USE OF VIDEOGAMES AS LEARNING STRATEGIES IN MEDICAL STUDENTS: A SYSTEMATIC REVIEW

DOI: https://doi.org/10.26758/15.1.12

(1) (2) (3) Faculty of Medicine & Psychology, Autonomous University of Baja California, E-mails: (1) ivan.hernandez.porras@uabc.edu.mx (2) diego.camacho@uabc.edu.mx (3) hernan.carrillo@uabc.edu.mx

Address correspondence to: Ivan HERNANDEZ-PORRAS, Faculty of Medicine & Psychology, Baja California Autonomous University, Universidad 14418, Parque Internacional Industrial Tijuana, Tijuana, BC, 22390, Mexico, e-mail: ivan.hernandez.porras@uabc.edu.mx

Abstract

Objective: This systematic review aimed to evaluate the relevance of videogame-based strategies in cognitive learning outcomes among the medical students.

Methods: Following the PRISMA guidelines, an electronic systematic search was conducted using the Web of Science, PubMed/MEDLINE, EBSCO, and Scopus databases of indexed journals from 2014 to 2024. The search criteria used were: ((“game-based learning” OR “videogames”) AND (“medical education” OR “medical students”) AND (“cognition” OR “education”)). All these studies which has evaluated the use of videogames in medical education as a learning strategy were included.

Results: The initial search yielded 125 results, leading to a final selection of 10 studies that met all inclusion criteria and were evaluated using the Physiotherapy Evidence Database (PEDro) scale. From all these key aspects, such as population, Game-Based Learning strategy, study type, objectives, variables, and results, were compiled from these documents. The publication frequency increased after 2021, with Spain contributing the most publications (n = 6). The analysis revealed various videogame-based approaches that generally showed some positive effects on student motivation and cognitive performance. However, several studies had methodological weaknesses, including the small sample sizes and a lack of randomization.

Conclusion: This review suggests that video games may improve cognitive learning and motivation among the medical students, although further research is required to confirm this. Future studies should use rigorous designs with larger randomized samples and longer follow-up periods to assess knowledge retention and long-term effects of game-based education.

Keywords: Video Game; Gamification; Medical Education, Systematic Review.

Suggested citation (APA)

Hernández-Porras, I., Camacho-Vega, D.O., & Carrillo-Várguez, L. H. (2025). Use of videogames as learning strategies in medical students: A systematic review. Anthropological Researches and Studies, 15, 188-198. https://doi.org/10.26758/15.1.12

Introduction

A game is a system in which the participants are engaged in a conflict in which they take into account a set of rules and a quantifiable outcome (Salen & Zimmerman, 2004). Video games have evolved over the last 40 years and are now more interactive, creating links through the player networks. In the United States, by 2021, 68% of the population played video games, 38% of them were between 18 and 34 years old, and during the pandemic, there was an increase in the popularity and use of video games, including those focused on math and science education (Essential Facts About the Video Game Industry, 2021). Asia consumes the most video games, followed by Europe and Latin America, with approximately 420 million users (Howarth, 2024). According to a Statista estimate, by 2022, the top four countries that consume the most video games are South Korea, England, Japan and Mexico (Zandt, 2023).

Games applied in the educational context may be classified into gamification, game-based learning (GBL) and serious games (SG). GBL or SG are applications, although not necessarily digital, that seek to turn a repetitive and boring activity into a playful way of interacting with simulated real content and environments to coach, train or offer interactive practice (De Byl, 2013; Plass, Homer, & Kinzer, 2015). The term educational video game can be an activity with gamification elements or a game with educational elements. Nussbaum and Beserra (2014) define an educational video game as the result of the balance between teaching/learning and gamification or the game mechanics that impact the player’s immersion, such as rules, objectives, feedback and narrative. This allows us to deduce that the level of immersion generated by an educational video game could develop the important skills expected from students.

Several studies have highlighted the effectiveness of GBL in enhancing cognitive learning outcomes, motivation and student engagement in medical education. Taylor & Hamdy have explained that the cognitive learning theory focuses on learning through perception and processing of information (2013). For instance, students reported that the educational games significantly helped them understand complex concepts, practically apply theoretical knowledge, and increase their interest in the subject matter (Sierra & Rodríguez-Conde, 2023). Kahoot! has been widely adopted as a GBL platform, showing improvements in student participation and performance in aspects such as anatomy and histology (Garza et al., 2023). A pilot study evaluated an online game designed to improve the diagnostic testing skills of medical trainees and clinicians, highlighting how educational games can train skills through rapid decision-making and immediate feedback (Morgan et al., 2024). Some articles discuss limitations in these studies, such as the difficulty in isolating the effects of the specific games or simulations on learning outcomes due to the complexity or to the real-world scenarios (Pineda-Martínez et al., 2023). Additionally, concerns about varying levels of prior knowledge among students and the potential for gaming experiences to overwhelm learners have been noted.

