(2016). An excellent way to develop these skills is to pursue a degree from a leading-edge organization in a field that is related to healthcare but also inclusive of foundational technology skills. ‘Easter eggs’). The healthcare domain has seen a rapid ascent of the adoption of gamification and serious games in health self-monitoring and management. This shift in attention from task to competition might, therefore, come at the expense of students’ performance and even their intrinsic motivation to learn (Reeve and Deci 1996). Benefits of gamification in education … However, because scientific theories are general statements describing or explaining causes or effects of phenomena, it remains unclear which specific game element has the highest potential of triggering social comparison and whether competition should be the most viable option. Wilson, K. A., Bedwell, W. L., Lazzara, E., Salas, E., Burke, S. C., Estock, J. L., et al. Therefore, the characteristic difference between gamification and serious games lies in their design intention. 2016; Van Nuland et al. The purpose of this systematic review was to provide a comprehensive overview of the use and effectiveness of gamification in health professions education and to add to the existing research on gamification in several ways. 2015). (2011). Susi, T., Johannesson, M., & Backlund, P. (2007). Perception and Psychophysics, 69, 865–878. Finley, J., Caissie, R., & Hoyt, B. We categorized the identified game elements into the game attributes for learning of Landers’ framework (Landers 2014). This study had several limitations. Scales, C. D., Moin, T., Fink, A., Berry, S. H., Afsar-Manesh, N., Mangione, C. M., et al. Anatomical Sciences Education, 8(5), 404–412. 2015; Landers et al. Hudon, A., Perreault, K., Laliberté, M., Desrochers, P., Williams-Jones, B., Ehrmann Feldman, D., et al. The first author (AvG) translated the PubMed search strategy for use in other databases and then systematically searched eight databases: Academic Search Premier; CINAHL; EMBASE; ERIC; Psychology and Behavior Sciences Collection; PsychINFO, PubMed and the Cochrane Library. Caponetto, I., Earp, J., & Ott, M. (2014). 2018). In the modern world with short attention spans, this is one of the most important tools to use in the education sector. (2015). Gamification Examples in Healthcare Leverage the performance in contact center Track key performance indicators (KPIs) such as: first call resolution, number of dials, total talk time and average after call … In Library (Issue 15). Dicheva, D., Dichev, C., Agre, G., & Angelova, G. (2015). They include fast mini-games, as simple as lining up dots in a row, through to augmented reality (AR), and intricate shared worlds. Computer games are played by millions of adolescents (1) and adults (2) around the world, with over 40% of the United States population playing computer games for 3 or more hours per week in 2015 (2). Vallverdú, J. 2017), out of which two were confounded by poor design (Table 1; asterisks). Med Educ., 47(5), 524–5. (1978). A systematic review of serious games in medical education: Quality of evidence and pedagogical strategy. 2016; Creutzfel dt et al. Technical Report HS- IKI -TR-07-001, School of Humanities and Informatics, University of Skövde, Sweden, Vol. One study focused on the level of health care outcome (Kerfoot et al. (2013). Perrotta, C., Featherstone, G., Aston, H., & Houghton, E. (2013). The process and rewards must be driven by outcomes. To ensure consistency in the application of selection criteria, we undertook double screening on a 10% random sample of the excluded articles as a form of triangulation. For healthcare professionals, among the most time-poor in the world, increased engagement and enjoyment will make training less boring. A number of healthcare organizations are hesitant to implement gamification in their workplace because healthcare … (2017) used Reinforcement Learning Theory to explain the effect of direct feedback in digital learning. According to the Social Comparison Theory, social comparison is a fundamental mechanism for modifying judgment and behaviour through the inner drive individuals have to gain accurate self-evaluations (Corcoran et al. We did not find a direct indication that the effects of game attributes were dependent on contextual factors, since all included studies reported positive results. A Harvard Graduate School of Education study in 2010 revealed that almost 1.2 million students fail in their graduation each year. Using an online neurological localisation game. Gamification in education: A systematic mapping study. What is the quality of existing research on gamified learning in health professions education? 