JMIR Publications

ABSTRACT

Background:

Game elements may inform the design of both simulations and games. However, the literature on how individual game elements influence the design of military trauma training simulations and affect learning outcomes remains underexplored

Objective:

This systematic review explores which game elements are used in the design of educational simulations for military trauma management, how they are implemented, for what purpose, and what outcomes are reported

Methods:

We conducted a systematic review following PRISMA guidelines, including qualitative, quantitative, and design studies involving simulations that incorporated game elements in military trauma training. Game elements were identified using established gamification frameworks. Data were synthesized thematically, and study quality was assessed using the MERSQI and the Côté & Turgeon grid

Results:

Forty studies were included, covering a wide range of simulation types and learner populations. Sixteen game elements were identified, with narrative, sensation, imposed choice, time pressure, and scoring being most prevalent. Justifications for the use of game elements were rarely provided; when present, they were primarily linked to realism and immersion. Elements such as badges and competition were underrepresented. No study explicitly linked individual game elements to specific educational outcomes

Conclusions:

Game elements are used in military trauma simulations but are rarely discussed in terms of their pedagogical purpose. More intentional research and transparent reporting are needed to clarify how specific game elements contribute to learning outcomes. Future studies should treat gamification as a set of targeted design choices rather than as a single overarching strategy and further explore how its playful and motivational dimensions can be effectively leveraged in military trauma training