Gamified Learning among Medical Undergraduates using Digital Platforms: A Quasiexperimental Study

Abstract

Background:

Gamified learning in medical education involves using game elements to improve learning behaviors and outcomes. Digital gamification is underexplored in community medicine. We aimed to assess students’ perceptions about gamified learning and their preference for individual or team-based participation, and compare the user experience between different digital platforms.

Materials and Methods:

We conducted this one-group posttest-only quasiexperimental study at a medical college in North India. We included students of Phase II and Phase III part 1 MBBS who had attended at least one gamified learning session of community medicine during the study period. We utilized six platforms per batch to deliver electronic quizzes for team-based (Classmarker and Nearpod) or individual participation (Formative, Google Forms, Quizizz, and Slido). We sought feedback using semistructured questionnaires. We used Jamovi version 2.3 for descriptive and inferential statistics. We performed manual inductive thematic analysis involving semantic-level coding of complete response units for qualitative data.

Results:

All 292 respondents (Phase II: 143; Phase III part 1: 149) attended at least three gamified learning sessions. Over 75% of the participants perceived gamification favorably across all parameters. Phase II students showed significantly higher favorability for perceived increase in interest (92.3% vs. 81.9%, P = 0.001) and engagement (87.4% vs. 83.2%, P = 0.003). Only 26.4% of students preferred team-based participation, with a higher preference in the junior batch (35.7% vs. 17.6%, P < 0.001). Formative and Slido received the highest median scores (9/10).

Conclusion:

Gamified learning is a well-received adjunct to traditional medical pedagogy.

INTRODUCTION

Teaching–learning modalities have been evolving in medical education. Theoretical education in medical sciences has been imparted predominantly through didactic lectures, which can become monotonous if they involve less interaction. Over the last decade, gamification has increasingly been employed in learning environments to enhance students’ motivation and encourage social interaction.[1] Gamification involves using game design elements in nongame, nonentertainment contexts. When used in education, it is called gamification of learning or gamified learning. Gamified learning, though not limited to, is often associated with digital means such as websites and applications, and gained prominence during the COVID-19 pandemic. Such platforms utilize game design elements like reward points, badges, progress bars, unlockable content, and leaderboards with a top scorer display.[2] Many gamified applications offer readymade or easy-to-create shorter educational activities, such as electronic (e-) quizzing and flashcards. E-quizzes enable structured learning, provide immediate feedback for rapid knowledge correction, promote recall and reinforcement of learned concepts, and allow testing cross-cutting concepts.

Students often perceive gamification as a novel, fun, and engaging learning approach.[1] It can improve the learning attitude and behavior of students pursuing health professions education and improve their academic results.[3] A smart learning environment can build upon the digital nativity of contemporary learners, the “Gen Z.” Given the increasing emphasis on learner-centered and technology-enabled education across medical subjects, it is important to explore how digitally gamified learning is perceived by medical undergraduates within specific disciplines such as community medicine. The literature revealed only one Indian study in this discipline, and it aimed to improve medical undergraduate (MBBS) students’ engagement in online lectures. The use of digital gamifying applications was restricted, and the activities were unsupervised.[4] Recognizing the need to assess perceptions about gamification in a physical classroom setting, beyond solely engagement in an online environment, we introduced multiple digital gamifying platforms in community medicine classrooms that could guide identification of contemporary useful pedagogical tools.

The objectives of this study were to assess medical students’ perceptions of gamified learning in community medicine, explore their preference for individual versus team-based participation, and compare user experience across different digital gamification platforms.

MATERIALS AND METHODS

Study design, setting, and duration

We conducted this one-group posttest-only quasiexperimental study with educational intervention at a medical college in North India from August to October 2024.

Ethical approval and informed consent

Institute Ethics Committee approval was taken before initiating the study (reference number IEC/IIMSR/2024/98). Informed consent was sought after apprising the participants about the study, data confidentiality, and voluntary participation.