2017) and in each of the remaining four studies the authors referred to a different theory: Reinforcement Learning Theory (Chen et al. Campbell, C. (1967). “Most nurses are facing a lot of different pieces when they are onboarding or training,” Sorrentino says. The global healthcare gamification market is expected to grow at a healthy CAGR of 54.7% from 2017 to 2022 to USD 3,780.6 million by 2022, driven by the growing technological advancements, … Multigenerational challenges and the future of graduate medical education. Game Studies, 14(1). Gamification … This randomized controlled trial had the highest MERSQI score and investigated whether gamification in an online learning activity could improve primary care clinicians’ hypertension management. To this end, we first clearly and carefully distinguished gamification studies from studies investigating other types of game-based learning. A total number of 313 studies were regarded as … Abstract Background: There is a worldwide shortage of health workers, and this issue requires innovative education solutions. Medical Journal of the Islamic Republic of Iran, 31, 52. Gamification has generated considerable interest in the field of education with its ability to inspire pupils across ages. Landers, R. N. (2014). (2007). 1997) and iPads (Kerfoot and Kissane 2014) are all types of rewards. Our review showed that researchers who did use theory hypothesized that effective gamified learning might strengthen students’ learning behaviours or positive attitudes towards learning, which in turn might improve their learning outcomes. They found that the intervention group outperformed their noncompeting peers on the second term test. 2011; Borro-Escribano et al. J Surg Educ., 74(6), 986–91. 2014; Scales et al. Instead of only focusing on specific game elements, we chose to use this framework to identify whether there is a class of game elements that hold the highest promise of improving health professions education. Kerfoot, B. P., Baker, H., Pangaro, L., Agarwal, K., Taffet, G., Mechaber, A. J., et al. (2018). Although justification research hardly allows for disentangling underlying processes, there should always be room for innovative ideas and interventions (e.g., applying infrequently used game attributes) to inform future research (Cook et al. Am J Pharm Educ., 74(7), 1–5. Gamification in medtech is a very new area, especially if you’re talking specifically about health and medicines, whereby there is a lot of legislation and costs, such as clinical trials and … 2014; Petrucci et al. Extrinsic rewards and intrinsic motivation in education: reconsidered once again. Van Dongen, K. W., Van Der Wal, W. A., Rinkes, I. H. M. B., Schijven, M. P., & Broeders, I. Whether or not increased use ensured improved learning remained uncertain. An online spaced-education game to teach and assess medical students: A multi-institutional prospective trial. The increased autonomy in the pursuit of knowledge is assumed to result in higher motivation (Knowles 1980). MERSQI is an instrument for assessing the methodological quality of experimental, quasi-experimental and observational studies in medical education, so it does not assess the qualitative parts of mixed methods studies. First, although we took a systematic approach to identifying relevant articles, it is possible that we unintentionally overlooked some articles that explored the same phenomenon using different keywords. Adv Physiol Educ [Internet]., 38(3), 277–8. van Gaalen, A.E.J., Brouwer, J., Schönrock-Adema, J. et al. In doing so, we added a new perspective to existing reviews on gamification in higher (Caponetto et al. Application of game-like simulations in the Spanish Transplant National Organization. 2017; Montrezor 2016; Patton et al. Faiella, F., & Ricciardi, M. (2015). Chen, P. H., Roth, H., Galperin-Aizenberg, M., Ruutiainen, A. T., Gefter, W., & Cook, T. S. (2017). Comparing a group of participants who took part in a gamified learning activity with a group of participants who did not take part in any learning activity is an example of a confounded comparison (Adami and Cecchini 2014). Adding game elements to learning tasks makes them more fun and engaging for students of all ages. Huotari, K., & Hamari, J. Simulation in Healthcare, 6, 244. Undermining children’s intrinsic interest with extrinsic reward: A test of the “overjustification” hypothesis. Using game-based virtual reality with haptics for skill acquisition. (2014). In fact, adopting and testing a combination of game elements without being able to disentangle their individual effects on learning is a quite general phenomenon in gamification research in health professions education. 