. The thirteen key elements for successful gamification in medical education were further organized into two main categories: (1) gamification design principles and (2) game mechanisms.

CONCLUSIONS

Integration with educational objectives, gamification in curriculum design and teaching methods, and balancing between the mechanisms and principles were the three key components for successful gamification. This study explored the gamification key elements, providing practical tips for medical educators in their efforts to gamify medical education. Future studies involving learners could be performed to examine the efficacy of these key elements in gamification.

Bridging theory and practice: a scoping review protocol on gamification's impact in clinical reasoning education

INTRODUCTION

In the rapidly evolving field of medical education, gamification has emerged as a promising strategy to enhance clinical reasoning skills among healthcare professionals. By incorporating game-like elements into the learning environment, gamification strives to enhance engagement, motivation and knowledge retention. Given the importance of clinical reasoning in medical decision-making and patient care, this scoping review protocol aims to systematically explore developments, implementations and outcomes of gamification in clinical reasoning education.

METHODS AND ANALYSIS

The scoping review will follow the Arksey and O'Malley methodological framework, enhanced by guidelines from the Joanna Briggs Institute. We will search four major databases: OVID Medline, Scopus and Web of Science using key terms such as "gamification," "clinical reasoning," and "medical education". Studies will be selected based on the participants, concepts and contexts (PCC) framework, focusing on literature published in English. Two independent reviewers will screen studies and extract data on gamification elements used in clinical reasoning education. Any disagreement between the reviewers will be resolved by consulting a third person. We will provide a narrative synthesis of the findings, highlighting the variety of gamified strategies and their effects on clinical reasoning skills. This review will also map out gaps in the current literature and provide direction for future research.

ETHICS AND DISSEMINATION

The scoping review, which aggregates and synthesises publicly available studies, does not require ethics approval due to its nature as a compilation of existing research. The reporting of findings will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist, promoting both thoroughness and transparency in our analysis. Our dissemination plan encompasses publication in a peer-reviewed journal and presentations at academic conferences focused on medical education. This strategy is designed to engage educators, curriculum designers and policymakers within the sector, ensuring our insights reach those who can apply them most effectively.

An Original Remote Digital Serious Game for Neonatal Resuscitation Training: New Opportunities from COVID-19 Era

Background: The social restrictions imposed by the COVID-19 pandemic have disrupted traditional teaching methods and encouraged the development of innovative and safer approaches based on distance learning. Among these novel techniques, digital game-based learning (DGBL) is a method that facilitates learning through the efficient use of interactive software tailored to the user. Methods: In this work, we investigated the effectiveness of the DGBL methodology for remote training using a game-based digital learning software designed about remote neonatal resuscitation. The DGBL approach was validated in 52 anesthesiologist trainees and compared to a homogenous retrospective control group of pediatric trainees with the same prior knowledge, who followed an in-person training course using the digital serious game. Scores obtained during each game session are recorded and used to assess progress in knowledge of the flowchart, decision time, timing of assisted ventilation, and ability to check equipment. Results: The results confirmed the effectiveness of the remote training mode for each of the analyzed features, whereas no statistically significant advantages of using a supervised DGBL were found. Conclusion: In conclusion, the DGBL remote training approach is a valuable tool that can provide users with an interactive, effective, and enjoyable learning experience. Future developments will concern the implementation of multiplayer versions to stimulate interaction between users for the development of inter-professional and teamwork skills.

Effectiveness of Escape Room in Medical Education: A Systematic Review and Meta-Analysis

The primary goal of this meta-analysis is to explore the five factors of knowledge, teamwork, learning satisfaction, anxiety, and interprofessional ability to determine the value of escape rooms in medical education. Up to January 2023, we searched ScienceDirect, Scopus, PubMed, Embase, Web of Science, CNKI, and the Cochrane Library for pertinent works in either English or Chinese. The Risk of Bias 2 (RoB 2) tool and Newcastle-Ottawa Scale (NOS) were used to assess the quality of studies. Subgroup and sensitivity analyses were used to assess statistical heterogeneity, and I2 was used to measure it. Overall, escape rooms had a more significant positive effect than traditional learning on knowledge (standardized mean difference [SMD]: 0.84; 95% confidence interval [CI]: 0.36-1.33), teamwork (SMD: 4.91; 95% CI: 4.58-5.24), learning satisfaction (MD: 0.36; 95% CI: 0.08-0.64), and interprofessional ability (SMD: 1.04, 95% CI: 0.81-1.27). Moreover, the impact of escape rooms on anxiety also had significant effects (SMD: -8.23, 95% CI: -11.64 to -4.82). Escape rooms affect medical students' knowledge, teamwork, learning satisfaction, interprofessional ability, and anxiety. The findings of this study can be used as evidence that escape rooms is a more effective method than traditional teaching for improving active learning.

Rethinking Surgical Safety: Investigating the Impact of Gamified Training on Severe Flow Disruptions in Surgery

OBJECTIVES

There is a need for effective and engaging training methods to enhance technical and nontechnical skills in robotic-assisted surgery (RAS), where deficiencies can compromise safety and efficiency. This study aims to evaluate the impact of a gamified team training intervention, the "RAS Olympics," on the safety and efficiency of RAS procedures.

METHODS

The study was conducted at a 958-bed tertiary care academic medical center in with a robust robotic surgery program. A total of 56 RAS procedures (general, urology, and gynecology) were included in the analysis, with a mix of procedure types representative of the surgical caseload at the medical center. A pretest posttest experimental design was employed, comparing the frequency and severity of flow disruptions (FD) between preintervention, postintervention without "RAS Olympics" participants, and postintervention with "RAS Olympics" participants. The "RAS Olympics" involved safety hazard identification, troubleshooting, workspace navigation, instrument retrieval, and turnover optimization.

RESULTS

Postintervention cases with "RAS Olympics" participants exhibited significantly lower overall FDs compared to the postintervention control group. The reduction was particularly notable during phase 3 (surgeon on console) and in cases involving more severe FDs.

CONCLUSIONS

Gamified team training interventions may improve the safety and efficiency of RAS procedures. The positive outcomes underscore the potential of innovative and engaging training methods to address the evolving challenges in surgical practice, emphasizing the relevance of gamification in healthcare education. As the healthcare landscape continues to advance, incorporating such interventions may be crucial in ensuring the adaptability and competence of surgical teams.