Study population, inclusion, and exclusion criteria

MBBS students of Phase II (batch 2022, junior batch, 150 students) and Phase III part 1 (batch 2021, senior batch, 154 students) were considered for eligibility, since a large proportion of the community medicine curriculum is taught in these two phases, allowing for comprehensive subject coverage to gamify learning and greater operational feasibility. As this was an exploratory educational intervention involving entire batches, formal sample size estimation was not performed. All Phase II and Phase III part 1 MBBS students who attended at least one gamified learning session of community medicine during the study period were invited to participate. Students who did not fill out at least one feedback form were excluded.

Intervention and study tools

The intervention was gamified learning by quizzing on digital platforms, utilizing game elements. Each gamified session was conducted over 15 minutes and had 10 multiple-choice questions (MCQs) that were scored and timed. The MCQ format was chosen due to its relevance to the current assessment system in India. MCQs were developed by the investigators based on session learning objectives, peer-reviewed by faculty from the department, and mapped to remembering, understanding, and application levels of Bloom’s taxonomy to ensure content standardization across platforms. The platforms were chosen based on suitability for medical education and feasibility of conducting regular classroom sessions if students also opined favorably. Attributes of free or trial versions were explored, such as duration of access and frequency of use, number of participants permitted at a time, number and type of questions permitted, timer characteristics, reviewing options for the teacher to optimize feedback, game design elements, and a user-friendly interface that also supports interactive classroom-based live quizzing.

1. Digital platforms to gamify learning:

   1. Classmarker (https://www.classmarker.com/)

   2. Formative (https://www.formative.com/)

   3. Google Forms (https://workspace.google.com/intl/en_in/products/forms/)

   4. Nearpod (https://nearpod.com/)

   5. Quizizz (now Wayground) (https://wayground.com/?lng=en)

   6. Slido (https://www.slido.com/)

   These platforms allow interactive quizzing and gamification by rewarding points and badges, displaying progress bars and leaderboards, etc., Students participated in teams during the Classmarker and Nearpod sessions, and individually in other sessions.

2. Questionnaires: Semistructured expert-validated questionnaires were administered over Google Forms to gather student feedback. Both questionnaires were pretested among a small group of medical students (not included in the final analysis) to assess clarity, wording, and completion time. Minor wording modifications were made based on feedback to improve comprehension.

   1. The first questionnaire was administered at the end of each gamification session, seeking feedback about the digital platform. Participants’ agreement with any item was rated over a five-point Likert scale, with rating 1 indicating strong disagreement to 5 indicating strong agreement. Additionally, participants were asked to assign an overall score to the platform, ranging from 0 to 10. An open-ended question about challenges faced while using the platform was also posed.

   2. The second questionnaire was administered toward the end of the study when all the sessions were completed, for feedback on the use of gamification for learning. Cronbach’s alpha was computed as a measure of the internal consistency (reliability) for this section of the questionnaire. Students’ perceptions were rated on a five-point Likert scale (1 = strongly disagree, 5 = strongly agree). The next section included questions about participant perceptions and preferences regarding team-based or individual participation were asked. At the end, an open-ended question was posed to receive comments or suggestions about the activities undertaken in the study.

Study process

In every 60-minute large group teaching session of community medicine taken by the investigators during the study period, the last 15 minutes were used to gamify learning. Students were directed to uphold the academic honor code. The top scorers were announced and applauded. Each batch was exposed to all six digital platforms once during the study period. The sequence of platforms was determined pragmatically based on teaching schedules and platform availability. Student feedback was sought through the first questionnaire at the end of each session. At the end of six sessions in every batch, the second questionnaire was administered to assess students’ perceptions about gamified learning based on their composite experience.

Data analysis and presentation

Data were extracted in Google Sheets and analyzed using Jamovi version 2.3 (The Jamovi project, Sydney, Australia). Nominal data were expressed as proportions and percentages. Ordinal data were presented as median with interquartile range. Continuous variables were expressed as mean with standard deviation. Chi-square test and Mann–Whitney U test were applied for the between-phase comparison of categorical data and ordinal Likert-scale data, respectively. A P value of less than 0.05 was considered statistically significant. Qualitative responses were analyzed using manual inductive thematic analysis. Initial open coding was performed on complete response units, followed by iterative code refinement and grouping into higher-order themes. Coding was conducted by a single investigator, and thematic saturation was considered achieved when no new codes emerged from successive responses. Illustrative verbatim quotes were presented to illustrate representative sentiments within each theme.

