Gamification and Game-Based Learning in Interprofessional Health Professions Education: A Systematic Review and Narrative Synthesis

Abstract

Background

Interprofessional education (IPE) prepares healthcare professionals for collaborative practice. Gamification and game-based learning (GBL) are increasingly used in health professions education, and multiple studies have examined their design, targeted competencies, and educational outcomes in IPE. However, the existing literature has not been adequately summarized. This systematic review aimed to summarize the available literature on the design, implementation, targeted competencies, and educational outcomes of gamification and GBL interventions in IPE.

Methods

A systematic review with narrative synthesis was conducted according to PRISMA 2020 guidelines. Five databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, and ERIC) were searched up to December 8, 2025. Eligible studies included participants from at least two health professions, used explicit game-based or gamified features, and reported educational outcomes. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Mixed Methods Appraisal Tool (MMAT) 2018. Findings were synthesized narratively using IPEC competency domains and a modified Kirkpatrick evaluation framework.

Results

Fifteen studies met the inclusion criteria and involved more than 15 health professions across diverse educational settings. Educational escape rooms were the most common intervention (7/15), followed by serious games (4/15). Teamwork and collaboration were the most frequently targeted competencies, followed by interprofessional communication and roles and responsibilities. Outcomes were concentrated at early Kirkpatrick levels: 13 studies reported learner reactions (Level 1), 13 assessed attitudes or perceptions (Level 2a), and 6 reported knowledge or skills outcomes (Level 2b). No study demonstrated organizational or patient-level outcomes, and evidence of sustained transfer to clinical practice was lacking.

Conclusion

Gamification and GBL show potential as complementary approaches to enhance engagement, teamwork, and communication in IPE. However, evidence of sustained behavioral change and clinical impact remains limited. Future research should employ more rigorous designs, standardized outcome measures, and evaluation of higher-level educational and healthcare outcomes, particularly in underrepresented settings.

Introduction

Today, with the transformation of healthcare systems and changes in healthcare delivery, effective collaboration among different health professions has become essential for providing high-quality, patient-centered care.^1–3 In response to these needs, Interprofessional Education (IPE) has been recognized as a key strategy in health professions education for preparing future healthcare professionals to effectively participate in interprofessional healthcare teams.^4,5 IPE is defined as a process in which students from different health professions learn about, from, and with one another to develop the competencies required for effective interprofessional collaboration and ultimately improve patient care.⁶

Despite the continued development of interprofessional education (IPE), its systematic integration into health professions curricula remains challenging. Barriers include limited financial and institutional resources, insufficient faculty support, curriculum-related challenges, and the complexity of coordinating multiple stakeholders involved in IPE implementation.^7–9 These challenges highlight the need for effective and innovative educational approaches to support the implementation of IPE.

Game-based approaches have increasingly been incorporated into health professions education, but related terms such as gamification, game-based learning (GBL), and serious games are not interchangeable. Gamification refers to the use of game design elements in non-game contexts, whereas GBL refers to the use of games as a medium for learning. Serious games are designed primarily for purposes such as education, skill development, or behavior change, rather than entertainment.^10–12 In health professions education, these approaches have been applied in various formats, including digital games, simulations, virtual environments, escape rooms, and collaborative games.^13–17 In IPE, game-based approaches can provide shared learning activities that engage students from different professions in interprofessional collaboration; for example, a randomized study evaluated a card game designed to introduce students to interprofessional collaboration.¹⁸

Recent studies have reported that game-based interventions in interprofessional education can enhance learners’ motivation, engagement, satisfaction, interprofessional interactions and attitudes, communication skills, teamwork, and, in some cases, knowledge and systems thinking.^{14–16,19–21} However, the available studies vary considerably in intervention formats, participating health professions, outcome measures, and study designs. Several studies have also used small samples, lacked control groups, relied on self-reported outcomes, or were conducted at a single institution, which may limit the comparability and generalizability of their findings.^14,16,17,22 Although these studies provide important evidence on the use of game-based interventions in IPE, the existing literature has not yet been adequately synthesized to describe how these interventions have been designed, implemented, and evaluated across different IPE contexts. In particular, the reported studies vary in intervention characteristics, such as game format, scenario design, debriefing, facilitator involvement, and the health professions engaged.^{16,18,23–26} Therefore, a systematic review is needed to summarize the existing literature and identify methodological and research gaps in the design, implementation, and evaluation of game-based interventions in IPE.