2015; Van Dongen et al. (2000). Put simply, gamification is the usage of game mechanics from a game in non-game contexts. Creutzfeldt, J., Hedman, L., Heinrichs, L. R., Youngblood, P., & Felländer-Tsai, L. (2013). 2000; Kolb and Boyatzis 2001). Social comparison theory poses that individuals compare their performances to those of others to evaluate their abilities and seek self-enhancement (Gruder 1971; Wills 1981). Although using the MERSQI enabled comparison between all studies included in our study, we realize that our outcomes neglected the quality of the qualitative parts of these studies and may not reflect the quality of each mixed-methods study in its entirety. Based on these main keywords we formulated the search strategy for PubMed. The Labor Games: A Simulation-Based Workshop Teaching Obstetrical Skills to Medical Students [2B]. 2015), Self-Directed Learning (Fleiszer et al. But you might be surprised … It was not the aim of this study to evaluate this method, however, future researchers may want to re-evaluate before applying it to systematic analyses. This framework posits that all existing game elements can be described and structured into nine attributes, while avoiding significant overlap between these attributes (Bedwell et al. 2015; Simões et al. Journal of Experimental Social Psychology, 7, 473–489. Bligh, J., & Prideaux, D. (2002). Game-based learning: Latest evidence and future directions. Psychological Bulletin, 90, 245. 1977; Møllerand and Jennions 2001) and that negative results remain un- or underreported. Simões, J., Redondo, R. D., & Vilas, A. F. (2013). Snyder, E., & Hartig, J. R. (2013). 2012 Oct 1;99(10):1322–30. Here, the use of social comparison theory helped clarify this effect through the comparative element underlying the competitive features of gamified learning that may have increased participants’ motivation to excel. 2014; Mekler et al. 2017). In theory, competition can hamper learning by turning projects into a race to the finish line. International Journal of Educational Technology in Higher Education, 14, 9. (2017). Gamification on the Digital Health Landscape refers to the application of games, game elements and game design techniques to encourage people to pursue a desired course of action and accomplish constructive tasks in non-game domains, such as health, education… The modern practice of adult education: From pedagogy to andragogy. Adv in Health Sci Educ (2020). If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Adami, F., & Cecchini, M. (2014). Longmuir, K. J. The Top 15 Examples of Gamification in Healthcare Technology can be your coach supporting lasting change. Game definitions: A Wittgensteinian approach. The stimulated release of endorphins helps us open ourselves to a world of learning and possibilities. Performance in physiology evaluation: Possible improvement by active learning strategies. Journal of Surgical Education, 72(3), 542–548. “The Ward”: A simulation game for nursing students. Gamification in health and fitness apps. Most studies involved undergraduate (n = 15) and postgraduate medical students (e.g. We used the following search terms: (gamif* OR gameplay* OR game OR games OR gamelike OR gamebased OR gaming OR videogam* OR edugam* OR flow-theor* OR “social network*” OR scoreboard* OR leveling OR levelling OR contest OR contests OR badgification) AND (medical educat* OR medical train* OR medical field training OR medical school* OR medical Intern* OR medical residen* OR medical student* OR dental student* OR nursing student* OR pharmacy student* OR veterinary student* OR clinical education* OR clinical train* OR clinical Intern* OR clinical residen* OR clinical clerk* OR teaching round* OR dental education* OR pharmacy education* OR pharmacy residen* OR nursing education* OR paramedics education* OR paramedic education* OR paramedical education* OR physiotherapy education* OR physiotherapist education* OR emergency medical services educat* OR curricul* OR veterinary education OR allied health personnel). The role of deliberate practice in the acquisition of expert performance. digital or analogue and type of study or profession); Intervention (type of game element(s) and game attributes used); Study outcomes (including satisfaction, attitudes, perceptions, opinions, knowledge, behaviour and patient outcomes); Theoretical frameworks used to design or evaluate gamified educational programs. Business and Information Systems Engineering, 5, 275–278. Downward comparison principles in social psychology. A new buzzword: Gamification in healthcare. In 2015, the gamification … Psychological theory and the gamification of learning. After this reflection, learners think of ways to improve themselves and, after this abstract conceptualization, they will try to improve their