To address this item, the present systematic review analyzed the relevance of the videogame-based strategies in cognitive learning outcomes among the medical students. This systematic review provides insights into effective research designs and assessment tools for evaluating the impact of video game-based learning on learning outcomes. This could help future researchers to choose the appropriate methods for their studies, providing a much-needed resource for researchers and educators interested in the intersection of video game-based learning and medical education.

Methods

This systematic review was developed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, conducting a review of the actual literature of application of videogames in the university context for educational purposes.

The electronic databases searched in this review included those identified as relevant to the medical education. Four databases were scrutinized: Web of Science, PubMed, EBSCO and Scopus. The search criteria used was: (“game base learning” OR “videogames”) AND (“medical education” OR “medical students”) AND (“cognition” OR “education”)); with a filter of publications in the last 10 years (2014-2024). All studies evaluating the use of videogames in medical education as a learning strategy were included.

Eligibility criteria

The type of studies which were included were the following: case studies, observational studies, quasi-experimental studies and randomized controlled trials. The study participants were medical students. It is important to point out that other health professions students were not excluded from the review (e.g. nursing or physiotherapy students and residents or practicing physicians), with the condition that the population was mixed with medical students and primarily was constituted by medical students. This study considered educational digital game-based strategies (e.g. Kahoot® and novel digital applications). The review did not cover other educational games (i.e. simulations, boardgames or escape rooms).

In April 2024, the following conditions were implemented to ensure an appropriate selection of papers. To be included in this review, papers had to date from 2014 to 2024 and published in English, explicitly state the videogame used in the study, and the terms videogame was required to appear in title or the abstract of the publication in order to avoid the confusion with other populations and learning strategies, includes participants primarily from medical school, and focuses on learning a subject.

Methodological quality and risk of bias

After applying all the criteria, the included papers were evaluated in a methodological quality/risk of bias analysis using the Physiotherapy Evidence Database (PEDro) scale. This scale features a 11-item checklist, with only 10 items being scored. For each criterion that the study met, 1 point was awarded. Clear and unambiguous fulfillment of a criterion leads to the award of 1 point. Thus, a total of 10 points are available. Studies were considered to be of a moderate quality if the score ranged from 5-7 and of high quality if the score ranged from 8-10 because according to the PEDro database website, a score of 8 is optimal for the complex interventions.

Results

Description of the included studies

The initial identification registered 125 results (Figure 1). Before screening 55 duplicates, 1 book chapter, 4 systematic review, 1 narrative review, 4 conference paper, 2 studies in non-medical student population and 4 non-digital strategies (n = 71) were removed. In the initial phase 54 original articles were screened in title and abstract for the established criteria, 2 simulation strategies, 3 focused on user perception or experience, 7 reviews, 5 guidelines or commentary, 7 focused on evaluating or developing non-learning skills, 6 non-digital strategy, 1 in non-medical student population, 4 conference papers and 1 book chapter (n = 36) were removed. The removed reviews focused on health staff, digital education, general teaching initiatives, active learning strategies or gamification elements, but not video games as a learning strategy. The remaining 18 of the full text results were screened and removed the following: 2 non-digital strategies, 3 evaluated perception, 1 was a commentary, 1 non-game strategy and 1 evaluated another method with Kahoot (n = 10).

Figure 1

PRISMA flow diagram depicting the process followed to identify eligible studies for the review (to see Figure 1, please click here)

Table 1

PEDro scale score of the screened studies  (to see Table 1, please click here)

Methodological quality and risk of bias of included studies

The 10 included manuscripts were assessed for the methodology quality using the PEDro scale to assess their quality (Table 1). The mean PEDro score of the included studies in the review was 5.1 ± 1.9 (Range: 1-7). Most of the studies scored between 4 and 7, indicating a moderate level of an internal validity and statistical reporting. The low scores are due to the limitations in the design of the interventions, such as not being able to blind the participants and whoever applied the experiment, which decreased the score by two points. From the 10 resulting documents, the main aspects, such as population, GBL strategy used, type of study, objectives, variables, and results, were compiled (Table 2).