Accordingly, this systematic review aimed to summarize the existing literature on the design, implementation, and evaluation of gamification and game-based learning interventions in interprofessional education for health professions. It also examined the targeted interprofessional competencies and educational outcomes, assessed the methodological quality of the available evidence, and identified existing research gaps.

Methods

Study Design and Reporting

This systematic review with narrative synthesis examined how gamification and game-based learning have been designed, implemented, and evaluated in interprofessional health professions education. The review was conducted and reported in accordance with the PRISMA 2020 statement. The protocol was not prospectively registered or published.

Interprofessional education was defined by the Center for the Advancement of Interprofessional Education as learning in which members of two or more professions learn with, from, and about one another to improve collaboration and the quality of care. The inclusion of participants from several professions was therefore not sufficient on its own; eligible interventions had to involve shared learning, meaningful interprofessional interaction, or explicit development of interprofessional competencies.

The review addressed the following question:

How have gamification and game-based learning interventions been designed, implemented, and evaluated in interprofessional health professions education?

Eligibility Criteria

Studies were eligible when they:

1. were conducted in health professions education, clinical training, continuing professional development, or healthcare workforce education;

2. included learners or professionals from at least two health or health-related professions;

3. involved a shared interprofessional learning activity;

4. evaluated an educational game, serious game, gamified activity, escape room, board or card game, quiz-based activity, simulation game, virtual reality application, virtual patient, or another intervention with explicit game-based features;

5. incorporated identifiable game structures or mechanics, such as rules, puzzles, missions, competition, scoring, progression, role-play, time limits, sequential tasks, or rewards;

6. reported extractable empirical data on educational, interprofessional, learner-experience, feasibility, or implementation outcomes; and

7. used quantitative, qualitative, mixed-methods, randomized, non-randomized, descriptive, pilot, feasibility, psychometric, implementation, or educational evaluation design.

Studies were excluded if they involved only one profession, included multiple professions without shared interprofessional learning, evaluated simulation or technology-enhanced learning without explicit game elements, focused primarily on patients or the public, were non-empirical publications, were outside health professions education, could not be retrieved in full text, or provided insufficient data for extraction.

Information Sources and Search Strategy

PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, and ERIC were searched. The final search was conducted on 8 December 2025. A pragmatic publication-date limit of January 2000 onward was applied to maintain a contemporary and manageable evidence base. Searches were restricted to English-language reports because resources for reliable translation and assessment of non-English full texts were unavailable.

The search combined terms related to interprofessional education with terms related to gamification and game-based learning. Broader terms such as interdisciplinary education, multidisciplinary education, team-based learning, and collaborative learning were included to improve sensitivity but were not treated as conceptually equivalent to interprofessional education. Eligibility was determined during screening using the predefined operational definition.

The PubMed strategy was:

(“interprofessional education”[Mesh] OR “interprofessional education” OR “interprofessional learning” OR “interdisciplinary education” OR “multidisciplinary education” OR “team-based learning” OR “collaborative learning”) AND (“educational gam*” OR “serious gam*” OR “simulation gam*” OR “digital gam*” OR “video gam*” OR “game-based learning” OR “gamification”[Mesh] OR gamif* OR “gameful design” OR “game element*” OR “escape room*”)

The strategy was adapted to the syntax and controlled vocabulary of each database. Complete search strategies are provided in Supplementary File 1. Reference lists of included studies and relevant reviews were also examined.

Study Selection

Records were exported to EndNote 21 for duplicate removal. Predefined ineligible publication types, including conference proceedings, books, and book chapters, were removed prior to title and abstract screening.