Use of an Escape Room Experience in Emergency Veterinary Medicine Education

Escape room experiences have been used as an educational tool in several health professions, and to the authors' knowledge, it is not yet documented in veterinary medicine. They are an example of gamification in a simulated environment where course objectives guide puzzle development. Veterinary emergency medicine can be very stressful as veterinarians often have to make quick decisions. The element of a time limit adds stress to the experience as learners must complete the puzzles within a specified time to successfully escape the room. This article describes the development and delivery of an escape room experience in emergency veterinary medicine to third year students at the Western College of Veterinary Medicine at the University of Saskatchewan. In a survey following the experience, learners indicated they enjoyed participating in the learning activity. They felt it encouraged the use of communication, collaboration, and leadership skills which have been identified as core competencies in veterinary education. While on average learners would disagree with the experience being stressful, several commented that it was a "good stress". This indicates that the experience may have been considered challenging to learners, which in simulation, supports a positive way to achieving learning objectives that may not overstress participants.

Gamification, Serious Games, and Simulation in Health Professions Education

Health care educators may enhance learning with thoughtful incorporation of game elements. Gamification has shown success across various fields in medical education. It has demonstrated deeper engagement by leveraging both intrinsic and extrinsic motivational factors. While beneficial, gamification requires thoughtful implementation to increase active learning and avoid potential negative effects, such as unhealthy competition. Serious games integrate learning objectives directly within their framework, making the educational experience an intrinsic part of gameplay. These games are specifically designed to enhance knowledge and skills while promoting decision making, teamwork, and communication. The immersive nature of serious games requires players to actively engage and apply their knowledge to solve complex problems. Serious games and simulation represent transformative educational approaches that not only enhance learning and retention but also develop essential competencies crucial for health care professionals. These strategies, when combined with effective debriefing, provide a robust framework to enrich education and training in health care. [Pediatr Ann. 2024;53(11):e401-e407.].

A mobile serious game about diabetes self-management: Design and evaluation

Type 2 Diabetes Mellitus (T2DM) is a chronic condition that requires ongoing self-management and education. In recent years, there has been a growing interest in utilizing mobile serious games as a tool for patient education and engagement. This article presents the development of DiaPo, a mobile serious game designed to improve self-management education for patients with T2DM. DiaPo integrates gamification techniques to increase patient engagement and motivation while providing essential information about disease management. The development of DiaPo followed a structured design process, utilizing the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) educational system. This systematic approach allowed for the integration of best practices in educational game design and diabetes care. The development team consisted of experts in medical informatics, game design, and diabetes care, ensuring a multidisciplinary approach to the game's creation. The game's narrative focuses on a T2DM patient who earns positive points for making healthy lifestyle choices and negative points for poor ones. This gamified approach aims to reinforce positive behaviors and provide immediate feedback on negative ones. Interactive animations confirm or deny options selected by the player, further enhancing the learning experience. DiaPo offers a flexible and adaptable platform suitable for diverse audiences, promoting inclusiveness and accessibility in T2DM education. DiaPo represents a novel approach to self-management education for patients with T2DM, utilizing gamification techniques and a multidisciplinary design process to create an engaging and informative mobile serious game. By promoting inclusiveness and accessibility, DiaPo has the potential to empower patients with T2DM to take an active role in their disease management. As the field of mobile serious games continues to evolve, DiaPo stands as a promising tool for improving T2DM education and patient outcomes.

Adapting Novel Augmented Reality Devices for Patient Simulations in Medical Education

Extended reality (XR) simulations are becoming increasingly common in educational settings, particularly in medical education. Advancing XR devices to enhance these simulations is a booming field of research. This study seeks to understand the value of a novel, non-wearable mixed reality (MR) display during interactions with a simulated holographic patient, specifically in taking a medical history. Twenty-one first-year medical students at the University of North Carolina at Chapel Hill participated in the virtual patient (VP) simulations. On a five-point Likert scale, students overwhelmingly agreed with the statement that the simulations helped ensure they were progressing along learning objectives related to taking a patient history. However, they found that, at present, the simulations can only partially correct mistakes or provide clear feedback. This finding demonstrates that the novel hardware solution can help students engage in the activity, but the underlying software may need adjustment to attain sufficient pedagogical validity.

Rising gamification in health education: A bibliometric study

BACKGROUND

The rising gamification in educational contexts has been driven by its potential to increase student motivation, engagement, interest and learning outcomes. Thanks to these effects, gamification has gained popularity in health education. Due to the increase in studies on gamification in health education in recent years, this study has been carried out to present the studies in the relevant literature to researchers.

AIM

This study presents a quantitative mapping of gamification in health education through a bibliometric analysis of its publications.

METHODS

In this study, a total of 475 articles were analyzed by searching "health education*" and "gamif*" and similar terms from Web of Science and Scopus databases. R bibliometric package program was used for the analysis. 1971 authors contributed to the studies, which were spread between 2012 and 2024. The number of studies on gamification in the field of health education has grown in recent years. In particular, it was seen that 2018 can be seen as the breaking point and the highest number of publications was in 2023, with 101 publications.

RESULTS

The descriptive results showed that Zhang, X. was the most productive author, Nurse Education Today and BMC Medical Education were the most productive journals and the United States was the most productive country. It is concluded that terms such as gamification, medical education, game-based learning, education, serious games, simulation and e-learning are the most frequently used words in gamification studies in the field of health education. It has been observed that the concept of gamification is trending, especially in 2018-2023, with a frequency of 150 uses.

CONCLUSIONS

This study is expected to guide researchers in terms of key points for future research on gamification in health education contexts. It is expected that the knowledge provided by this study will enable researchers to be involved in this field and/or focus their research more effectively.

RheumMadness Over Two Years: Engaging Participants in Active Learning and Connecting Early Trainees to the Rheumatology Community

OBJECTIVE

RheumMadness is an online learning collaborative that seeks to actively engage the rheumatology community. The objective of this manuscript is to analyze the educational experience of RheumMadness over two years.

METHODS

Direct measures of participant engagement were obtained using web-based analytics. An electronic survey was created after the tournament to capture self-reported engagement and educational experience using the Community of Inquiry framework. Data were analyzed according to the following objectives: (1) compare demographics, engagement, and educational experience of participants between 2021 and 2022; (2) describe the educational experience of those who created scouting reports; (3) explore the impact of RheumMadness on early learners (medical students and residents).

RESULTS

Compared with 2021, the 2022 tournament had more participants who submitted a bracket, more early learners, and more scouting report creators. Self-reported engagement and educational experience was high in both years of the tournament among all participants. Over 85% of scouting report creators reported that making a report was a fun and valuable learning experience. Early learners reported significantly higher levels of knowledge integration, sense of belonging in the rheumatology community, social connection, and overall learning experience compared with more advanced participants. Eighty-five percent of early learners reported that RheumMadness increased their interest in rheumatology.