Table 2

Studies that included videogames as a learning tool (to see Table 2, please click here)

 The majority of the studies examined (seven out of ten) demonstrated significant positive effects in various fields, including educational outcomes, student engagement, diagnostic precision, and overall efficacy. For example, Aktekin, Çelebi, & Aktekin (2018) noted the beneficial effects of GBL on both learning and motivation. Garza et al. (2023) revealed the substantial enhancements in academic achievement and overall grades compared to the conventional teaching approaches. Additionally, Morgan et al. (2024) found that even a single GBL session led to an improved diagnostic accuracy among medical trainees and practicing clinicians, with benefits observed immediately and persisting at a three-month follow-up assessment.

Discussion

Some reviews have evaluated learning with video games among university students from different areas; however, this is the first review on the effects of video games on learning in medical students, and several authors have established the viability of video games in content learning (Sierra & Rodríguez-Conde, 2023; Vergne, Smith, & Bowen, 2020). However, it cannot be considered taken into consideration that the results may be extrapolated to all educational contexts, Galindo-Dominguez (2019) explains that among the three factors which determine the applicability, these may be: the affinity of students towards the video games; the access to the sufficient technological resources; the knowledge that the teacher has about the educational technology. There is evidence that the most demanded degrees are related to health, specifically medicine; therefore, the results presented in this review will be of a great support in order    to know what is the state of the field and encourage the implementation of more specific interventions.

Most proposed video games (n = 7) are new digital applications and innovative learning strategies with great potential in medical education. Medical education has been characterized as physically and mentally demanding; therefore, some teaching strategies such as the video games which increase the motivation and decrease the cognitive load of students are all welcome.

Research has demonstrated several benefits of videogaming. Some studies have indicated that these games may provide a valuable platform for social interaction, enabling players to develop significant interpersonal relationships. The evidence suggests that the friendships formed through online gaming may lead to the improved face-to-face interactions (Vázquez-Cano et al., 2024).

The quality of each study was measured using the PEDro scale. One of the primary advantages of the PEDro scale is its ability to provide a standardized method for assessing methodological quality. For instance, in systematic reviews, the use of the PEDro scale has been shown to enhance the reliability of quality assessments (Cardoso, Meneses, & Lumini-Oliveira, 2017). Only three studies randomized participants. Several studies (n = 4) compared the intervention group to one or more historical control groups. Others did not compare outcomes with baseline data (n = 3). Only one study measured knowledge retention at one and three months (Morgan et al., 2024), the rest measured once. In reference to the years of publication, there was an increase from 2021 onwards. Spain had the highest number of publications (n = 6).

It must be admitted that the study identified a difference between the voluntary and the compulsory participants, with the former having a greater effect than the latter, which led us to consider that the motivational effect is not applicable to all participants (Rudolphi-Solero et al., 2021a). Another study found a positive effect of combining video games with traditional classes compared with the traditional classes alone (Yadav et al., 2022).

However, the literature has identified a greater number of non-digital games, such as board games, card games, or escape rooms. These games have been shown to have a positive effect on teaching and learning processes (Abdulmajed, Park, & Tekian, 2015). Denham, Spokes, Coward-Gibbs and Veal (2023) argue that dialogic video games, i.e., those which focus on narrative, may help their users to develop communication skills, critical thinking, problem solving, resource and time management, with the aim of identify power dynamics and develop an opinion about reality. Pineda-Martínez, Llanos-Ruiz, Puente-Torre and García-Delgado (2023) identified that in sustainable education, cooperative video games favor creativity, innovation and student awareness, in addition to strengthening students’ cognitive, emotional and behavioral engagement. Sierra and Rodriguez-Conde (2023) applied 3 video games in an introductory course of economic management. In addition to improving the learning experience and students’ satisfaction, they claim that it contributed to obtain the expected learning results in economics, business and management. Vergne et al. (2020) developed a video game in Google Forms ® and applied it remotely to chemistry laboratory students, arguing that it is possible to replace certain face-to-face practices with the game. Carenys, Moya and Perramon (2017) observed the usefulness of mixing simulations and video games to complement their effects on motivation and learning experience.

Considering the limitations, all included studies had, in different magnitude, some positive results on the information retention, were well received by the students and motivated the students to be more engaged in this activity. In some cases the positive effect achieved in the test scores persisted months after this activity.

Some limitations of this study are that during the search, Kahoot was considered as a video game even though some authors consider it a gamified application; however, for the purposes of this study, it was considered because there are few studies with new proposals of video games as a learning strategy for medicine. Considering the high stress derived from studying medicine, it is believed that new learning approaches may obtain the same or better results than the traditional methods with a ludic or in a more casual way. Additionally, no studies have explored other areas of the cognition, such as the cognitive load, the behavior, and the metacognition in medical students, which leads to the consideration of these areas as areas of opportunity for the future research.