Two reviewers independently screened titles and abstracts and then assessed potentially eligible full texts. Disagreements were resolved through discussion, with consultation of a third reviewer when required. Full-text exclusion reasons were recorded and summarized in the PRISMA flow diagram.

During full-text assessment, studies involving multiple professions were included only when the intervention demonstrated shared learning, interprofessional interaction, teamwork, communication, role clarification, collaboration, or another explicit interprofessional competency.

Intervention Definitions and Classification

Gamification was defined as the use of game design elements within an activity that was not itself a complete game. Game-based learning referred to the use of a structured game as the principal vehicle for learning. Serious games were complete games designed primarily for education, training, behavior change, or skill development.

Educational escape rooms were defined as time-limited, scenario-based activities in which teams completed puzzles or sequential challenges to achieve learning objectives. Board games, card games, quizzes, virtual reality, virtual patients, and digital simulations were included only when gameplay or explicit game mechanics formed part of the educational design. Simulation, immersion, interactivity, or feedback alone was not sufficient.

Each intervention was assigned to one primary category according to its dominant instructional format. Secondary mechanics and instructional features were recorded separately.

Data Extraction

A standardized extraction form was piloted and refined before use. Two reviewers independently extracted data, with disagreements resolved by consensus or consultation with a third reviewer.

Extracted information included:

• study design, country, setting, and follow-up;

• participant professions, learner level, and sample size;

• intervention type, game mechanics, delivery mode, duration, comparator, facilitation, and debriefing;

• theoretical or instructional framework;

• targeted interprofessional competencies;

• educational, behavioral, engagement, acceptability, feasibility, and implementation outcomes;

• measurement instruments, psychometric status, assessment type, and timing;

• resources, costs, barriers, facilitators, fidelity, and author-reported limitations.

Classification of Competencies and Outcomes

Interprofessional learning was mapped to the four Interprofessional Education Collaborative domains: values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork. Additional domains, including systems thinking, leadership, patient safety, shared decision-making, interprofessional socialization, and collaborative practice, were coded separately. Studies could be assigned to more than one domain.

Educational outcomes were classified using a modified Kirkpatrick framework:

• Level 1: satisfaction, engagement, enjoyment, motivation, usability, relevance, and acceptability;

• Level 2a: changes in attitudes, perceptions, role understanding, teamwork, collaboration, or interprofessional socialization;

• Level 2b: changes in knowledge, confidence, reasoning, communication, teamwork skills, systems thinking, or performance in educational or simulated settings;

• Level 3: sustained transfer to professional behavior or routine collaborative practice;

• Level 4a: organizational or service-delivery change;

• Level 4b: patient or service-user outcomes.

Performance demonstrated only during the intervention or an immediately related simulation was classified as Level 2b. Self-reported intention to change practice was not treated as objectively demonstrated Level 3 change.

Methodological Quality Appraisal

Methodological quality was assessed using the Mixed Methods Appraisal Tool 2018. Each study was assigned to one primary MMAT design category. Pilot, feasibility, psychometric, and implementation descriptors were treated as secondary characteristics.

Two reviewers independently rated each applicable criterion as “Yes”, “No”, or “cannot tell”. Disagreements were resolved by consensus or third-reviewer consultation. Studies were not excluded on the basis of quality, and no overall numerical MMAT score was calculated. Criterion-level findings were used to interpret the credibility of the evidence. Detailed assessments are provided in Supplementary File 2.

Data Synthesis

Meta-analysis was not undertaken because of substantial heterogeneity in intervention formats, professional groups, learner levels, settings, study designs, comparators, outcome measures, and assessment time points.

A structured narrative synthesis was conducted. Studies were grouped by primary intervention format and compared according to participant characteristics, delivery mode, game mechanics, interprofessional competency focus, theoretical framework, outcome level, measurement approach, follow-up, implementation features, and methodological quality.

Quantitative findings were summarized descriptively using reported effect directions, within-group or between-group comparisons, statistical significance, and measurement instruments. Qualitative findings were synthesized around recurring concepts such as engagement, teamwork, communication, role understanding, debriefing, time pressure, facilitator support, resource requirements, barriers, and facilitators.