behaviours accordingly (Kolb et al. Zuk, R. (2012). Sabri, H., Cowan, B., Kapralos, B., Porte, M., Backstein, D., & Dubrowskie, A. For instance, Van Nuland et al. Lobo, V., Stromberg, A. Q., & Rosston, P. (2017). receiving points or negative, red-coloured responses, respectively) would improve the subjective learning experience and help learners acquire implicit skills in radiology (Chen et al. A serious game skills competition increases voluntary usage and proficiency of a virtual reality laparoscopic simulator during first-year surgical residents’ simulation curriculum. We formulated five principal research questions that guided this systematic review: What are the contexts in which game elements are used in health sciences education? Jacobs, J. W., & Dempsey, J. V. (1993). In a literal sense, to be motivated means ‘to want to … The Journal of the American Osteopathic Association, 116(1), 22. Educause, March. Subsequently, they have to determine which game attribute or combination of game attributes and matching game elements may help prevent consolidation of undesirable behaviours and/or attitudes. Furthermore, our study offers a unique analysis approach implying a combination of four core elements—namely (a) an alternative way to distinguish gamification from other forms of game-based learning, (b) structuring game elements in a comprehensive way, (c) uncovering theories underpinning gamified intervention and (d) assessing study quality—which sets our study apart from existing systematic reviews on gamification. Understanding the principles of gamification. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Computers in Human Behavior, 87, 197–206. The goal of that pilot study was to collect validity evidence for a gaming platform as training and assessment tool for surgical decision making of general residents. Clarification studies apply a theoretical framework to understand and possibly explain the processes underlying the observed effects, describe why and how interventions (i.e. Journal of Experimental Psychology: Learning, Memory, and Cognition, 9, 384. Raising engagement in e-learning through gamification. Cyberpsychology, Behavior, and Social Networking, 19, 635. Although the use of leader boards appears to be a valid choice, it can also hamper learning when it (1) shifts attention from learning to competition (see earlier), (2) is not liked by all students and (3) is not the only game attribute that triggers social comparison. In addition, researchers might focus on identifying reasons for choosing specific (combinations of) attributes in a specific context. JAMA Surgery, 149(11), 1208–1209. A systematic mapping on gamification applied to education. Journal of Personality and Social Psychology, 28(1), 129–137. Theoretically based game for student success: Clinical education. The right education can provide a valuable familiarity with gamification … (2018). The literature in this review represents a broad spectrum of gamified applications, investigated across the health professions education continuum. Aided by the rise of technology, gamification offers both patients and providers novel ways … We would also like to encourage design-based research for interventions that combine different outcome measures, such as learning outcomes and frequency of using gamified educational interventions. Serious games address real-world topics in a gameplay context. Reed, D. A., Cook, D. A., Beckman, T. J., Levine, R. B., Kern, D. E., & Wright, S. M. (2007). Cook, D. A., Bordage, G., & Schmidt, H. G. (2008). Our findings suggest that it is possible to improve learning outcomes in health professions education by using gamification, especially when employing game attributes that improve learning behaviours and attitudes towards learning. Development and evaluation of an interactive dental video game to teach dentin bonding. Relationships between game attributes and learning outcomes: Review and research proposals. Verkuyl, M., Romaniuk, D., Atack, L., & Mastrilli, P. (2017). In this sense, gamification could be seen as an experimental educational tool to resolve behavioural or attitudinal problems towards learning which, therefore, may improve learning outcomes. Hospitals and clinics have begun to use eLearning and gamification heavily in recent years, but the use is usually reserved for treating patients. 2014; De Sousa Borges et al. We calculated individual total MERSQI scores, mean scores and standard deviations. 