Conclusions

The effects of the video games have been shown in other areas of knowledge. In medical school, videogames are perceived as having the potential of positive effects upon motivation, learning and development of soft skills. However, the methodology used with the aim to measure these effects, and the number of studies is still deficient, so it is difficult to establish an applicable and lasting positive effect.

The integration of the video games into the medical education holds a significant promise. This systematic review, while highlighting the potential of the video games in order to enhance the cognitive learning and the motivation in medical students, underlines the need for more robust research to solidify these findings. The current body of evidence, though indicative of positive effects, is hampered by methodological limitations. Future studies should prioritize rigorous designs, incorporating larger, randomized samples, and long-term follow-up having the aim to assess the knowledge retention and the lasting impact of game-based learning.

Moreover, exploring the diverse applications of video games beyond the factual knowledge acquisition is crucial. This includes investigating their role in developing critical thinking, problem-solving skills, and fostering collaborative learning in medical students. By addressing these gaps, future research may provide a more comprehensive understanding of the potential of video games to transform the medical education and not least contribute to a better patient care.

Acknowledgments

Ivan Hernandez-Porras and Luis Hernan Carrillo-Varguez received PhD economic support from Consejo Nacional de Humanidades Ciencias y Tecnologias.

Competing interests

The authors declare no competing interests.