Findings from studies using comparative designs, validated instruments, objective assessments, or follow-up evaluations were interpreted with greater confidence. The results were therefore presented as a systematic narrative synthesis rather than a pooled estimate of effectiveness.

Results

Study Selection

The database search identified 2783 records: Web of Science (n = 903), Scopus (n = 1386), ERIC (n = 145), PubMed/MEDLINE (n = 181), and Embase (n = 168). After removal of 976 duplicate records, 1807 unique records remained. A further 901 records were removed before screening because of ineligible publication type, including conference abstracts, conference papers, proceedings, and related non-journal records (n = 796), and books or book chapters (n = 105).

Consequently, 906 records underwent title and abstract screening, of which 802 were excluded. The full texts of 104 reports were sought for retrieval; 10 could not be obtained. Ninety-four full-text reports were assessed for eligibility, and 79 were excluded because of absent shared interprofessional learning, single-profession participation, lack of explicit game-based or gamified elements, ineligible study design or population, or insufficient extractable information.

Fifteen studies met all eligibility criteria and were included in the narrative synthesis. The study selection process is presented in Figure 1.

Figure 1.

PRISMA 2020 flow diagram of the study selection process.

Study and Participant Characteristics

The 15 included studies were published between 2018 and 2025. Most were conducted in the United States, with additional studies from Switzerland, France, Spain, Germany, South Korea, and Australia. One continuing medical education study enrolled participants from the United States and Europe.

Most interventions (n = 11) were delivered in university or student-based educational settings (classrooms, university simulation centers, or university-affiliated facilities). The remaining studies took place in clinical or simulation-based settings (hospital simulation centers or continuing professional education contexts). Eleven studies primarily involved undergraduate, graduate, or pre-licensure learners, whereas four included residents, trainees, practicing clinicians, or mixed professional groups. Sample sizes ranged from 18 to 1032 participants. One qualitative study did not clearly report the total number of participating students. More than 15 health and health-related professions were represented. Medicine and nursing were most frequently included, commonly alongside pharmacy, physical therapy, occupational therapy, speech-language pathology, dietetics, midwifery, dentistry, public health, physician assistant studies, audiology, athletic training, social work, counseling psychology, and other allied health disciplines.

The evidence base included two randomized controlled trials and a heterogeneous group of quantitative non-randomized, quantitative descriptive, mixed-methods, and qualitative evaluations. Detailed characteristics are presented in Table 1. Detailed study-level data on participant characteristics, intervention design, game mechanics, outcome measures, key findings, and implementation features are provided in Supplementary Table S1.

Table 1.

Characteristics of the Included Studies

Study	Country/Setting category	Participants (professions)	Sample size	Intervention type
Murgu et al, 2018	USA and Europe; Continuing professional education	Multidisciplinary clinicians involved in lung cancer care	416	Serious game
Dittman et al, 2021	USA; University/student-based	Students from dentistry, dental hygiene, nursing, pharmacy, physical therapy, occupational therapy, and public health	1032	Educational escape room
Fusco et al, 2022 (a)	USA; University/student-based	Students from nine health professions	276 enrolled; 229 evaluable	Game-based collaborative learning
Fusco et al, 2022 (b)	USA; Clinical/simulation-based	Nursing, pharmacy, and physical therapy students	262	Educational escape room
Alejandre et al, 2022	Spain; Clinical/simulation-based	Pediatric medical and nursing residents	48	Educational escape room
Claypool et al, 2024	USA; University/student-based	Multiple health professions learners	50; 18 survey respondents	Educational escape room
Joseph et al, 2024	USA; University/student-based	Undergraduate students from five health-related programs	148	Educational escape room
Kwon et al, 2024	South Korea; University/student-based	Medical and nursing students	Not reported	Serious game
Ferns et al, 2024	Australia; University/student-based (rural health facilities)	Students from eight health professions	53; 50 evaluated	Game-based collaborative learning
Neher et al, 2024	Switzerland; Clinical/simulation-based	Nursing and medical students	42	Serious game
Fusco et al, 2024	USA; University/student-based	First-year students from 13 health professions programs	626	Educational escape room
Freyer et al, 2025	France; Continuing professional education	Medical students, physicians, nurses, nursing assistants, and paramedics	120; 114 analyzed	Educational escape room
Büsser et al, 2025	Switzerland; University/student-based	Students from nursing, physiotherapy, midwifery, nutrition, and pharmacy	197 matched pairs	Card- or quiz-based gamification
Lenhardt et al, 2025	USA; University/student-based	Occupational therapy, physical therapy, and speech-language pathology students	18	Educational escape room
Schmahl et al, 2025	Germany; University/student-based	Students from six health professions	97	Card- or quiz-based gamification