CONCLUSION

RheumMadness expanded from 2021 to 2022, engaging more participants in collaborative learning. Our results demonstrate that RheumMadness is particularly impactful among medical students and residents by helping them explore rheumatology topics and connect with the rheumatology community.

Applying simulation learning theory to identify instructional strategies for Generation Z emergency medicine residency education

Introduction

Generation Z learners are entering emergency medicine (EM) residency training, bringing unique learning preferences that influence their engagement with residency education. To optimally teach and motivate this incoming generation of learners, EM educators must understand and adapt to the changing instructional landscape.

Methodology

The Simulation Leaders Advancing the Next Generation in Emergency Medicine (SLANG-EM) Workgroup was created to identify effective educational strategies for Generation Z learners entering EM. Members were faculty in the Society for Academic Emergency Medicine (SAEM) Simulation Academy, well versed in learning theory supporting simulation-based education (SBE) and actively involved in EM residency education.

Unique treatment/analysis

Through primary and secondary literature searches, the SLANG-EM Workgroup identified four distinctive learning preferences of Generation Z learners: (1) individualized and self-paced learning, (2) engaging and visual learning environments, (3) immediate and actionable feedback, and (4) combined personal and academic support. Workgroup members evaluated these learning preferences using a novel conceptual framework informed by the theoretical principles underpinning SBE, recommending instructional strategies for Generation Z EM residency learners across multiple educational environments.

Implications for educators

Instructional strategies were described for the didactic, simulation, and clinical learning environments. In the didactic environment, identified instructional strategies included meaningful asynchronous education, interactive small-group learning, and improved multimedia design. In the simulation environment, educational innovations particularly suitable for Generation Z learners included learner-centered debriefing, rapid-cycle deliberate practice, and virtual simulation. In the clinical environment, described instructional strategies involved setting learner-centered goals and delivering facilitative feedback in the context of an educational alliance. Overall, these instructional strategies were clustered around themes of student-centered education and the educator as facilitator, which align well with Generation Z learning preferences. These findings were synthesized and presented as an advanced workshop, "Delivering Effective Education to the Next Generation," at the 2023 SAEM Annual Meeting.

Reviewing the Potential Role of Artificial Intelligence in Delivering Personalized and Interactive Pain Medicine Education for Chronic Pain Patients

The integration of artificial intelligence (AI) in patient pain medicine education has the potential to revolutionize pain management. By harnessing the power of AI, patient education becomes more personalized, interactive, and supportive, empowering patients to understand their pain, make informed decisions, and actively participate in their pain management journey. AI tailors the educational content to individual patients' needs, providing personalized recommendations. It introduces interactive elements through chatbots and virtual assistants, enhancing engagement and motivation. AI-powered platforms improve accessibility by providing easy access to educational resources and adapting content to diverse patient populations. Future AI applications in pain management include explaining pain mechanisms, treatment options, predicting outcomes based on individualized patient-specific factors, and supporting monitoring and adherence. Though the literature on AI in pain medicine and its applications are scarce yet growing, we propose avenues where AI may be applied and review the potential applications of AI in pain management education. Additionally, we address ethical considerations, patient empowerment, and accessibility barriers.

The House Cup: Using Longitudinal Gamification to Improve Didactic Attendance

OBJECTIVE

Determine if a point-based attendance system combined with longitudinal gamification is feasible and improves didactic session attendance and learner perceptions at our internal medicine residency.

METHODS

A prospective before-after cohort study. Weekly attendance was tracked from June 2022 through April 2023 at our university-affiliated internal medicine residency program. We implemented a point-based longitudinal game incentivizing residents to attend didactics with positive reinforcement in July 2022 (C: carrot). We added tiered positive reinforcement and positive punishment to the game in January 2023 (CS: carrot and stick). Attendance during these periods was compared to pre (P) and postintervention (S). Perceptions were assessed during the P, C, and CS periods with Likert scale ratings.

RESULTS

CS was associated with higher attendance than other study periods (P = .002). Median attendance was P-51% (IQR 37.5-64.5), C-65% (IQR 50-74), CS-81% (IQR 78-94), and S-66% (IQR 63-71). Perceptions were similar during pre and intervention study periods, including perceptions of camaraderie (P-4.4, C-4.4, CS-4.5; P = .56), interest in attending didactic sessions (P-3.7, C-3.4, CS-3.2; P = .21), and mandate as the primary reason for attending didactics (P-3.1, C-3.1, CS-3.2; P = .96).

CONCLUSIONS

A point-based attendance system combined with a longitudinal game that included tiered positive reinforcement and positive punishment was feasible and associated with higher didactic attendance but not associated with changes in resident perceptions.

Development and Implementation of a Game-Based Neonatal Resuscitation Refresher Training: Effect on Registered Nurse Knowledge, Skills, Motivation, Engagement

Game-based learning theory and Google Docs Editors suite were used to develop an online, self-directed neonatal resuscitation refresher training for registered nurses to improve their resuscitation knowledge and skills and enhance their learning motivation and engagement. Results indicated that a self-directed, online game-based refresher training was motivating, engaging, and improved nurses' resuscitation knowledge and skill performance. Nurse professional development practitioners can use similar game-based online materials to enhance learning.

Bridging Visual-Spatial Ability and Skill Performance: The Impact of Perceived Quality of a Practical Seminar in Interventional Radiology Education

BACKGROUND

Medical education integrates skills training and simulation to prepare students for clinical tasks. A seminar on interventional radiology was restructured to include specific practical training utilizing a 3D-catheter model. We aimed to investigate the complex interplay between student evaluations, their visual-spatial ability and practical performance.

METHODS

The seminar comprised a short plenary introduction followed by 3 practical training units. Students were tested for their visual-spatial ability and their catheter insertion performance. Students rated the seminar and their interest in the subject. Data were subjected to descriptive, factorial, regression, and moderating analysis.

RESULTS

A total of 141 medical students enrolled in the seminar. They attributed a high didactic and practical quality and expressed great interest in the subject. Male students outperformed females in the cube perspective test. In the practical examination, males needed significantly less time on average (57.9 s) compared to females (73.1 s). However, there were no significant differences in the performance score, with a maximum of 5 attainable points: males 4.61 and females 4.51. The seminar evaluation explained a large portion of the variance (48.6%) in students' interest in the subject. There was a moderating role of practical quality (β = 0.12, P < .05) on the link between the cube perspective test and the practical examination: rated high practical quality could partly compensate for low cube perspective scores, enhancing performance in the practical examination.

