Lee Ching-Yi, Lee Ching-Hsin, Lai Hung-Yi, Chen Po-Jui, Chen Mi-Mi, Yau Sze-Yuen
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Radiation Oncology, Proton and radiation therapy center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
BMC Med Educ. 2025 Mar 25;25(1):435. doi: 10.1186/s12909-025-07044-7.
Clinical reasoning is a fundamental skill in healthcare education, crucial for diagnosing and managing patient care effectively. Traditional pedagogical techniques often fall short in fully engaging students or simulating real-life medical decision-making complexities. Gamification, which applies game-design elements in educational settings, has emerged as a promising strategy to enhance learning outcomes by making the educational process more interactive and engaging. This scoping review aims to comprehensively map the existing literature on gamification techniques used to enhance clinical reasoning education, identifying trends, gaps, and opportunities for future research.
The review followed the Joanna Briggs Institute (JBI) methodology and the Arksey and O'Malley framework for scoping reviews. A systematic search of Medline, Scopus, and Web of science, complemented by hand-searching reference lists. Studies published between 2014 and 2023, focusing on gamification applied to clinical reasoning education for healthcare professionals and trainees, were eligible for inclusion. Two independent reviewers screened and selected studies, and data were extracted using a pre-defined tool. Findings were synthesized using both quantitative summaries and qualitative thematic analysis.
Fifty-three studies met the inclusion criteria, representing research from 20 countries, with the United States contributing the largest proportion (28.3%), followed by Germany (9.4%) and France (7.6%). The majority of studies were cross-sectional (28.3%) or pilot studies (22.6%). Gamification was most frequently applied in university and academic settings (37.7%), followed by clinical and hospital-based training (18.9%), and digital platforms and simulations (17.0%). Medicine (28.3%) and nursing (22.6%) were the most targeted disciplines, with pharmacy (13.2%) following. Serious games were the most common gamification technique (45.3%), with additional strategies including escape rooms (11.3%), board and card games (7.5%), and branching case-based games (5.7%). Most studies (88.7%) referenced at least one theoretical framework, predominantly game-based learning theories (34.0%), followed by constructivist learning (13.2%) and experiential learning theories (13.2%). However, cognitive theories, directly relevant to clinical reasoning, were referenced in only 11.3% of studies, highlighting a theoretical gap.
Amification offers diverse and flexible strategies for enhancing clinical reasoning education across healthcare disciplines and settings. However, significant gaps remain, including limited longitudinal evidence, inconsistent use of validated reasoning assessments, underutilization of cognitive reasoning theories, and a lack of standardized design and reporting frameworks. Moreover, research predominantly focuses on medicine and nursing, with limited attention to interprofessional reasoning and underrepresented fields such as dentistry, rehabilitation, and allied health. Future research should prioritize theoretically informed gamification design, apply robust reasoning outcome measures, and explore emerging technologies such as AI-enhanced adaptive gamification and immersive virtual reality simulations to support clinical reasoning development. Addressing these gaps will ensure that gamification evolves from a promising innovation into a rigorously evidence-based strategy for enhancing clinical reasoning competence in healthcare education.
临床推理是医疗保健教育中的一项基本技能，对于有效诊断和管理患者护理至关重要。传统的教学方法往往难以充分吸引学生或模拟现实生活中的医疗决策复杂性。游戏化是将游戏设计元素应用于教育环境的一种方法，它已成为一种有前景的策略，通过使教育过程更具互动性和吸引力来提高学习效果。本范围综述旨在全面梳理用于加强临床推理教育的游戏化技术的现有文献，确定未来研究的趋势、差距和机会。
该综述遵循乔安娜·布里格斯研究所（JBI）的方法以及阿克西和奥马利的范围综述框架。对Medline、Scopus和科学网进行系统检索，并辅以手工检索参考文献列表。纳入2014年至2023年发表的、侧重于将游戏化应用于医疗保健专业人员和学员临床推理教育的研究。两名独立评审员筛选并选择研究，使用预定义工具提取数据。研究结果通过定量总结和定性主题分析进行综合。
53项研究符合纳入标准，代表了来自20个国家的研究，其中美国占比最大（28.3%），其次是德国（9.4%）和法国（7.6%）。大多数研究为横断面研究（28.3%）或试点研究（22.6%）。游戏化最常用于大学和学术环境（37.7%），其次是临床和基于医院的培训（18.9%）以及数字平台和模拟（17.0%）。医学（28.3%）和护理（22.6%）是最受关注的学科，药学（13.2%）紧随其后。严肃游戏是最常见的游戏化技术（45.3%），其他策略包括密室逃脱（11.3%）、棋盘游戏和纸牌游戏（7.5%）以及分支式基于案例的游戏（5.7%）。大多数研究（88.7%）引用了至少一个理论框架，主要是基于游戏的学习理论（34.0%），其次是建构主义学习（13.2%）和体验式学习理论（13.2%）。然而，仅11.3%的研究引用了与临床推理直接相关的认知理论，凸显了理论上的差距。
游戏化为加强医疗保健各学科和环境中的临床推理教育提供了多样且灵活的策略。然而，仍存在重大差距，包括纵向证据有限、有效推理评估的使用不一致、认知推理理论利用不足以及缺乏标准化的设计和报告框架。此外，研究主要集中在医学和护理领域，对跨专业推理以及牙科、康复和联合健康等代表性不足的领域关注有限。未来的研究应优先考虑基于理论的游戏化设计，应用可靠的推理结果测量方法，并探索人工智能增强的自适应游戏化和沉浸式虚拟现实模拟等新兴技术，以支持临床推理发展。解决这些差距将确保游戏化从一项有前景的创新发展成为一种严格基于证据的策略，以提高医疗保健教育中的临床推理能力。