Intervention Characteristics

Educational escape rooms were the most common intervention type (n = 7; 46.7%), followed by serious games (n = 4; 26.7%), game-based collaborative learning activities (n = 2; 13.3%), and card- or quiz-based interventions (n = 2; 13.3%).

Escape rooms were delivered in virtual, tabletop, physical, and simulation-based formats. Common mechanics included puzzles, sequential tasks, time constraints, clinical or non-clinical scenarios, and collaborative problem-solving.

Serious games included the Friday Night at the ER® board simulation and an immersive virtual reality intervention. The remaining interventions included gamified workshops, a collaborative educational card game, and a student-led interprofessional pub quiz.

Most interventions were delivered face-to-face in small interprofessional teams. Duration ranged from approximately 30 minutes to a multi-component program involving online preparation and a six-hour in-person session. Only two studies used an active comparator.

Reported educational foundations included experiential learning, Social Cognitive Theory, adult learning theory, constructivism, systems-thinking theory, TeamSTEPPS®, IPEC competencies, ISBAR, serious-game pedagogy, and structured debriefing models.

Evaluation of Interventions for IPE Outcomes

Targeted Interprofessional Competencies

Teamwork and collaboration were the most frequently targeted domains and were represented across all included studies. Interprofessional communication was also prominent, particularly in escape rooms, simulation-based activities, virtual reality training, and continuing professional education.

Roles and responsibilities were addressed through role clarification, interprofessional socialization, and understanding of professional scope and expertise. Systems thinking was primarily examined in studies using Friday Night at the ER®. Leadership, values and ethics, and patient safety were addressed less frequently.

Because individual studies could target more than one competency, categories were not mutually exclusive.

Educational Outcomes

Reported outcomes were concentrated at Levels 1, 2a, and 2b of the modified Kirkpatrick framework.

Level 1: Learner Reaction

Thirteen studies reported satisfaction, engagement, enjoyment, motivation, usability, acceptability, or perceived relevance. Learner reactions were generally favorable across escape rooms, serious games, virtual reality, card games, and quiz-based interventions.

These outcomes were predominantly measured using post-intervention questionnaires, evaluation forms, open-ended responses, or interviews.

Level 2a: Attitudes and Perceptions

Thirteen studies reported outcomes relating to interprofessional attitudes, socialization, role understanding, teamwork perceptions, patient safety attitudes, or systems-thinking attitudes.

Several studies found statistically significant improvements in interprofessional perceptions, role understanding, socialization, and teamwork-related attitudes. Validated instruments included SPICE-R, SPICE-R2, ISVS, ISVS-21, APSQ-III, and interprofessional competency measures.

Level 2b: Knowledge and Skills

Six studies reported clearly identifiable knowledge or performance outcomes. These included sepsis knowledge, lung cancer knowledge, immediate recall, handover performance, diagnostic reasoning, confidence, communication, and performance in educational or simulated settings.

The pediatric sepsis escape room produced immediate knowledge gains that remained higher at three-month follow-up. The multidisciplinary lung cancer program reported a 13% increase in knowledge, and the randomized escape-room trial reported improved immediate recall in the themed intervention group.

Performance demonstrated only during an educational activity or immediately associated simulation was classified as Level 2b rather than Level 3.