CONCLUSIONS

Well-designed practical courses and a perceived high teaching quality may assist students with deficits in visual-spatial ability to acquire clinical-practical skills. Such initiatives not only enhance learning outcomes across diverse student groups but also stimulate interest in specialized fields like interventional radiology, thereby potentially guiding future career paths in medicine.

Gamified versus non-gamified online educational modules for teaching clinical laboratory medicine to first-year medical students at a large allopathic medical school in the United States

BACKGROUND

Medical educators seek innovative ways to engage learners efficiently and effectively. Gamification has been explored as one way to accomplish this feat; however, questions remain about which contexts gamification would be most useful. Time constraints and student interest present major barriers for teaching laboratory medicine to students. This study aims to compare two versions of an interactive online module, one gamified and one not, for teaching laboratory medicine concepts to pre-clinical medical students.

METHODS

First-year medical students reviewed either a gamified or non-gamified version of an interactive online module in preparation for an in-person flipped classroom session on Laboratory Medicine. Learning theory guided the design of the modules and both contained identical content, objectives, and structure. The "gamified" module included the additional elements of personalization, progress meters, points, badges, and story/role play. After reviewing the module, students completed an anonymous knowledge check and optional survey.

RESULTS

One hundred seventy-one students completed the post module knowledge check as assigned (82 gamified, 89 non-gamified). Knowledge check scores were higher for the students who reviewed the gamified module (p < 0.02), corresponding to an effect size of 0.4 for the gamified module. Eighty-one students completed optional post-module surveys (46 gamified, 35 non-gamified). Instructional efficiency was calculated using task difficulty questions and knowledge check scores, and the resulting instructional efficiency was higher for the gamified module. There was no significant difference in the student-reported time required to complete the modules. Additionally, both versions of the module were well received and led to positive ratings related to motivation and confidence. Finally, examination of open-ended survey results suggested that the addition of game elements added value to the gamified module and enhanced engagement and enjoyment.

CONCLUSIONS

In this setting, the addition of gamification to an interactive online module enhanced learning outcome, instructional efficiency, student engagement and enjoyment. These results should inspire further exploration of gamification for teaching Laboratory Medicine concepts to pre-clinical medical students.

Transitioning from face-to-face to distance education. Part 2: A qualitative study in the former Yugoslavia during COVID-19

BACKGROUND

Similar to other countries, Departments of Family Medicine in the former Yugoslavia had to transition from face-to-face to distance education during COVID-19.

OBJECTIVES

To elucidate obstacles and facilitators of the transition from face-to-face to distance education.

METHODS

A cross-sectional, multicentre, qualitative study design was used to analyse nine open-ended questions from an online survey using inductive thematic analysis. The questionnaire was distributed to 21 medical schools, inviting them to involve at least two teachers/students/trainees. Data were collected between December 2021 and March 2022.

RESULTS

In 17 medical schools, 23 students, 54 trainees and 40 teachers participated. The following themes were identified: facilitators and barriers of transition, innovations for enhancing distance education, convenience of distance education, classical teaching for better communication, the future of distance education, reaching learning outcomes and experience of online assessment. Innovations referred mainly to new online technologies for interactive education and communication. Distance education allowed for greater flexibility in scheduling and self-directed learning; however, participants felt that classical education allowed better communication and practical learning. Teachers believed knowledge-related learning outcomes could be achieved through distance education but not teaching clinical skills. Participants anticipated a future where a combination of teaching methods is used.

CONCLUSION

The transition to distance education was made possible thanks to its flexible scheduling, innovative tools and possibility of self-directed learning. However, face-to-face education was considered preferable for fostering interpersonal relations and teaching clinical skills. Educators should strive to strike a balance between innovative approaches and the preservation of personal experiences.

An Interuniversity Competition for Medical Students to Learn Radiology in the Second Life Metaverse

PURPOSE

The aim of this study was to evaluate an interuniversity competition online to learn radiology held in a 3-D virtual world, the Second Life metaverse, by analyzing the results of the game and students' perceptions.

METHODS

Medical students voluntarily participated in teams of four, for 6 weeks, successively covering radiologic anatomy and radiologic semiology of the chest, abdomen, and musculoskeletal. Each week, participants had 4.5 days to study self-learning presentations and 2.5 days to complete an individual multiple-choice test and a team task, the results of which determined the game's ranking. Participants were asked to complete a cognitive-load test, a perception questionnaire, and a postexposure knowledge test.

RESULTS

The competition was repeated for 2 years (editions), in 2020 and 2021. Seventy-five of 102 teams (73.5%) registered completed the game; 76% of them included third-year students. The average percentage of correct answers in the individual tests and team tasks was 74.2 ± 15.1 and 71.6 ± 14.7 respectively, without significant differences between both competitions. In general, the experience was valued positively (scores >8 on a 10-point scale). A lower perception score was found in 2021 among students from universities other than the organizing university, showing a positive correlation with the in-game score.

CONCLUSIONS

An interuniversity competition in the Second Life metaverse for undergraduate learning radiology is feasible and reproducible. Participating medical students considered it interesting and useful and also identified this activity during the 2 years of the coronavirus disease 2019 pandemic as a playful learning and social interaction experience.

Escape the Monotony: Gamification Enhances Nursing Education

INTRODUCTION

Creating meaningful and engaging learning opportunities can be challenged by budgets, time, and learning management systems with limited methods of interaction. An innovative method was necessary to meet competency evaluation and continuing education needs for emergency department staff.

DESIGN

Gamification and simulation techniques were combined to offer an interactive learning opportunity through an escape room format to improve engagement and knowledge retention. This educational offering was designed to enhance staff learning of trauma care and processes at emergency departments that are not designated trauma centers.

OUTCOMES

Emergency department team members completed the trauma escape room challenge, and postsurvey results demonstrated favorable ratings of new knowledge acquisition, skill competency, teamwork, and confidence when providing care for a trauma patient.

DISCUSSION

Nurse educators can "escape" the monotony of passive learning by using active learning strategies including the fun of gamification to improve clinical skills and confidence.

Escaping the Silos: Utilization of a Pediatric Trauma Escape Room to Promote Interprofessional Education and Collaboration

BACKGROUND

Millions of children are treated annually for trauma-related injuries but comprise a smaller proportion of emergency department visits than adults. As a result, emergency department teams may not have the knowledge, skills, and confidence to care for pediatric patients, and specialty teams may not interact enough as an interprofessional team to provide high-quality patient care.