RESULTS

There were 292 respondents for the questionnaire on perceptions about gamified learning, comprising 149 were from the senior batch, and 143 from the junior batch. Participant age ranged from 20 to 27 years. Mean age was 22.27 years (SD 1.303). Female and male participants constituted 53.4% (n = 156) and 46.6% (n = 136) of the total respondents, respectively. All the respondents had attended at least three sessions of gamified learning, and 96.9% had attended four or more sessions. From the senior batch, 99.3% had attended four or more sessions, while this fraction was 94.4% from the junior batch.

Perceptions about gamified learning

Over 75% of the participants rated all items as 4 or 5 on the Likert scale, indicating positive perceptions about gamified learning [Table 1]. Cronbach’s alpha for the responses in Table 1 was 0.987 for the senior batch, 0.982 for the junior batch, and 0.985 overall.

Table 1.

Students’ perceptions about gamified learning

Item	Students reporting 4 or 5 on Likert scale			Median score (IQR) (n=292)	P*
	Pooled (n=292) n (%)	Phase III part 1 (n=149) n (%)	Phase II (n=143) n (%)
Gamified learning was an enjoyable experience.	252 (86.3)	124 (83.2)	128 (89.5)	5 (4,5)	0.010
Gamification increased my interest in learning.	254 (87.0)	122 (81.9)	132 (92.3)	5 (4,5)	0.001
Gamification kept me attentive during the class.	240 (82.2)	121 (81.2)	119 (83.2)	5 (4,5)	0.016
I felt more engaged during the gamified learning class as compared to routine lectures.	249 (85.3)	124 (83.2)	125 (87.4)	5 (4,5)	0.003
Gamification helped to simplify the complex subject concepts.	243 (83.2)	119 (79.9)	124 (86.7)	4 (4,5)	0.019
Gamification helped me retain the class contents better.	243 (83.2)	118 (79.2)	125 (87.4)	5 (4,5)	0.012
Gamification motivated me to read more about the discussed topic after the class.	234 (80.1)	120 (80.5)	114 (79.7)	4 (4,5)	0.301
Gamification motivated me to read about the topic of the next class and come prepared for it.	227 (77.7)	112 (75.2)	115 (80.4)	4 (4,5)	0.158
Gamification promoted competition with classmates.	247 (84.6)	123 (82.6)	124 (86.7)	5 (4,5)	0.002
The competition associated with gamification motivated me to learn more.	241 (82.5)	119 (79.9)	122 (85.3)	5 (4,5)	0.016
Gamified learning improved my understanding of the subject matter.	245 (83.9)	123 (82.6)	122 (85.3)	5 (4,5)	0.123
When I answered a question correctly in gamification, it improved my self-confidence.	242 (82.9)	118 (79.2)	124 (86.7)	5 (4,5)	0.005
When I performed well in gamification, my reputation in the class improved.	226 (77.4)	118 (79.2)	108 (75.5)	4 (4,5)	0.409
I felt motivated by the rewards associated with gamification (such as ranks, badges, points, and leaderboard display).	240 (82.2)	119 (79.9)	121 (84.6)	5 (4,5)	0.016
Digital platforms used for gamification helped me to improve my time-management skills.	240 (82.2)	117 (78.5)	123 (86.0)	5 (4,5)	0.029
Gamification enhanced my overall learning experience.	246 (84.2)	120 (80.5)	126 (88.1)	5 (4,5)	0.020
Gamification enhanced the interaction with faculty as compared to usual classes.	243 (83.2)	124 (83.2)	119 (83.2)	5 (4,5)	0.072
Overall, I feel satisfied with gamified learning.	252 (86.3)	124 (83.2)	128 (89.5)	5 (4,5)	0.010
I recommend using gamification for other classes of community medicine.	248 (84.9)	122 (81.9)	126 (88.1)	5 (4,5)	0.003
I recommend using gamification for classes of other subjects of MBBS.	246 (84.2)	121 (81.2)	125 (87.4)	5 (4,5)	0.011

IQR: Interquartile range. *P values indicate the output of Mann–Whitney U test for between-phase comparison of Likert scale data on perceptions. Values in brackets represent column-wise percentages, where the denominator is the total number of students in the respective column (e.g., Phase) reporting a Likert score of 4 or 5

A total of 81.8% students liked the experience of quizzing over a smartphone or digital device relative to paper-based quizzing (score 4 or 5 on Likert scale; median 5 and IQR 4,5), with 83.9% respondents of the junior batch in favor versus 79.9% respondents of the senior batch (P = 0.006).