Levels 3 and 4

Three studies included follow-up beyond immediate intervention. Two reported self-reported practice- or behavior-related outcomes; however, none objectively demonstrated sustained transfer to routine clinical practice.

The pediatric sepsis study assessed knowledge retention rather than behavioral change. No study evaluated organizational change, service-delivery outcomes, healthcare utilization, or patient-level outcomes (Table 2).

Table 2.

Targeted Interprofessional Competencies and Educational Outcomes Mapped to the Modified Kirkpatrick Framework

Domain / Outcome level	Number of studies	Summary of findings
Teamwork and collaboration	15	Targeted in all studies
Interprofessional communication	12	Especially prominent in escape rooms and simulation-based activities
Roles and responsibilities	8	Addressed via role clarification and interprofessional socialization
Interprofessional attitudes or socialization	6	Improvements reported in several studies
Systems thinking	2	Primarily examined with Friday Night at the ER®
Leadership	2	Less frequently targeted
Values, ethics, or patient safety	2	Less frequently targeted
Level 1 (Reaction)	13	Generally favorable satisfaction, engagement, and acceptability
Level 2a (Attitudes/perceptions)	13	Significant improvements in interprofessional perceptions and role understanding in multiple studies
Level 2b (Knowledge/skills)	6	Immediate knowledge gains and performance improvements; limited longer-term data
Level 3 (Behavior)	0	No objective demonstration of sustained transfer to clinical practice
Level 4 (Organizational/patient outcomes)	0	No studies evaluated organizational or patient-level outcomes

Measurement and Implementation Characteristics

Self-reported questionnaires were the predominant measurement approach. Frequently used validated instruments included SPICE-R/SPICE-R2, ISVS/ISVS-21, APSQ-III, systems-thinking scales, usability and technology-acceptance measures, handover tools, and interprofessional competency questionnaires.

Several studies used investigator-developed knowledge tests or locally developed program evaluation forms whose psychometric properties were not reported. Qualitative data were collected through focus groups, reflective writing, open-ended responses, thematic analysis, and text-network or topic-modeling methods.

Objective or observer-rated performance measures were uncommon. Only three studies included follow-up assessment beyond the immediate post-intervention period.

Most interventions required faculty facilitators, instructors, simulation educators, or game masters. Escape rooms required puzzles, locks, clues, props, mannequins, physical or virtual spaces, and scenario-reset procedures. Virtual reality interventions required headsets, software, technical support, and dedicated facilities, whereas card games, quizzes, and tabletop activities were less technologically demanding.

Structured debriefing was explicitly described in at least eight studies. Information regarding total cost, development time, faculty workload, implementation fidelity, scalability, and sustainability was inconsistently reported.

Discussion

Principal Findings and Gamification Approaches in Interprofessional Education

This systematic review synthesized evidence from 15 studies examining gamification and game-based learning (GBL) approaches within interprofessional health professions education. Overall, gamified approaches were associated with favorable learner-level outcomes, particularly in engagement, teamwork, communication, collaboration, and other interprofessional competencies. The included studies predominantly evaluated immediate learner reactions and short-term educational outcomes, whereas fewer studies examined outcomes at higher levels of the Kirkpatrick model. Thus, the current evidence supports the potential role of gamification and GBL as complementary educational strategies, but provides less information about whether improvements observed during educational activities are sustained and transferred to clinical practice.

Educational Approaches and Interprofessional Competencies

Escape room-based interventions accounted for nearly half of the included studies. This finding is consistent with the systematic review by Quek et al, which highlighted the increasing application of educational escape rooms in healthcare education and their potential to address diverse learning objectives, including knowledge acquisition, critical thinking, communication, teamwork, and clinical reasoning.²⁷ The frequent use of escape rooms in IPE may be related to their inherent emphasis on information exchange, coordination of responsibilities, negotiation, and collaborative problem-solving under time constraints.^26,28,29 These features may provide opportunities for learners from different professional backgrounds to engage directly with interprofessional processes within a structured educational environment.

