JMIR Publications

ABSTRACT

Background:

There is a worldwide shortage of health workers, requiring innovative education solutions. Serious gaming and gamification education has the potential to provide a quality, cost-effective, novel approach, which is flexible, portable, enjoyable, and allows interaction with tutors and peers.

Objective:

The aim of this systematic review was to evaluate the effectiveness of serious gaming/gamification for health professions education compared with traditional learning, other types of digital education , or other serious gaming/gamification interventions, in terms of patient outcomes, knowledge, skills, professional attitudes and satisfaction (primary outcomes) and education economics outcomes and adverse events (secondary outcomes).

Methods:

A comprehensive search of MEDLINE, EMBASE, Web of Knowledge, Educational Resources Information Centre, Cochrane Central Register of Controlled Trials, PsycINFO and CINAHL from 1990 to August 2017 was conducted. Randomized controlled trials (RCTs) and cluster RCTs (cRCTs) were eligible for inclusion. Two reviewers independently searched, screened, assessed study quality and extracted data. Meta-analysis was not deemed appropriate due to heterogeneity of populations, interventions, comparisons and outcomes and a narrative synthesis is presented.

Results:

Twenty-seven RCTs and 3 cRCTs with 3634 participants were included. One study reported a small statistically significant difference between serious gaming and digital education for primary care physicians in time to blood pressure control among a subgroup of their patients already taking antihypertensive medications. There was evidence of moderate to large magnitude of effect from five studies evaluating individually delivered interventions for objectively measured knowledge compared with traditional learning. There was also evidence of small to large magnitude of effect from ten studies for improved skills compared with traditional learning. Two and four studies respectively suggested equivalence between interventions and controls. Evidence suggested serious gaming was at least as effective as other digital education modalities for these outcomes. There was insufficient evidence to conclude whether one type of serious gaming/gamification intervention is more effective than any other. There was limited evidence measuring effects on professional attitudes. Serious gaming/gamification may improve satisfaction but evidence was again limited. Evidence was low or very low quality for all outcomes. Quality of evidence was downgraded due to imprecision, inconsistency and study limitations.

Conclusions:

Serious gaming/gamification appears to be at least as effective as controls, and in many studies more effective, for improving knowledge, skills and satisfaction. However, the available evidence is mostly of low quality and calls for further rigorous, theory driven research.