OBJECTIVE

The purpose of this project is to describe a novel interprofessional simulation-based education initiative to assist pediatric trauma team readiness.

METHODS

An escape room was designed to provide an interactive educational environment focused on pediatric trauma education. Using an interprofessional dyad of a trauma nursing specialist and a pediatric nursing expert, the escape room was designed as a series of clues to improve pediatric skills and interprofessional collaboration between specialty teams. The escape room training was conducted (from February to March, 2023) in a large Southeastern U.S. Level II adult trauma center.

RESULTS

Twenty-one registered nurses from different specialty teams participated in the simulation exercises with overwhelmingly positive feedback. Colleagues reported this was a unique way to deliver education that resulted in innovative team building and enriched collegiality between the specialty teams.

CONCLUSIONS

The escape room educational format was positively received, and future events are planned across disciplines and various topics. Trauma centers with lower pediatric volumes seeking to provide engaging team-based education may use this format as a unique and innovative way to develop teams for clinical success.

The impact of gamification and potential of kaizen in radiology education

Gamification is an emerging tool in medical education that has been increasingly adopted in the field of radiology. The purpose of this non-systematic review is to explore the use of gamification in medical education with a particular focus on new generations of learners and radiology education. This manuscript begins by examining the effectiveness of gamification in improving learning outcomes in medicine and radiology. Future research recommendations and the potential impact of gamification on new learners are discussed. Finally, this review provides insight into a gaming platform, Kaizen, as a promising approach to enhance education by improving motivation and increasing interest in radiology knowledge.

Novel Academic Tabletop 2022 (NAT22): A Dynamic Dice-Based Emergency Medicine Education Tool

Gamification is an effective teaching tool that improves engagement and knowledge retention. Tabletop role-playing games are dynamic games that use random chance and foster player/leader partnership. To date, there are no teaching tools that mimic dynamic or unpredictable patient presentations. This style of game may work well as a tool for medical education in a simulation-based modality. In this report, we document the rules, materials, and training required to reproduce a hybrid game created to combine facets of simulation and tabletop role-playing games (TRPGs) to create a dynamic medical education tool. After testing the game for flaws and fluidity of gameplay, we plan to collect data evaluating emergency medicine residents' enjoyability and knowledge retention. In this article, we describe a novel TRPG simulation hybrid game that we hypothesize will improve learner enjoyability/engagement and have similar educational benefits to standard medical education.

RheumMadness: Creating an Online Community of Inquiry in Rheumatology

OBJECTIVE

To evaluate the educational impact of RheumMadness, an online tournament of rheumatology concepts grounded in social constructivist theory, as viewed through the community of inquiry (CoI) framework.

METHODS

The curricular scaffold of RheumMadness was a bracket of 16 rheumatology concepts competing as "teams" in a tournament. Participants could create and review "scouting reports" about each team, listen to a RheumMadness podcast, discuss on social media, and submit a bracket predicting tournament outcomes according to the perceived importance of each team. Engagement was measured with direct analytics and through self-report on a survey. The survey also assessed participants' educational experience using an adapted 34-item CoI survey, which describes the cognitive, social, and teaching presences in a learning activity.

RESULTS

One hundred brackets were submitted. On average, each scouting report was viewed 92 times, each podcast episode was downloaded 163 times, and 486 tweets were sent about #RheumMadness from 105 users. The survey received 58 of 107 responses (54%). Respondent agreement with prompts related to each CoI presence was: 70.3% cognitive, 61.7% social, 84.9% teaching. Reported engagement in RheumMadness correlated strongly with overall CoI survey scores (r = 0.72, P < 0.001).

CONCLUSION

RheumMadness created an online CoI that fostered social constructivist learning about rheumatology.

The influence of Gamification on medical students' diagnostic decision making and awareness of medical cost: a mixed-method study

BACKGROUND

The gamification of learning increases student enjoyment, and motivation and engagement in learning tasks. This study investigated the effects of gamification using decision-making cards (DMCs) on diagnostic decision-making and cost using case scenarios.

METHOD

Thirty medical students in clinical clerkship participated and were randomly assigned to 14 small groups of 2-3 medical students each. Decision-making was gamified using DMCs with a clinical information heading and medical cost on the front, and clinical information details on the back. First, each team was provided with brief clinical information on case scenarios. Subsequently, DMCs depending on the case were distributed to each team, and team members chose cards one at a time until they reached a diagnosis of the case. The total medical cost was then scored based on the number and contents of cards drawn. Four case scenarios were conducted. The quantitative outcomes including confidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical costs were measured before and after our gamification by self-evaluation using a 7-point Likert scale. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using DMCs.

RESULT

Confidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical cost were significantly higher after the gamification. Furthermore, comparing the clinical case scenario tackled last with the one tackled first, the average medical cost of all cards drawn by students decreased significantly from 11,921 to 8,895 Japanese yen. In the content analysis, seven advantage categories of DMCs corresponding to clinical reasoning components were extracted (information gathering, hypothesis generation, problem representation, differential diagnosis, leading or working diagnosis, diagnostic justification, and management and treatment).

CONCLUSION

Teaching medical students clinical reasoning using DMCs can improve clinical decision-making confidence and learning motivation, and reduces medical cost in clinical case scenarios. In addition, it can help students to acquire practical knowledge, deepens their understanding of clinical reasoning, and identifies several important clinical reasoning skills including diagnostic decision-making and awareness of medical costs. Gamification using DMCs can be an effective teaching method for improving medical students' diagnostic decision-making and reducing costs.