The educational value of these activities may be further supported by structured reflection and debriefing.³⁰ In the included studies, debriefing was reported in several interventions and may represent an important mechanism for connecting the gaming experience with intended educational objectives. Evidence from simulation-based education similarly indicates that facilitated reflection can help learners analyze their performance, identify teamwork challenges, and relate educational experiences to clinical practice.^31,32

Serious games represented another commonly implemented approach. Previous reviews suggest that their use of challenge, feedback, progression, and collaboration can support engagement and active learning.^33–35 However, the educational value of gamification depends not simply on the presence of game elements, but on their alignment with learning objectives, theoretical foundations, and assessment strategies. Poorly designed gamified activities may prioritize entertainment features without necessarily supporting meaningful competency development.^11,35

Across the included studies, teamwork, collaboration, and communication were the most frequently addressed interprofessional competencies. Most interventions required learners to exchange information, coordinate responsibilities, and work toward shared objectives. These characteristics are consistent with the collaborative nature of IPE and may provide experiential opportunities that are less readily achieved through didactic instruction alone.^36–40 Roles and responsibilities were also commonly addressed, consistent with the IPEC competency framework, which identifies understanding professional roles and responsibilities as an important component of collaborative practice.^36,38,39 In contrast, higher-order domains such as leadership, systems thinking, and values, ethics, and patient safety were less frequently addressed. Future gamified IPE could therefore incorporate more complex scenarios that require leadership, ethical decision-making, resource allocation, and system-level problem-solving.^36–41

Educational Outcomes and Appropriateness of Evaluation

The outcomes reported across the included studies were predominantly concentrated at the early levels of the Kirkpatrick model, particularly learner reactions, attitudes, knowledge, and perceived competence. This pattern is consistent with broader IPE research, in which learner-level outcomes are more frequently assessed than behavioral transfer or patient-related outcomes.^42–44

Although several studies included follow-up assessments or evaluated collaborative performance, these assessments were predominantly conducted in educational or simulated settings rather than routine clinical practice.^23,25,45 Consequently, the available evidence provides greater coverage of short-term educational outcomes than of outcomes at higher levels of evaluation.

No Level 4 evaluations were identified among the included studies, and patient-related and broader healthcare outcomes were therefore less frequently examined in this literature. This distinction is important because the ultimate purpose of IPE extends beyond learner competence toward improvements in collaborative healthcare delivery and patient care.⁴⁶ Such outcomes are particularly relevant when the intended educational claim extends beyond learner achievement to sustained changes in collaborative healthcare delivery or patient care.

Within the Kirkpatrick model, reaching a higher level does not necessarily indicate higher research quality; high-quality research can be conducted at any level of the model. Rather, research quality depends on the researcher’s ability to design an appropriate intervention for the intended level and to employ suitable instruments for evaluating the relevant outcomes.⁴⁷

Methodological Limitations and Transferability of the Evidence

The methodological characteristics of the included studies may limit causal interpretation and the transferability of the findings. The evidence base was largely characterized by single-group pre–post designs, convenience sampling, small single-institution samples, self-reported outcomes, and limited follow-up. Similar methodological concerns have been reported in previous reviews of gamification in health professions education.^33–35 Importantly, these challenges are not unique to gamified IPE and have also been reported in the broader IPE literature, including limited use of comparator groups and validated measures, reliance on self-reported outcomes, and methodological limitations affecting the certainty of findings^48,49 given the heterogeneity of the components and approaches used in IPE strategies, it is not possible to determine with certainty which strategy is most effective in improving IPE learning outcomes.⁵⁰ Nevertheless, well-designed interventions may achieve varying levels of success depending on the quality of their implementation.⁵¹ Greater methodological rigor, strategic dissemination of research findings, and broader representation of the disciplines involved in IPE research may help strengthen the quality and impact of future IPE research and implementation.^49,51

Beyond methodological considerations, the implementation and transferability of gamified IPE may also be influenced by contextual factors. The geographical distribution of the evidence is concentrated in high-income countries, with comparatively limited representation of low- and middle-income countries (LMICs). This concentration may restrict the applicability of the findings to settings with different levels of resources, workforce capacity, educational infrastructure, and institutional support.^39,52–54 The limited evidence from the Global South therefore represents an important gap, particularly regarding the feasibility, contextual requirements, and implementation of gamified IPE in resource-constrained settings. Future research conducted across diverse geographical and educational contexts could help clarify the extent to which findings from existing studies are transferable to different healthcare and educational systems.