To explore the student preference for participation as an individual or a team, responses from students who had attended at least one team-based session (n = 288) were analyzed. Overall, 26.4% (n = 76) students preferred team-based participation. The preference was significantly different between the batches, wherein 35.7% of the junior batch respondents preferred team-based participation compared to 17.6% of the senior batch (χ² = 11.28, df = 1, P < 0.001). Overall, 80.2% respondents agreed upon “Gamified learning in teams promoted collaborative learning with my peers” (4 or 5 rating on Likert scale; median 4 and IQR 4,5). Junior batch responses were more favorable for this statement than senior batch responses (84.3%, 76.4%, P = 0.002).

Sixty-eight participants gave comments/suggestions responding to the open-ended question. The themes, analytic codes, and illustrative verbatim quotes are shown in Table 2.

Table 2.

Results of thematic analysis of students’ perceptions about gamified learning

Themes	Analytic codes	Illustrative verbatim quotes
1. Engagement and motivation	1.1 Enjoyment	1.1.1 “Enjoyed studying”
	1.2 Interest	1.2.1 “Very interesting” 1.2.2 “It was very nice platform and made the topics interesting.” 1.2.3 “We need individual (participation) and leaderboard so as to increase the interest in attempting quiz”
	1.3 Reward	1.3.1 “We need individual (participation) and leaderboard so as to increase the interest in attempting quiz”
	1.4 Novelty	1.4.1 “It was a very nice experience and new type of teaching method”
	1.5 Platform-related	1.5.1 “Some platforms are engaging while others (few) are irritating apps”
2. Pedagogical value	2.1 Specific learning benefits	2.1.1 “It is helpful to understand the concept” 2.1.2 “Ma’am comes with the best version (platform) every time.Session is so interactive and knowledge enhancing” 2.1.3 “Game interaction helps me learn and retain knowledge better”
	2.2 Positive perceptions	2.2.1 “Effective learning” 2.2.2 “Effective teaching” 2.2.3 “Good teaching method” 2.2.4 “Liked the way of teaching” 2.2.5 “It was a very nice experience and new type of teaching method” 2.2.6 “Please continue this type of teaching” 2.2.7 “It’s a good way of learning” 2.2.8 “A good way of teaching”
	2.3 Novelty	2.3.1 “It was a very nice experience and new type of teaching method” 2.3.2 “Very creative and interactive method of teaching”
3. Classroom dynamics	3.1 Session management	3.1.1 “It was smoothly conducted” 3.1.2 “The session went pretty smoothly”
	3.2 Teacher–student interaction	3.2.1 “Very creative and interactive method of teaching” 3.2.2 “Interactive sessions” 3.2.3 “Ma’am comes with the best version (platform) every time.Session is so interactive and knowledge enhancing”
	3.3 Teacher appreciation	3.3.1 “Ma’am comes with the best version (platform) every time.Session is so interactive and knowledge enhancing” 3.3.2 “Thankyou” 3.3.3 “Ma’am always come forward with the best question and her speech conduction is also the best” 3.3.4 “Effective teaching” 3.3.5 “Liked the way of teaching”
	3.4 Participation type preference	3.4.1 “Can’t assess individual performance and understanding in a group activity” 3.4.2 “We need individual (participation) and leaderboard so as to increase the interest in attempting quiz”
4. Perceptions of time and pacing	4.1 Lack of time	4.1.1 “More questions, Less time, Intense battle”
	4.2 Excess time	4.2.1 “Time in each question too long”
	4.3 Suggestion for pacing	4.3.1 “Can be better without a timeline”
5. Overall perception	5.1 Positive sentiment	5.1.1 “Wonderful experience” 5.1.2 “Excellent sessions” 5.1.3 “Overall good experience” 5.1.4 “Nice experience” 5.1.5 “Very good” 5.1.6 “Great sessions” 5.1.7 “Satisfied” 5.1.8 “No suggestion, everything is perfect” 5.1.9 “Overall best” 5.1.10 “Thankyou” 5.1.11 “ :) “ <Smiling emoticon>
	5.2 Desire for future activities	5.2.1 “More game activities for educational learning in future!!” 5.2.2 “Please continue this type of teaching”