References

1. Abdulmajed, H., Park, Y. S., & Tekian, A. (2015). Assessment of educational games for health professions: A systematic review of trends and outcomes. Medical Teacher, 37(S1), S27–S32. https://doi.org/10.3109/0142159X.2015.1006609
2. Aktekin, N. Ç, Çelebi, H., & Aktekin, M. (2018). Let’s Kahoot! Anatomy Utilicemos Kahoot! Anatomía.  Morphol, 36(2), 716–721. https://doi.org/10.4067/S0717-95022018000200716
3. Cardoso, R., Meneses, R., & Lumini-Oliveira, J. (2017). The effectiveness of physiotherapy and complementary therapies on voice disorders: a systematic review of randomized controlled trials. Frontiers in Medicine, 4. https://doi.org/10.3389/fmed.2017.00045
4. Carenys, J., Moya, S., & Perramon, J. (2017). Is it worth it to consider videogames in accounting education? A comparison of a simulation and a videogame in attributes, motivation and learning outcomes. Revista de Contabilidad-Spanish Accounting Review, 20(2), 118–130. https://doi.org/10.1016/j.rcsar.2016.07.003
5. De Byl, P. (2013). Factors at play in tertiary curriculum gamification. International Journal of Game-Based Learning, 3(2), 1–21. https://doi.org/10.4018/ijgbl.2013040101
6. del Blanco, Á., Torrente, J., Fernández-Manjón, B., Ruiz, P., & Giner, M. (2017). Using a videogame to facilitate nursing and medical students’ first visit to the operating theatre. A randomized controlled trial. Nurse Education Today, 55(65353263), 45–53. https://doi.org/10.1016/j.nedt.2017.04.026
7. Denham, J., Spokes, M., Coward-Gibbs, M., & Veal, C. (2023). Personal, pedagogic play: a dialogic model for video game learning. Pedagogy, Culture and Society, 00(00), 1–18. https://doi.org/10.1080/14681366.2023.2272164
8. Association, E. S. (2021). Essential Facts About the Video Game Industry. Retrieved from https://www.theesa.com/2021-essential-facts-about-the-video-game-industry/
9. Galindo-Domínguez, H. (2019). Los videojuegos en el desarrollo multidisciplinar del currículo de Educación Primaria: el caso Minecraft. Pixel-Bit, Revista de Medios y Educación, 55, 57–73. https://doi.org/10.12795/pixelbit.2019.i55.04
10. Garza, M., Olivan, S., Monleón, E., Cisneros, A. I., García-Barrios, A., Ochoa, I., … Lamiquiz-Moneo, I. (2023). Performance in Kahoot! activities as predictive of exam performance. BMC Medical Education, 23(1), 1–8. https://doi.org/10.1186/s12909-023-04379-x
11. Howarth, J. (2024). How Many Gamers Are There?Retrieved October 25, 2024 from Exploding Topics website: https://explodingtopics.com/blog/number-of-gamers
12. Hu, H., Liu, Z., & Li, H. (2022). Teaching Disaster Medicine With a Novel Game-Based Computer Application: A Case Study at Sichuan University. Disaster Medicine and Public Health Preparedness, 16(2), 548–554. https://doi.org/10.1017/dmp.2020.309
13. Lorenzo-Alvarez, R., Rudolphi-Solero, T., Ruiz-Gomez, M. J., & Sendra-Portero, F. (2020). Game-Based Learning in Virtual Worlds: A Multiuser Online Game for Medical Undergraduate Radiology Education within Second Life. Anatomical Sciences Education, 13(5), 602–617. https://doi.org/10.1002/ase.1927
14. Marín-Díaz, V., & Martín-Párraga, J. (2014). Can videogames be used to develop the infant stage educational curriculum? Journal of New Approaches in Educational Research, 3(1), 20–25. https://doi.org/10.7821/naer.3.1.20-25
15. Morgan, D., Scherer, L., Pineles, L., Baghdadi, J., Magder, L., Thom, K., … Korenstein, D. (2024). Game-based learning to improve diagnostic accuracy: a pilot randomized-controlled trial. Diagnosis, 1–6. https://doi.org/10.1515/dx-2023-0133
16. Nussbaum, M., & Beserra, V. D. S. (2014). Educational videogame design. Proceedings – IEEE 14th International Conference on Advanced Learning Technologies, ICALT 2014, 2–3. IEEE. https://doi.org/10.1109/ICALT.2014.9
17. Pineda-Martínez, M., Llanos-Ruiz, D., Puente-Torre, P., & García-Delgado, M. Á. (2023). Impact of Video Games, Gamification, and Game-Based Learning on Sustainability Education in Higher Education. Sustainability (Switzerland), 15(17), 13032. https://doi.org/10.3390/su151713032
18. Plass, J. L., Homer, B. D., & Kinzer, C. K. (2015). Foundations of Game-Based Learning. Educational Psychologist, 50(4), 258–283. https://doi.org/10.1080/00461520.2015.1122533
19. Rudolphi-Solero, T., Jimenez-Zayas, A., Lorenzo-Alvarez, R., Domínguez-Pinos, D., Ruiz-Gomez, M. J., & Sendra-Portero, F. (2021a). A team-based competition for undergraduate medical students to learn radiology within the virtual world Second Life. Insights into Imaging, 12(1). https://doi.org/10.1186/s13244-021-01032-3
20. Rudolphi-Solero, T., Lorenzo-Álvarez, R., Domínguez-Pinos, D., Ruiz-Gómez, M. J., & Sendra-Portero, F. (2024). An Interuniversity Competition for Medical Students to Learn Radiology in the Second Life Metaverse. Journal of the American College of Radiology, 21(5), 812-821. https://doi.org/10.1016/j.jacr.2023.09.012
21. Rudolphi-Solero, T., Lorenzo-Alvarez, R., Ruiz-Gomez, M. J., & Sendra-Portero, F. (2021b). Impact of compulsory participation of medical students in a multiuser online game to learn radiological anatomy and radiological signs within the virtual world Second Life. Anatomical Sciences Education, 15(5), 863–876. https://doi.org/10.1002/ase.2134
22. Salen, K., & Zimmerman, E. (2004). Rules of Play: Game Design Fundamentals(1st ed.). Cambridge: The MIT Press. Retrieved from https://books.google.com.mx/books/about/Rules_of_Play.html?hl=de&id=UM-xyczrZuQC&redir_esc=y
23. Sierra, J., & Rodríguez-Conde, M. J. (2023). Learning by ruling: Use of videogames to simulate public economics management. International Journal of Management Education, 21(2), 100819. https://doi.org/10.1016/j.ijme.2023.100819
24. Taylor, D. C. M., & Hamdy, H. (2013). Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11). https://doi.org/10.3109/0142159X.2013.828153
25. Vázquez-Cano, E., Quero-Gervilla, M., Quicios-García, MP., López-Meneses, E. (2024) The psycho-social impact of video games on K12 Spanish students. New Approaches Educ. Res.13 (14). https://doi.org/10.1007/s44322-024-00014-9
26. Vergne, M. J., Smith, J. D., & Bowen, R. S. (2020). Escape the (Remote) Classroom: An Online Escape Room for Remote Learning. Journal of Chemical Education, 97(9), 2845–2848. https://doi.org/10.1021/acs.jchemed.0c00449
27. Yadav, A., Mala, R., Reddy, R., Padmasree, D., Nandakumar, L. G., & Anmol Manaswini Yadav, G. (2022). Real-Time Reflection by Gamification as Teaching-Learning-Assessment Tool In Competency-Based Medical Education. Future of Medical Education Journal, 12(3), 3–6. https://doi.org/10.22038/fmej.2022.61699.1443
28. Zandt, F. (2023). The World’s Biggest Gaming Nations. Retrieved October 25, 2024 from Statista website: https://www.statista.com/chart/28244/countries-with-the-highest-estimated-user-penetration-in-the-video-game-segment/