Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). 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.

Nondigital board games are being used to engage players and impact outcomes in health and medicine across diverse populations and contexts. This systematic review and meta-analysis describes and summarizes their impact based on randomized and nonrandomized controlled trials. An electronic search resulted in a review of n = 21 eligible studies. Sample sizes ranged from n = 17 to n = 3110 (n = 6554 total participants). A majority of the board game interventions focused on education to increase health-related knowledge and behaviors (76%, n = 16). Outcomes evaluated included self-efficacy, attitudes/beliefs, biological health indicators, social functioning, anxiety, and executive functioning, in addition to knowledge and behaviors. Using the Cochrane Collaboration tool for assessing bias, most studies (52%, n = 11) had an unclear risk of bias (33% [n = 7] had a high risk and 14% [n = 3] had a low risk). Statistical tests of publication bias were not significant. A random-effects meta-analysis showed a large average effect of board games on health-related knowledge (d* = 0.82, 95% confidence interval; CI [0.15–1.48]), a small-to-moderate effect on behaviors (d* = 0.33, 95% CI [0.16–0.51]), and a small-to-moderate effect on biological health indicators (d* = 0.37, 95% CI [0.21–0.52]). The findings contribute to the literature on games and gamified approaches in healthcare. Future research efforts should aim for more consistent high scientific standards in their evaluation protocols and reporting methodologies to provide a stronger evidence base.

This research explores the educational impact of an online study aid-game for studying human vascular anatomy (n = 24) versus a similar non-game study aid (n = 22) and how it relates to medical students' demographic traits and voluntary use over a 35-day period. Hierarchical linear regression models revealed that study aid success rate (a metric for assessing performance through the study aids) was a significant predictor of anatomy test improvement with the game (β = 0.41, p = 0.05), but not for the non-game (β = 0.14, p = 0.56). Our analyses suggest that game mechanics encouraged more specific problem-solving strategies than did the control study aid, leading to greater predictability of learning outcomes. There was a non-significant trend among game treatment participants, who were more likely to complete study tasks than those assigned to the control treatment (p = 0.11). It would appear that students' studying habits had the greatest influence (though opposite in both tools) on level of engagement in study aid use. However, contrary to expectations, self-reported gaming habits did not impact participation. Overall, these findings support the integration of game design into undergraduate study aids as a means of increasing use of supplementary educational tools and assessing knowledge

Incorporating feedback into the learning process is crucial for learners’ success. Recent advancements in Learning Analytics (LA) and Artificial Intelligence (AI) have introduced a range of feedback generation and delivery opportunities to improve teaching and learning processes, yet questions remain about how learners engage with such tools and their impact. In this study, we investigated postgraduate students’ engagement with analytics feedback in relation to their level of self-regulated learning (SRL) competence and performance in a semester-long (ten-week) course. We specifically focused on the Interactive-Constructive-Active–Passive (ICAP) framework of cognitive engagement. Initially, students were asked to participate in an established SRL questionnaire, based on Zimmerman’s theory of self-regulation to evaluate their SRL competence (N = 39). Throughout the semester, their online behaviour data from Moodle and Google Docs was collected and analyzed to form personalised analytics feedback for each student. We examined how students with different SRL competencies engage with analytics feedback and the impact of this engagement on students’ course performance. Results indicated that students with high SRL competence actively engage with analytics feedback more than students with low SRL competence. However, students' analytics feedback engagement did not significantly affect their course performance. Additionally, we analyzed students’ reflections on the feedback provided to investigate how they perceived it in relation to their learning experiences and performance. Students argued in their reflections that analytics feedback was beneficial in identifying and regulating their online behaviours and providing motivation through objective insights. They also noted limitations in accurately reflecting their behaviours and learning quality, the need for more personalised recommendations and timely feedback, and suggested design improvements to ensure clarity, foster interaction and incorporate tailored, in-depth insights. We conclude the paper with a discussion on future design and research suggestions for ways of monitoring and supporting students’ cognitive engagement with analytics feedback interventions.