Note: Illustrative verbatim quotes may appear under multiple themes/analytic codes if they reflect more than one aspect of student perception

Students’ experience with the digital platforms

Students’ experience regarding the digital platforms is shown in Table 3. Response rates ranged from 91.1% to 93.8% across platforms [Table 3]. The overall median score was at least 8 for each platform. Formative and Slido fared the best with a median score of 9. All these platforms were rated at least 4 (median) on the ease of login, navigation, response submission, visual appeal, and enjoyment [Table 3, Figure 1]. Distinct challenges or shortcomings of the digital platforms that are not shown in Table 3 responses are shown in Table 4.

Table 3.

Students’ experience with the digital platforms

Item	Classmarker (n=270)	Formative (n=274)	Google Forms (n=266)	Nearpod (n=272)	Quizizz (n=272)	Slido (n=266)
It was easy to log into the platform.	5 (4,5)	5 (4,5)	4 (3,5)	4 (3,5)	5 (4,5)	5 (4,5)
It was easy to navigate the platform during the quiz.	5 (4,5)	5 (4,5)	4 (3,5)	4 (3,5)	4 (4,5)	5 (4,5)
It was easy to submit answers.	5 (4,5)	5 (4,5)	4 (4,5)	4 (3,5)	4 (4,5)	5 (4,5)
I am satisfied with the visual appearance of the platform on the phone screen.	4 (4,5)	5 (4,5)	4 (3,5)	4 (3,5)	5 (4,5)	5 (4,5)
I enjoyed using this platform.	4 (4,5)	4 (4,5)	4 (3,5)	4 (3,5)	5 (4,5)	5 (4,5)
Mean (SD) of overall score assigned by participants (range 0 to 10).	8.0 (1.8)	8.4 (1.7)	7.8 (1.8)	7.6 (2.3)	8.1 (1.8)	8.2 (1.8)
Median (IQR) of overall score (range 0 to 10).	8 (7,10)	9 (8,10)	8 (7,9)	8 (7,9)	8 (7,9)	9 (7,10)

IQR: Interquartile range; SD: Standard deviation. Cell values in the first five rows represent the median (IQR) obtained from Likert scale responses to the user-experience questionnaire for digital platforms

Figure 1.

Heat map of median Likert scores for user experience across digital platforms

Table 4.

Challenges/shortcomings regarding digital platforms

Platform	Key responses
1. Classmarker	1.1 “Advertisements”
2. Formative	2.1 “Difficulty in selecting the answer: unable to click or had to click twice” 2.2 “Font is not attractive” 2.3 “Leaderboard will make this more interesting”*
3. Google Forms	(Challenges such as login were reflected in Table 3 item responses)
4. Nearpod	4.1 “Unable to click on the “next” button on phone screen” 4.2 “Laggy interface”
5. Quizizz	5.1 “Session time out”
6. Slido	6.1 “After selecting answer, it did not get submitted if time ran out. Ticked answer should be considered as submitted.” 6.2 “Slow loading”

*The recently introduced “Game paced mode” was unavailable at the time of our study

DISCUSSION

This study assessed student perceptions and acceptability regarding gamified learning and did not evaluate objective learning outcomes or effectiveness. Most participants communicated positive learning experiences and satisfaction about the incorporation of gamification in large group teaching. Most respondents enjoyed it and perceived an increase in interest, attentiveness, engagement, motivation, knowledge retention, understanding, and self-confidence. Additionally, perceived improvement in time management skills and perceived enhancement in faculty interaction were reported. Students responded in favor of using gamification for other classes of community medicine as well as other medical subjects. Our study involved multiple strategies, as considered effective in existing literature, through which gamification works.[5,6] The interactive digital interfaces could have made learning enjoyable while leveraging technology. Leaderboard indicated position and progress, which could have provided feedback, facilitated competition, and mediated social reinforcement. Points, rewards, and badges could have acted as external motivators. Team-based approaches may have enhanced collaboration.