2017), it was assumed that incorporating gamification into courses could enhance students’ experience and, therefore, their reflection on and conceptualization of that experience (Kolb et al. Since we explicitly added “game-intention” to our definitions of gamification, serious games and simulations, there may have been subjectivity in our decision-making process for inclusion/exclusion of studies. This way, the researchers intended to modify students’ perceptions of a task and made it seem like an exciting adventure, with a story built around a fictitious organisation. Eight studies revealed that this specific combination had increased the use of the learning material, sometimes leading to improved learning outcomes. Oxford English Dictionary. Mallon D, Vernacchio L, Leichtner AM, Kerfoot BP. Only 56% of the students complete their 4-years graduation in 6 years. 2016; Sabri et al. Gamification — the use of game-like scenarios for teaching or training purposes — is trending. Demonstrating its wide impact, healthcare technology isn’t always patient-facing nor directly applicable to care contexts. The remaining seven justification studies, which were without confounds, showed an average MERSQI score of 12.5 (SD 2.6), which was the highest study quality in our sample. 2.2. Reflexion Health aims to “reimagine the physical therapy experience.” Co-founder … The goal of healthcare is to provide patients with the best medical care, and gamification techniques make this possible. Gamification in healthcare is gaining popularity and momentum with attempts of applying gaming principles to improve clinical outcomes of patients. The examination game. Similarly, shifts of motivation may occur with different game attributes. Gamification techniques can be employed not just in professional training settings, but also in everyday life. The strategy is to use rewards for users … Game mechanics include things like: Points & Levels; Progress Bars; Badges; Leaderboards; These mechanics are pretty much the only si m ilarity between games and gamification. In twelve studies (Table 1), groups involved in gamified learning sessions were compared with control groups to investigate whether gamification enhances learning outcomes. Here is a glimpse of how three medical schools are fostering the gamification … Game-style engagement can bring an element of enjoyment to otherwise dull or challenging tasks, thus it will become a vital aspect of training, personal health, business, and education. Deterding, S., Khaled, R., Nacke, L., & Dixon, D. (2011). This also provides patients with a better understanding of their own health and wellness needs, enabling them to be more collaborative and communicative with providers as they work together toward a treatment plan. Computers in Human Behavior, 29, 345–353. We included peer-reviewed journal articles on the use of gamification or game elements in education for (future) health professionals. Third, a simulation can be defined as a situation in which a particular set of conditions is created artificially in order to study or experience something that could exist in reality (Oxford English Dictionary 2017). Repetition and memory. If a desired behaviour or action is followed by a reward, individuals’ tendency to perform that action will increase. 2018; Zuk 2012), a commonly applied definition is that of Deterding et al. This, in turn, suggests that our study selection process may also be prone to subjectivity. Promoting a healthy lifestyle. 2015), but only one study found improved performance (El-Beheiry et al. Wells, L. (2018). Gamification refers to using game attributes in a non-gaming context. Gamification in healthcare helps in mobility of doctors treating their patients and provides with an easy and quick service. Gentry, S., L’Estrade Ehrstrom, B., Gauthier, A., Alvarez, J., Wortley, D., van Rijswijk, J., et al. In Handbook of theories of social psychology: Volume One. 2016; Van Dongen et al. Intervention studies with assessment attributes particularly used scoring (n = 26) and rewards (n = 10). Learn more about making technology work for learning. The Ambiguity of Play. 2016; Verkuyl et al. 2017; Kerfoot et al. In addition, we hand-searched the reference lists of included articles and citations for additional articles. In the context of health IT, gamification is typically employed in medication adherence, medical education-related simulations, fitness and wellness apps. We excluded articles that (a) only described the development of gamified learning activities in educational contexts without reporting the effects of their interventions, (b) only focused on qualitative data, (c) focused on serious games, (d) focused on patient education, (e) focused on simulations, except when the focus was on the effects of gamification in simulations (gamified simulations), (f) described adapted environments such as game-shows (e.g., “jeopardy” or “who wants to be a millionaire”) and board-games (e.g., “monopoly” or “trivial pursuit”) which we considered to be game contexts, and (g) were not written in Dutch or English. (2012). On the contrary, gamification has been commonplace in fields like education and military for years. To take advantage of gamification, healthcare leaders must: Think differently. (2018). 