Gamification in Biomedical Science Education: The Successful Implementation of Resimion, a Scenario-Based Learning Tool

Introduction: Scenario-based learning and gamification have many advantages in comparison to traditional didactic teaching methods, including development of many higher-level skills such as analysis and evaluation. It is hoped that these simulations provide a real-world experience in a format accessible to students. Integration of these tools into teaching excelled during the COVID-19 pandemic, an event that completely changed education and initiated the greatest advancement in digital learning to date. We discuss our experiences using Resimion, a novel scenario-based learning tool that was adapted to biomedical science, both for teaching and assessment. Methods: Our cohort included 769 students studying BSc(Hons) Biomedical Science at the University of the West of England from 2020 to 2023. Data was obtained from assessments within four different modules, two at FHEQ level 5 and two at level 6. Students were grouped based on reasonable adjustment (RA) status, including physical issues, specific learning differences and neurodiversity, with differences between student groups and assessment types analysed by ANOVA. Results: Data clearly demonstrate good engagement from students utilising Resimion software, representing 18,436 student interactions in total, across both assessed and non-assessed activities. RAs of any type did not alter submission rates (p = 0.53) or student outcome in any of the assessment types analysed. However, submission rates for Resimion assessments were notably higher than for other assessment types (p = 0.002). Whist outcomes were not significantly different, students with RAs did take significantly longer to complete the Haematology and Transfusion assessments (p = 0.0012). Specifically, neurodiverse students and those with specific learning differences used on average 81% of their allocated time, students with other RAs used 76%, whereas students without RAs used just 56% (p ≤ 0.0001), highlighting the appropriate adjustment of extra time provided for these students. It was further observed that 1.3% of Resimion activities undertaken by students utilised the in-built inclusivity features in the software. Both students with known RAs, and those without, utilised these features, therefore also aiding students without a formal diagnosis. Conclusion: The scenario-based learning tool Resimion was successfully integrated into the teaching of biomedical science and provided an engaging platform for students, with comparable results to other traditional assessment types.

"Show me how to use a microscope" - The development and evaluation of certification as direct assessment of practical lab skills

Practical lab skills are rarely directly assessed. To improve constructive alignment between the described learning outcomes of practical skills and assessment, we developed and tested a certification procedure for microscopy skills. The procedure was embedded into the ordinary learning activity, so no additional time was needed. Three slightly different protocols were developed within the framework of sociocultural learning theory and built like a skill ladder, including direct peer assessment and elements of gamified learning. The protocols varied slightly in the way students were prepared for the certification, the number of steps/levels of achievement, and the consequences of failing. We tested the protocols at three different academic institutions and within 11 courses of varying sizes and academic levels in biology or geology. Feedbacks were collected through online surveys (n = 207) or orally after sessions. One protocol provided instruction videos as preparation material. Instruction videos provided increased understanding of the task, but tactile training was most important for learning. Regardless of institution, type of preparation, and level of former experience, the certification procedure made students clearly more engaged in the exercise. The majority reported that the certification procedure increased their motivation to learn, increased their perceived learning outcome, and was appropriate for assessing practical skills. Students with no or little experience in microscopy before the exercise were more positive about the certification procedure compared to skilled students, and the level of engagement and preparation was higher when there were some consequences of failing. Most students felt comfortable being certified by peers, but some students expressed concern about peers making mistakes. The presented certification procedure can easily be adapted to assess other practical skills and, with some adjustments, be an efficient method for assessment-as-learning, merging formative- and summative assessment.

IPEx: A gamification tool for learner application of pharmacologic principles of opioid use, misuse, and addiction

Opioids are often prescribed to treat chronic pain ailments, despite lack of evidence for many conditions. Prescriptions frequently become the gateway to opioid misuse and abuse. In response to the opioid crisis, medical school educators in the state of Pennsylvania developed core competencies pertaining to opioids and addiction for which all medical students should demonstrate proficiency before graduation. To enable students to achieve these competencies, we developed a web-based app (IPEx) that delivers a gamified experience for learners in which they are (re)exposed to opioid competencies and practice applying pharmacologic principles in the context of a series of longitudinal patient scenarios. Learning and application are measured by student responses to application questions before and after each of five modules. Prior to launching the IPEx tool broadly, we wished to test the application questions; thus, we invited fourth year medical students to complete a 45 question quiz based on IPEx module content. Students had no specific preparation prior to taking the quiz but had been exposed to all content elsewhere in the curriculum. A total of 45 of 141 medical students (32%) opted to complete the quiz (mean score was 47% ± 13%; range 18%-73%). Cronbach alpha for the instrument was .74. These results suggest that the instrument has internal validity, and medical students have room for growth when it comes to application of opioid related competencies, a situation that the IPEx tool may be uniquely suited to remedy.

Analysis of different gamification-based teaching resources for physiotherapy students: a comparative study

BACKGROUND

For health professionals, gamification is a new teaching method that has achieved an important role in recent years, with excellent results in learning and knowledge acquisition. Thus, the objective of this study was to analyze the gaming experience through different gamification resources in the classroom with physiotherapy students.

METHODS

A comparative study on gamification-based teaching resources was carried out during the first semester of the 2021-2022 academic year. A total of 33 physiotherapy students participated in this study. After the theoretical topics were taught, the participants were invited to participate in different gamification resources such as Kahoot!, Physiotherapy Party and Escape Room. The gaming experience with the different gamification resources was measured with the GAMEX scale.

RESULTS

The Physiotherapy Party showed a higher score in relation to the enjoyment dimension compared to the Kahoot! and Escape Room (p = 0.004). The Escape Room presented higher scores in absorption, creative thinking, activation and dominance compared to Kahoot! and Physiotherapy Party (p < 0.005).

CONCLUSIONS

Gamification resources promote enjoyment and creativity in the students in the classroom. The use of new teaching methods based on gamification, such as Escape Room as Physiotherapy Party should be considered as first choice in the use of gamification resources due to the benefits they bring to students.

Envisioning gamification in anesthesia, pain management, and critical care: basic principles, integration of artificial intelligence, and simulation strategies

Unlike traditional video games developed solely for entertainment purposes, game-based learning employs intentionally crafted approaches that seamlessly merge entertainment and educational content, resulting in captivating and effective learning encounters. These pedagogical methods include serious video games and gamification. Serious games are video games utilized as tools for acquiring crucial (serious) knowledge and skills. On the other hand, gamification requires integrating gaming elements (game mechanics) such as points, leaderboards, missions, levels, rewards, and more, into a context that may not be associated with video gaming activities. They can be dynamically (game dynamics) combined developing various strategic approaches. Operatively, gamification adopts simulation elements and leverages the interactive nature of gaming to teach players specific skills, convey knowledge, or address real-world issues. External incentives stimulate internal motivation. Therefore, these techniques place the learners in the central role, allowing them to actively construct knowledge through firsthand experiences.Anesthesia, pain medicine, and critical care demand a delicate interplay of technical competence and non-technical proficiencies. Gamification techniques can offer advantages to both domains. Game-based modalities provide a dynamic, interactive, and highly effective opportunity to learn, practice, and improve both technical and non-technical skills, enriching the overall proficiency of anesthesia professionals. These properties are crucial in a discipline where personal skills, human factors, and the influence of stressors significantly impact daily work activities. Furthermore, gamification can also be embraced for patient education to enhance comfort and compliance, particularly within pediatric settings (game-based distraction), and in pain medicine through stress management techniques. On these bases, the creation of effective gamification tools for anesthesiologists can present a formidable opportunity for users and developers.This narrative review comprehensively examines the intricate aspects of gamification and its potentially transformative influence on the fields of anesthesiology. It delves into theoretical frameworks, potential advantages in education and training, integration with artificial intelligence systems and immersive techniques, and also addresses the challenges that could arise within these contexts.