Gamified learning involves translating an amalgam of various learning theories into practice.[7] For example, leaderboard and rewards over a smart learning environment integrate the pedagogical and the cybergogical approach. Exposure to team-based learning in a mutually respectful and collaborative environment is an intersection of andragogy and peeragogy. The observed preferences and perceptions in our study can be most plausibly explained by andragogy and self-determination theory. Learners valued autonomy, immediate feedback, and relevance to examination-oriented goals.[8] While gamified learning in our study has features of behaviorist and cognitivist approaches, advanced gamification can further unlock constructivist and humanistic approaches and fully embrace heutagogy.[9]

Gamification using digital and physical modalities has been researched in different medical education disciplines, yielding favorable learning outcomes and behaviors, such as improved engagement, attention, motivation, understanding, perceived knowledge retention, and increased classroom interaction.[1,3,4,10,11,12,13,14,15,16] An Indian study conducted in community medicine used game-based learning to improve student engagement in online sessions, but did not use mobile gamifying applications, the activities were unsupervised, and team-based participation was not explored.[4] To our knowledge, our study is the first to employ multiple digital platforms for gamifying community medicine learning in classroom environment, with more comprehensive objectives, and in a supervised setting enabling smooth sessions and better implementation of the academic honor code. Median platform scores clustered between 8 and 9, suggesting high overall acceptability but limited discriminative validity between platforms. Since differences were unlikely to be educationally meaningful, formal inferential comparisons between platforms were not undertaken. Additionally, we explored participation preferences. Although most students acknowledged the collaborative benefits of team-based learning, a clear preference for individual participation emerged. This apparent paradox may reflect the dominant examination culture in Indian medical education, where individual performance, ranking, and self-assessment are prioritized, potentially outweighing perceived collaborative gains. Responses to open-ended questions also endorse this explanation. Additionally, performance review and feedback by teacher/facilitator is also clearer and focused when individuals log in using their own devices. Nevertheless, peer learning and collaboration can be valuable for solving complex public health problems, such as simulated field scenarios involving public health crises or medical/surgical procedures. A review reported participant satisfaction, perceived knowledge retention, and attitudinal change in infection control practices after administering gamified pandemic preparedness modules.[17] Gamification also has potential in skill development and ability assessment while safeguarding patients from medical errors.[18] While our findings align directionally with existing literature in terms of learner acceptability, comparisons with previous studies should be interpreted cautiously, as gamification interventions differ substantially in platforms, duration, instructional design, and outcome measures.

While gamification was generally well-received by our study participants, the more favorable perceptions among the junior batch may reflect differences in curricular stage and assessment proximity. Early-phase learners may perceive gamified activities as supportive scaffolds, whereas senior students nearing high-stakes examinations may prioritize efficiency and predictability, perceiving gamified elements as exploratory or play-based approaches that add extraneous cognitive load.[19] While these explanations warrant focused investigation, the batch-wise difference hints at the importance of aligning instructional strategies with learners’ situational needs and priorities.

Our study findings support the use of digital gamification for formative assessment and evaluation of self-directed learning, which is a component of competency-based medical education in India.[13,20] Use of assessment attributes and challenge or conflict attributes in digital gamification is associated with increased usage of learning material, occasionally paving the way to better academic results.[3] Findings, such as higher attendance, active student participation, better classroom environment, enhanced collaboration, and improved concentration, can also translate into better academic outcomes.[14,19] Most of our participants were receptive to the platform rewards and felt motivated by competition. These findings align with a meta-analysis of 40 years, suggesting that extrinsic motivation enhances performance as long as it does not exhaust internal motivation.[21] Competition and visible stagnation on the leaderboard can adversely affect learners and can manifest as anxiety, disengagement, and a reduction in existing internal motivation.[22] Furthermore, in exam-oriented settings, competition may reinforce performance comparison rather than mastery goals. Therefore, competitive elements should be used judiciously in a context-specific manner for selected modules, with options to de-emphasize leaderboards or allow anonymous participation.[21,22] Our study design is aligned with extant literature supporting the purposeful inclusion of game elements to complement a robust instructional design and not as a substitute for didactics.[15,22,23]