1973). Journal of Computer Based Instruction, 15, 40–47. Journal of Graduate Medical Education, 8(3), 442–443. Organizations do this through a range of healthcare and therapy apps as well as remote patient monitoring. Gamification refers to using game attributes in a non-gaming context. Burke, B. Medical Education, 42, 128–133. Philosophical Transactions of the Royal Society B: Biological Sciences, 369, 20120468. Looking at healthcare in particular, gamification can take the form of simulations, virtual reality (VR) constructs and games designed with educational purposes in mind. In Proceedings of the European Conference on Games-Based Learning. Nemer, L. B., Kalin, D., Fiorentino, D., Garcia, J. J., & Estes, C. M. (2016). Simulation and Gaming, 20, 217–266. (2010). 1. It is also important to master the art of teamwork, which is necessary to implement gamification on a broad level and maintain consistent standards. Gorbanev, I., Agudelo-Londoño, S., González, R. A., Cortes, A., Pomares, A., Delgadillo, V., et al. Perspectives on Cognitive, Learning, and Thinking Styles, 1, 227–247. International Journal of Human Computer Studies, 74, 14–31. Ericsson, K. A., Krampe, R. T., & Tesch-Römer, C. (1993). To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Gamification in healthcare uses challenges, rewards, achievement badge, mastery levels, competitions to keep the users engaged and motivated in achieving their goals, which may range anywhere from chronic disease management to tracking the fitness regime. 2015; Faiella and Ricciardi 2015; Nah et al. Advances in Health Sciences Education The hallmark of clarification studies is the use of theory to explain the processes that underlie observed effects (Cook et al. Rules of play: Game design fundamentals. Deci, Edward L., Koestner, R., & Ryan, R. M. (1999). (1955). Hanus, M. D., & Fox, J. Normal forgetting of verbal lists as a function of their degree of learning. As a form of triangulation and to assess the level of agreement between the researchers, a random sample of 10% of the excluded articles was double screened by the other members of the team. (2018) used story-telling and game-terminology (together with other game-elements) to improve students’ attitudes towards academic writing. Montrezor, L. H. (2016). For instance, two comparable studies using assessment and conflict/challenge attributes each reported increased use of simulators, but did not investigate or report learning outcomes (Kerfoot and Kissane 2014; Van Dongen et al. Chen, A. M. H., Kiersma, M. E., Yehle, K. S., & Plake, K. S. (2015). The Sound Games: Introducing Gamification into Stanford’s Orientation on Emergency Ultrasound. Learning by playing: A cross-sectional descriptive study of nursing students’ experiences of learning clinical reasoning. Dichev, C., & Dicheva, D. (2017). Reflexion Health. B., & Robins, L. (2016). - 45.79.173.91. Kaylor, S. K. (2016). https://www.gamified.uk/user-types/gamification-mechanics-elements/. 2018). Seaborn, K., & Fels, D. I. Our review revealed a relatively small number of studies involving high-quality control groups, which limited recommendations for evidence-based teaching practice. 2018; Ericsson et al. According to Van Nuland et al. Serious games for knee replacement surgery procedure education and training. Simulation and Gaming, 45, 752–768. Impact of a web based interactive simulation game (PULSE) on nursing students’ experience and performance in life support training — A pilot study. Because theories are general ideas, researchers should focus on (separate) specific game elements to identify the most promising game attributes in relation to a specific theory. A. M. J. Systematic review of serious games for medical education … Description studies make no comparison, focus on observation and describe what was done. In Environment. Future research should clarify mechanisms underlying gamified educational interventions and explore theories that could explain the effects of these interventions on learning outcomes, using well-defined control groups, in a longitudinal way. In addition, realist evaluation can help provide a deeper understanding by identifying what works for whom, in what circumstances, in what respects and how (Tilley and Pawson 2000). 2008). However, it wasn’t until recently that the concept of gamification started to generate interest in the healthcare industry.
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