JMIR Publications

ABSTRACT

Background:

Formative assessment plays a central role in medical education by allowing students to practice in low-risk contexts and receive timely feedback, particularly in courses with high visual and practical demands such as Morphology. In this context, gamified digital tools, such as online quiz platforms, have been progressively incorporated to support active learning. However, evidence on how these tools are experienced in visually intensive disciplines remains limited, and their educational value largely depends on their pedagogical integration rather than on the technology itself. The Technological Pedagogical Content Knowledge (TPACK) framework offers an appropriate perspective for analyzing this interaction.

Objective:

To explore studentsā€™ and a teacherā€™s perceptions of the use of Kahoot! as a gamified formative assessment tool in a first-year medical Morphology course, identifying facilitators, tensions, and perceived educational value, informed by the TPACK framework and using reflexive thematic analysis.

Methods:

An exploratory qualitative study with a phenomenological-interpretive approach was conducted as part of the RAƍCES 2 project (2025) at Universidad San SebastiĆ”n (Valdivia, Chile). Kahoot! was implemented face-to-face as an end-of-class activity designed to simulate the visual and time-related demands of the courseā€™s practical assessments. Data collection included two online focus groups with first-year medical students (n=14) and one semistructured interview with the course instructor (n=1). Transcripts were analyzed using a combined process of deductive coding, guided by the TPACK framework and the projectā€™s analytical axes, and inductive reflexive thematic analysis following Braun and Clarke. The analysis was supported by ATLAS.ti software, and ethical approval and informed consent were obtained.

Results:

Six interrelated themes emerged. Kahoot! was valued when its design closely aligned with disciplinary demands, particularly through the use of authentic images and time constraints comparable to those of practical assessments. As an end-of-class activity, it functioned as a rapid formative check that facilitated self-assessment and the identification of learning gaps for both students and the instructor. The formative value of the tool depended critically on the teacherā€™s mediation after each question, as the explanation of correct and incorrect answers transformed the competitive dynamic into a learning opportunity. Gamification increased motivation and engagement but also generated ambivalent emotional responses associated with time pressure and ranking. Implementation was influenced by contextual factors such as connectivity, device availability, and in-class time management. Participants indicated that more systematic use and more carefully designed items could enhance its educational impact.

Conclusions:

Kahoot! was perceived primarily as a formative assessment strategy in the context of Morphology I. Its educational value emerged from the alignment between technology, pedagogy, and disciplinary content, consistent with the TPACK framework. The findings suggest that gamified tools can support learning in visually demanding medical courses when they are intentionally integrated, accompanied by explicit feedback, and attentive to studentsā€™ emotional experiences. More than the technology itself, pedagogical mediation determines their formative impact.