[The following notes were generated by Thomas Thesen, Ph.D.]
Presenter: JR Georgiadis, PhD, Associate Professor and Section Head at the University Medical Center Groningen in the Netherlands
Gamification in Biomedical Education
The Winter 2023 IAMSE Webinar Seminar Series, titled “Not Just Fun & Games: Game-based Learning in Health Professions Education,” opened on January 5. This series explores the benefits of using games in healthcare education and offers strategies for incorporating different types of games into the basic science curriculum. It covers existing literature on the theories behind using games in medical education and the results of recent research studies on the topic. The series also features speakers who will provide practical tips for implementing game-based learning in the classroom. The first session was led by Dr. Janniko Georgiadis, head of Anatomy & Medical Physiology at the University of Groningen in the Netherlands. In his presentation, “Gamification in Biomedical Education,” Dr. Georgiadis discussed the behavioral and neuroscientific theories linking motivation and gaming and presented the findings of a recent systematic review on the use of games in health professions education.
Dr. Georgiadis began by discussing the neuroscientific theory of reward-based learning and the role of the brain’s reward system in learning and motivation. He explained that the release of neurotransmitters like dopamine during pleasurable experiences can reinforce certain behaviors and increase the likelihood of repeating them in the future. This process can also apply to learning and performance – if we enjoy an activity or find it pleasurable, we may be more motivated to engage in it and put in more effort, leading to better learning outcomes. On the other hand, if we do not find an activity enjoyable, we may lack motivation and perform poorly. Dr. Georgiadis pointed out that game-based learning or receiving instructions or acquiring knowledge in a game-like framework, relates to play, a natural learning process that can be observed in both young animals and humans. He emphasized that the evidence supports the effectiveness of games in engaging learners, citing the example of teenagers playing video games.
Dr. Georgiadis then distinguished between serious games, which have education as their primary goal (such as simulations in healthcare education), and gamification, which refers to the use of game elements in a non-game context (such as incorporating gaming elements like competition, story, and rules into an online learning platform). He discussed the nine attributes of game elements, as classified by Bedwell et al. (2015): 1) rules and goals, 2) action language, 3) assessment, 4) environment, 5) conflict/challenge, 6) control/ability to alter the game, 7) game fiction/story/narrative, 8) human interaction among players, and 9) immersion. He provided an example of a grocery store rewards program, demonstrating how rewards, challenges, goals, and other game-based attributes can create behavioral engagement that can be utilized by medical educators in the classroom.
The findings of the review revealed that the MERSQI scores of the included studies ranged from 5 to 18, with an average score of 9.8. This average score was considered relatively low due to the descriptive nature of most of the studies and the limited number of controlled studies on gamification in healthcare profession education. The game attributes most frequently studied were conflict/challenge and assessment, or a combination of these two, indicating a bias towards competition and scoring in the use of games in medical education, particularly in Western settings. While no negative effects were reported, the outcome measures of the studies primarily focused on knowledge acquisition and student satisfaction. However, Dr. Georgiadis pointed out that it is difficult to determine whether the positive effects observed were due to the use of games or other factors, such as novelty, because of the lack of proper controls in the majority of the studies. The review concluded that there is limited empirical evidence supporting the effectiveness of games in facilitating learning, and that future research should include proper controls to allow for a more definitive conclusion.
The systematic review showed that only 18% of the selected studies on gamification in medical education were grounded in a theoretical framework. The applied theories included Experiential Learning Theory, Reinforcement Learning Theory, Social Comparison Theory, and Self-Directed Learning/Self-Determination Theory. However, the evidence from high-quality studies is mainly at the level of use, and it is unclear how increased use relates to learning and reward. Additionally, the positive effects on knowledge and satisfaction need to be verified through well-controlled studies. Most of the studies were purely descriptive and did not test a theory, making it difficult to understand the mechanism by which gamification impacts the learning process. It was suggested that future studies should be grounded in a solid theoretical framework and consider other gaming attributes and societal values, as well as examine the impact of gamification on knowledge retention and the suitability of different parts of the basic science curriculum. The presentation, which lasted approximately 45 minutes, was followed by a 15-minute question and discussion period. Questions that were raised include: Do low stakes vs high stakes constitute a game attribute, and what do we know about games as part of formative vs summative assessment? Is there any compelling data that looked at knowledge retention and what the results say? What portions of the basic science curriculum are better suited for implementing games than others?