Card and board game design for medical education: length and complexity considerations

PURPOSE

There is growing use of games for health professions education. Card and board games are relatively easy to develop, effective for education, supported by educational theory, and generally well accepted by learners; yet, they remain relatively infrequently described in the medical education literature.

METHODS

A questionnaire was developed to understand barriers to use of card and board games and to understand user preferences to inform their development. The questionnaire was offered to students and educators downloading a printable antibiotic card game online.

RESULTS

The questionnaire was completed by 335 health professionals primarily by physicians, pharmacists, and their trainees. Participants described preferences for shorter games and games with lower complexity. Player counts in the two to four range were the most commonly desired. The most frequently cited barriers were lack of availability in desired subjects, cost, and concerns about content accuracy.

CONCLUSION

Educators looking to develop or use serious card and board games should start with shorter, lower-complexity games. Methods to assure and demonstrate content accuracy for educational games should be explored by educators and researchers.

Gamified learning in dermatology and dermoscopy education: a paradigm shift

Teaching methods in medical education have been changing. More recent teaching modalities have gone beyond the traditional delivery of knowledge, promoting learning motivation, and improving teaching and learning outcomes. 'Gamification' and 'serious games' are methodologies that use the principles of games to facilitate learning processes and the acquisition of skills and knowledge, thereby improving attitudes towards learning when compared with traditional teaching methods. As dermatology is a visual field, images are a key component of different teaching strategies. Likewise, dermoscopy, a noninvasive diagnostic technique that allows the visualization of structures within the epidermis and upper dermis, also uses images and pattern recognition strategies. A series of Apps using game-based strategy have been created to teach and facilitate dermoscopy learning; however, studies are required to demonstrate their effectiveness. This review summarizes the current evidence of game-based learning strategies in medical education, including dermatology and dermoscopy.

An interactive e-learning module on peripheral blood smear analysis is an effective option for teaching pathology trainees

OBJECTIVES

This study compares the effectiveness of an interactive e-learning module with a traditional text-based method for teaching peripheral blood smear analysis.

METHODS

Pathology trainees at Accreditation Council for Graduate Medical Education residency programs were asked to participate. Participants completed a multiple-choice test on peripheral blood smear findings. Trainees were randomized into completing an e-learning module or a PDF reading exercise with the same educational content. Respondents rated their experience and completed a postintervention test composed of the same questions.

RESULTS

In total, 28 participants completed the study; 21 improved their score in the posttest (mean, 21.6 correct answers) compared with the pretest (19.8; P < .001). This improvement was seen in both the PDF (n = 19) and interactive (n = 9) groups, with no difference in performance between the 2 groups. Trainees with less clinical hematopathology experience showed a trend of having the largest performance improvement. Most participants completed the exercise within 1 hour, rated the exercise as easy to navigate, were engaged, and reported learning new information about peripheral blood smear analysis. All participants indicated that they would likely complete a similar exercise in the future.

CONCLUSIONS

This study suggests that e-learning is an effective tool for hematopathology education and equivalent to traditional narrative-based methods. This module could easily be incorporated into a curriculum.

Differentiated Instruction as a Viable Framework for Meeting the Needs of Diverse Adult Learners in Health Professions Education

Health professions education (HPE) instructors are often challenged with simultaneously teaching adult learners of varying educational levels, needs, and backgrounds. With an increased focus on interprofessional education, instructors may be tasked with teaching extremely diverse audiences during a single educational session. While some aspects of differentiated instruction (DI) have been implemented within HPE contexts, the DI framework appears to be relatively unknown in many fields. Evidence from a range of educational fields outside of HPE supports the use of DI as a framework to enhance fairness, diversity and inclusion while meeting core instructional needs. In this Monograph, we explore DI and offer strategies for implementation amenable to many HPE settings.

A preceptor development program using an interactive board game

BACKGROUND AND PURPOSE

Colleges and schools of pharmacy and residency programs must be engaged in the purposeful development of their preceptors. Preceptor development needs vary widely from a new preceptor needing foundational preceptor skills to a more experienced preceptor who may wish to incorporate more sophisticated precepting methods such as layered learning or interprofessional precepting. It can be challenging to create preceptor development activities that meet these varied needs and keep preceptors of all levels engaged.

EDUCATIONAL ACTIVITY AND SETTING

The Preceptor's Game of Life was developed to incorporate serious gaming into preceptor development to increase engagement and promote learning across all precepting levels. This game was designed to review precepting fundamentals and focused heavily on the application of these principles to authentic precepting scenarios. An element of friendly competition, collaboration, and storytelling created a safe and fun environment where participants could discuss solutions to scenario-based problems.

FINDINGS

The Preceptor's Game of Life has been well received by state and national audiences. Audience members were engaged and invested as they discussed the scenarios presented. Individual, informal feedback following the session and formal session evaluations were positive.

SUMMARY

Though the Preceptor's Game of Life required careful logistical planning, the outcome was positive. High levels of engagement amongst the participants were noted in the form of note taking and audience participation. Audience members appreciated activating their prior knowledge and experiences and applying that to future scenarios. This manuscript serves as a tool for others interested in novel preceptor development methods.

Analysis of female pre-clinical students' readiness, academic performance and satisfaction in online learning: an assessment of quality for curriculum revision and future implementation

BACKGROUND

The acceptance of online courses by medical and dental students, especially during the coronavirus disease 2019 crisis, is substantial, as reported in various studies. However, the unfavourable online learning experiences of the students during the pandemic were also highlighted. As the teaching-learning process is returning to the "new normal," it is necessary to identify online learning domains implemented during the pandemic crisis that may be applied in pre-clinical courses in the future.

METHODS

A validated Student Online Learning Readiness questionnaire assessed pre-clinical students' online learning competence. Students' academic performance in face-to-face post-pandemic was compared with their performance in online settings during the pandemic crisis. Students' satisfaction with online learning was evaluated using a self-made survey questionnaire. Descriptive statistics, the t-test, and multiple regression analysis were used to analyze the data gathered with a p-value ≤ 0.05 considered statistically significant.