Practical Implications and Future Research

Taken together, the findings suggest that gamification and GBL are best considered complementary educational approaches rather than substitutes for established strategies such as simulation, case-based learning, or team-based learning.^11,35 Their educational value appears greatest when game mechanics are deliberately aligned with clearly defined learning objectives and interprofessional competencies, and when opportunities for reflection and debriefing are incorporated into the learning process.^27,31,32

Future research should improve the consistency and transparency of reporting by clearly describing game characteristics, learning objectives, theoretical foundations, implementation processes, and assessment methods. Greater consistency in terminology and clearer definitions of gamification, serious games, GBL, and related approaches would also improve comparability across studies. The use of validated and appropriately matched outcome measures, together with comparative, multicenter, or longitudinal designs where feasible, could strengthen the evidence base and clarify whether educational gains are sustained or transferred beyond the learning environment. Greater sharing of game scenarios, educational materials, and implementation requirements may further facilitate replication and adaptation across institutions. Research in LMICs and other underrepresented regions is also needed to examine contextual requirements for implementation.

Strengths and Limitations of the Review

This review has several strengths, including its focused examination of the intersection between gamification, GBL, and interprofessional health professions education; systematic searching across multiple databases; adherence to PRISMA 2020; and use of the IPEC competency domains and modified Kirkpatrick framework to organize the findings.

Several limitations should be considered. The protocol was not prospectively registered, and conference abstracts, proceedings, and other non-journal records were excluded. Restriction to English-language publications and studies published from 2000 onward may have resulted in the omission of relevant evidence. Ten potentially eligible full-text reports could not be retrieved. Considerable heterogeneity in intervention characteristics, terminology, study designs, and outcomes limited direct comparison across studies, and classification of interventions into primary categories involved some degree of judgment. Finally, publication and reporting bias could not be formally assessed, and no formal assessment of overall certainty of evidence was undertaken.

Conclusion

This systematic review found that gamification and GBL have been used across diverse interprofessional health professions education settings, with generally favorable learner-level outcomes, particularly for engagement, teamwork, communication, collaboration, and related competencies. The evidence predominantly addressed immediate and short-term educational outcomes, while longer-term behavioral and patient-related outcomes were less frequently examined. Heterogeneity in intervention design and evaluation, reliance on self-reported outcomes, limited follow-up, and geographical concentration of studies further constrain interpretation and transferability. Future research should emphasize transparent reporting, consistent terminology, appropriately matched outcome measures, and evaluation designs aligned with the intended educational objectives, alongside greater representation of under-studied and resource-constrained settings.

Funding Statement

The authors declare that no financial support was received for the research, authorship, and/or publication of this article.

Declaration of Generative AI and AI-Assisted Technologies in the Manuscript Preparation Process

During the preparation of this work, the authors used [ChatGPT (Version 5.5)] in order to [translation, editing, and improving the language, grammar, clarity, and readability of the manuscript]. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the published article.

Data Sharing Statement

All data generated or analyzed during this systematic review are included in the published article and its Supplementary Materials. The Supplementary Materials include Supplementary File1, which contains the detailed search strategies used for all databases; Supplementary Table S1, which provides detailed study-level data on participant characteristics, intervention design, game mechanics, outcome measures, key findings, and implementation features; and Supplementary File 2, which contains the methodological quality assessment of the included studies using the Mixed Methods Appraisal Tool (MMAT).

Ethics Approval and Consent to Participate

This systematic review used data from previously published studies and did not involve the collection of new data from human participants.

Author Contributions

All authors made a significant contribution to the work reported, including the conception and design of the study, development of the review methodology, literature search, study screening and selection, data extraction, analysis and interpretation of the findings; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no competing interest in this work.