Gamified learning can curate an engaging and time-efficient experience in large group teaching. E-quizzing can also be integrated into flipped classroom methods and self-directed learning. Variations, like beginning-of-session and interpolated quizzing, are also effective.[19,24] Exploring upcoming platforms suited for the class climate, learning objectives, and the current assessment system is an iterative process. Digital technologies can be time-saving, ecologically sound, logistically easier, practical for storing and analyzing data, and helpful to provide regular feedback and identify gaps in teaching–learning processes, benefitting the entire education system and its stakeholders.[16] Additionally, they can enable question banking and standardized assessments.

A study noted that gamification and its research in medical education are driven mainly by a particular teacher’s ingenuity and interest.[23] Although free or trial versions facilitated implementation in this study, long-term sustainability and scalability would require basic institutional support, including reliable internet connectivity, access to digital devices, faculty time for content development and moderation, and training in the use of digital tools. Institutional encouragement for educational innovation also plays an enabling role. Additionally, indirect costs, such as potential subscription fees for advanced features and infrastructure-related expenses, should be acknowledged. These requirements, although modest, may influence feasibility in resource-constrained or high student–faculty ratio settings. Nevertheless, compared with commercially licensed learning management systems or simulation-based tools, these platforms represent a relatively low-cost option for formative assessment and student engagement.

Future work in this area could focus on longitudinal and comparative study designs to assess the impact of gamified learning on objective educational outcomes, such as examination performance, knowledge retention, and skill acquisition. Exploring context-specific use of gamification across different curricular phases, subjects, and assessment formats may help identify conditions under which gamified approaches are most effective. Deeper qualitative exploration can help understand student motivation better and aid in tailoring the intervention to enhance their learning experience. Incorporation of more immersive or simulation-based gamification, particularly for field-based public health scenarios, may further enhance experiential learning in community medicine and provide the satisfaction of mastering relevant public health techniques.

A key strength of this study is its operational feasibility in a routine classroom setting, with high student participation across two academic phases. The use of multiple digital gamification platforms allowed triangulation of learner perceptions and reduced platform-specific bias. Standardization of content, peer-reviewed question design aligned with Bloom’s taxonomy, and delivery by a single investigator ensured consistency across sessions. Additionally, the use of a pretested, expert-validated questionnaire with high internal consistency strengthens the credibility of the findings.

Limitations

This study has several limitations. First, the absence of a control group and lack of objective outcome measures, such as pre–posttest scores or examination performance, preclude causal inference regarding the effectiveness of gamified learning. Second, selection bias is possible, as only students who attended the sessions and completed feedback forms were included. Third, the findings are based on self-reported perceptions and immediate feedback, which may be influenced by recency effects, social desirability and Hawthorne effects, and faculty–student power dynamics, despite assurances of anonymity and voluntary participation. Fourth, the study was conducted in a single discipline over a short three-month duration at a single medical college, limiting generalizability to other institutions, disciplines, or settings with lower digital access. Fifth, qualitative analysis was conducted by a single investigator, introducing the possibility of coder bias, and deeper latent thematic exploration was beyond the scope of this study. Finally, order effects could not be controlled as each platform was used only once per batch, and multiple statistical comparisons were performed without formal adjustment, increasing the possibility of type I error.

CONCLUSION

Our study is a stepping stone toward building evidence on digitally gamified learning in community medicine. Results from diverse platforms converged to unanimously favorable students’ perceptions about gamified learning. Findings should be interpreted as exploratory, focusing on acceptability and perceived usefulness rather than causal or comparative effectiveness. Gamification can be a valuable adjunct to current instructional methods by helping organize knowledge, reinforce curricular material, and evaluate. A gamified learning approach is responsive to the lifelong learners’ needs for engagement, stimulation, motivation, and self-directed learning. In this way, gamification can empower students to realize the learner goals envisioned for medical students, including Indian Medical Graduates.[20]

Conflicts of interest

Nil.

Funding Statement

Nil.