What are gamification and game-based learning?
Gamification is the application of game design elements—such as points, feedback, badges, and storylines—in non-game contexts (Deterding et al., 2011). It takes many forms, from simple interactives like drag and drop to branching scenarios. Van Gaalen et al. (2020) highlight the following components which underpin effective gamification:
- Rapid, visual feedback to support timely learning
- Points and leaderboards to recognise achievement
- Freedom to fail in a safe, low-risk environment
Game-based learning takes things a step further. Game-based learning refers to environments in which game content and gameplay enhance the acquisition of knowledge and skills. These game-based activities present problem-solving scenarios and challenges that give learners a sense of achievement (Qian & Clark, 2016). This can have more tangible benefits by simulating real-world decision making that results in learning outcomes that closely map on to situations that learners would find themselves in and tasks that they might have to perform.
Why do we add game elements to learning?
Adding game elements has shown strong potential across several key learning domains.
Enhanced motivation and engagement
Including game elements in learning can enhance learner confidence and motivation. Ishizuka et al. (2023) found that students reported greater enjoyment and increased awareness of diagnostic limitations after game elements were introduced. These outcomes are likely supported by self-determination theory, as game elements can foster autonomy through choice, competence through instant feedback, and relatedness through collaborative or scenario-based elements— all key factors in sustaining intrinsic motivation.
Real-world skill application
Game-based learning allows students to simulate clinical scenarios and practise real-world decision-making in a structured, low-risk environment (Ishizuka et al., 2023). This deepened their understanding of clinical reasoning and key diagnostic skills.
Improved knowledge retention and clinical skills
Game-based learning enhances not only engagement but also learning depth. Peanchitlertkajorn et al. (2024) found that a game-based learning approach in clinical reasoning education improved knowledge retention, with significant assessment gains among both undergraduate and postgraduate learners.
Gamify thoughtfully: strategies for impact
Adding game elements is most effective when aligned with learning goals. Like any pedagogical enhancement, it needs thoughtful implementation. Advice from Van Gaalen et al. (2020) and Wang et al. (2024) highlights that game elements work best when we align gameplay with curriculum, establish a clear structure (rules, grouping, scoring, and progression), incorporate feedback loops and use team-based formats.
There are also important caveats to consider carefully when adding game elements to learning. Research shows that competition can sometimes reduce intrinsic motivation by shifting focus from learning to “winning” (Reeve and Deci 1996). Over-reliance on badges or external rewards might have an adverse effect for students who are already motivated.
As with most innovative practice, novelty can also wear off, and without evolving complexity, the initial excitement game elements bring may fade (Huang et al., 2024). To maintain long-term engagement, we can combine game elements with other meaningful tasks that encourage deeper cognitive processing over time.
How we have used games in our CARE agenda program
At the Digital Education Studio, we have worked closely with academic teams to co-create game-based learning experiences which aligns meaningfully with learning outcomes. Grounded in the pedagogical principles outlined above, we have embedded game elements in several modules. Here are two examples that illustrate this approach:
MSc Advanced Neonatal Practice
We collaborated with Dr Burak Salgin to design a game focused on neonatal resuscitation. The game guides learners through a series of decisions modelled on real clinical steps, using Neonatal Life Support guidelines as the framework. At each stage, students make choices that reflect best practice, and they receive instant feedback linked to the guideline. This reinforces competence through repetition and feedback, and helps learners build confidence in applying protocols in an authentic situation—directly supporting clinical reasoning.
Figure 1 Screenshot from the module ICM7301 Clinical Assessment of the foetus, neonate and young infant
MSc Cancer Studies
We created a research ethics game centred around using mice for research with Professor Fran Balkwill. Students review a protocol for using mice in cancer research and make informed decisions that affect a “mice bar,” which tracks their use of animal resources for cancer research. The aim is not only to align with regulatory knowledge but also to foster ethical reflection on the appropriate use of mice for cancer research. While students receive immediate feedback on their choices, the game concludes with an open-ended reflective task to deepen critical thinking—a strategy that moves beyond surface engagement and helps sustain learning beyond the novelty effect.
Figure 2 and 3: Screenshots from the module CANM107 Biological Therapies
Looking ahead: Utilising games that grow with learners
Incorporating game elements, when aligned to learning outcomes, can create an engaging, reflective, and skill-rich experience. Our work in the Digital Education Studio shows that co-creating educational games with academics holds strong potential in enhancing clinical reasoning, ethical awareness, and learner motivation. As innovations continue, iterative design informed by feedback from students and academics ensures that learning with game elements remains purposeful, inclusive, and impactful.
Find out more
Visit the Advance HE webpage if you are interested in exploring the origins of gamification and game-based learning.
References
Deterding, S., Dixon, D., Khaled, R., & Nacke, L. (2011). From game design elements to gamefulness: Defining "gamification". In Proceedings of the 15th international academic MindTrek conference (pp. 9–15). ACM.
Huang, L., Zhao, J., Xu, D., Liu, C., & He, W. (2024). Reflecting on gamified learning in health professions education using the SOLO taxonomy: A qualitative synthesis. BMC Medical Education, 24, Article 195.
Ishizuka, T., Nishigori, H., Inoue, M., Suzuki, T., & Sugawara, T. (2023). Effectiveness of gamification on medical students’ diagnostic decision-making and cost awareness: A mixed-methods study. BMC Medical Education, 23, Article 472.
Peanchitlertkajorn, K., Chinviriyasit, S., Srithavaj, T., & Watcharakorn, S. (2024). The impact of an online gamified virtual tour on cognitive enhancement in dental practice management: A mixed-methods study. Scientific Reports, 14, Article 75128.
Reeve, J., & Deci, E. L. (1996). Elements of the competitive situation that affect intrinsic motivation. Personality and Social Psychology Bulletin, 22(1), 24–33.
Van Gaalen, A. E., Brouwer, J., Schönrock-Adema, J., Bouwkamp-Timmer, T., Jaarsma, D. A. D. C., & Georgiadis, J. R. (2020). Gamification of health professions education: A systematic review. Advances in Health Sciences Education, 26, 683–711.
Wang, Y.-F., Hsu, Y.-F., Fang, K.-T., & Kuo, L.-T. (2024). Gamification in medical education: Identifying and prioritizing key elements through Delphi method. Medical Education Online, 29(1), 2302231.
Qian, M., & Clark, K. R. (2016). Game-based learning and 21st century skills: A review of recent research. Computers in Human Behavior, 63, 50–58.