RESULTS

Except for social skills with classmates and groupmates, in which 47.5% of respondents indicated unreadiness, most students were prepared for online learning. Theory-wise, online learners outperformed traditional learners, but the difference was insignificant. In contrast, students' practical skills in face-to-face modality are significantly higher (p = 0.029). Students rated their satisfaction with online learning higher for interactions with instructors and staff and lower for interactions with classmates and group mates and skill acquisition.

CONCLUSION

Providing high-quality pre-clinical online teaching was achieved for theoretical components but not practical skills acquisition. Students' social engagement with peers is one of the key elements crucial to online learning success. Academic leaders and curriculum developers must recognize potential gaps as they transition to online learning.

Assessment and evaluation of a serious game for teaching factual knowledge in dental education

OBJECTIVES

A serious game application was developed to train factual knowledge and for self-assessment. The aim of the present study was to compare the effects of a game application (intervention group) or paper scripts (control group) on knowledge acquisition and to evaluate the acceptance of the new application among dental students.

METHODS

The 4th semester students of the second preclinical prosthodontics course were randomly assigned to one of the two groups (n = 58/51) for two consecutive years. The study was conducted in two phases: First, all participants took a pretest, with the intervention group using the game application and the control group receiving the same set of questions in a paper script. In the second phase, all participants took a post-test. After the post-test, both groups had access to the application for another three weeks. After that, all participants completed standardized questionnaires and a scale to evaluate the usability of the system. Usage statistics were also tracked. Differences between groups were evaluated together and for both years separately in terms of pretest and posttest scores and learning success.

RESULTS

There was no significant difference between the groups with regard to the posttest and learning success. A significant improvement in knowledge between pretest and posttest (p < 0.05) was demonstrated in both groups. Each student played approximately 350 questions. Participants rated the application with the German school grade "good". Participants appreciated the application and rated it positively. They stated that the game motivated them to learn and that they spent more time with the learning content.

CONCLUSION

Due to the positive perception achieved through the game, this application is able to motivate students to learn. The learning effect achieved is similar to learning on paper.

Anaesthetic National Teaching Programme for Students (ANTPS)

The COVID-19 pandemic has significantly undermined undergraduate anaesthetic teaching in spite of the vital role of the specialty against the pandemic. Anaesthetic National Teaching Programme for Students (ANTPS) was designed to meet the evolving needs of undergraduates and tomorrow's doctor by standardising anaesthetic training, preparing for final exams and equipping competencies vital for doctors of all grades and specialties. Our Royal College of Surgeons England-accredited University-College-Hospital-affiliated programme consisted of six-biweekly sessions were delivered online by anaesthetic trainees. Prerandomised and postrandomised session-specific multiple-choice questions (MCQs) assessed students' improvement in knowledge. Anonymous feedback forms were provided to students after each session and 2 months following the programme. 3743 student feedback forms (92.2% of attendees) across 35 medical-schools were recorded. There was a mean improvement in test score (0.94±1.27, p<0.001). 313 students completed all six sessions. Based on 5-point Likert scale, students who completed the programme showed an improvement in their confidence in knowledge and skills to face common foundation challenges (1.59±1.12, p<0.001) and thus felt better prepared for life as junior doctors (1.60±1.14, p<0.001). With an increase in confidence in students to pass their MCQs, Observed Structured Clinical Examinations and case-based discussion assessments, 3525 students stated they would recommend ANTPS to other students. Unprecedented COVID-19 factors impacting training, positive student feedback and extensive recruitment, demonstrate that our programme is an indispensable learning resource which standardises anaesthetic undergraduate education nationally, prepares undergraduates for their anaesthetic and perioperative exams and lays strong foundations for implementation of clinical skills required by all doctors, to optimise training and patient care.

Using Technology to Overcome Vaccine Hesitancy

Technology holds great potential to address many vaccine hesitancy determinants and support vaccine uptake given its ability to amplify positive messages, support knowledge, and enhance providers' recommendations. Modalities previously implemented with variable success have included automated reminder systems, decision support for clinicians, online education programs, social media campaigns, and virtual reality curricula. Further research is needed to identify the optimal uses of technology at the patient/parent and provider levels to overcome vaccine hesitancy. The most effective interventions will likely be multipronged providing patients, parents, and providers with information related to vaccine status.

Gamification of robotic simulation to train general surgery residents

BACKGROUND

Gamification applies game design elements to non-game contexts in order to engage participation and increase learner motivation. Robotic surgery is gaining popularity in general surgery but requires specialized technical skills. We sought to determine whether gamification of robotic simulation training could increase robotic simulator utilization among general surgery residents.

METHODS

General surgery residents were recruited and sent weekly progress on simulator performance including leaderboards for 4 weeks during the intervention periods. There were also two control periods setup in an ABAB study design. Usage time and mean scores were compared between the control periods and intervention periods. A post-study qualitative assessment interview using semi-structured interviews determined barriers and motivational components of simulator usage.

RESULTS

Fifteen general surgery residents enrolled in the study (n = 15). Intervention increased total simulator usage time 9.7-fold from 153 to 1485 min. Total simulator days increased threefold from 9 to 27 days. Resident participation increased from 33 to 53%. Median average scores were higher during the intervention periods (58.8 and 81.9 vs 44.0). During the first intervention period, median individual-level simulator usage time increased 17 min (P = 0.03). However, there was no individual-level increase in median usage minutes or days during the second intervention period. Qualitative assessment determined barriers to be limited time due to clinical duties, and simulator availability while motivational factors included competitive factors such as leaderboards and gaming aspects. Potential improvements were increasing attending visibility of scores to increase recognition of progress by the residents and creating dedicated time for training.

CONCLUSION

Gamification of robotic simulation training increased general surgery resident participation, usage time and scores. Impact was not durable. Instituting dedicated practice time and more attending engagement may increase trainee motivation and performance.

Billing Bonanza: Improving Resident Knowledge of the 2021 Revised American Medical Association Outpatient Billing Guidelines Through Gamification

Introduction

Residents often feel unprepared for independent practice, citing an unfamiliarity with billing as a common cause. Gamification has been well studied as a means to engage learners but not as a way to improve resident knowledge of outpatient billing guidelines.

Methods

We delivered a session to incoming PGY 1 residents with a goal of improving billing proficiency. The session included a pretest and posttest questionnaire, a prerecorded PowerPoint lecture, and Billing Bonanza, a game with instructions and rules that used gamification to reinforce billing concepts.

Results

Residents demonstrated improvement in percentage of correctly answered questions from 42% on the pretest to 67% on the posttest, which resulted in a statistically significant increase of 0.24 questions correct.

Discussion

This session led to improvement in baseline billing knowledge.