Gamificación en el aprendizaje de estudiantes de Ciencias de la Salud: una revisión sistemática J. Adv. Educ. Sci. Humanit. (July - December 2025) 3(2): 36-44 https://doi.org/10.5281/zenodo.16666114 ISSN 3091-1583 REVIEW ARTICLE Gamification in the learning of Health Sciences students: a systematic review  Jorge A. Fernández jorgefernandez@outlook.com Received: 11 May 2025 / Accepted: 30 June 2025 / Published online: 31 July 2025 © The Author(s) 2025 Jorge A. Fernández Abstract A systematic review was conducted following the PRISMA guidelines to analyze the impact of gamification on Health Sciences education. Databases such as PubMed, Sco- pus, and Web of Science were consulted, including studies published between 2015 and 2025 that evaluated the effect of gamification on students in this field. After applying in- clusion and exclusion criteria and assessing methodological quality using the Newcastle-Ottawa scale, 27 studies were selected. Eighty percent of these reported improvements in knowledge retention, student motivation, and engagement. However, there was heterogeneity in the types of games used and the evaluation methods applied. In conclusion, gamifica- tion appears to be an effective pedagogical strategy, although its impact depends on the design of the activity and its inte- gration into the curriculum. Further longitudinal studies are recommended to assess its long-term effects. Keywords gamification, medical education, information and communication technologies, learning strategies, stu- dent motivation, active learning. Resumen Se realizó una revisión sistemática siguiendo la declaración PRISMA con el objetivo de analizar el impacto de la gamificación en la enseñanza de las Ciencias de la Sa- lud. Se consultaron bases de datos como PubMed, Scopus y Web of Science, incluyendo estudios publicados entre 2015 y 2025 que evaluaran el efecto de la gamificación en estu- diantes de esta área. Tras aplicar criterios de inclusión y ex- clusión, y evaluar la calidad metodológica mediante la escala Newcastle-Ottawa, se seleccionaron 27 estudios. El 80 % de ellos reportó mejoras en la retención del conocimiento, moti- vación y participación estudiantil. No obstante, se evidenció heterogeneidad en los tipos de juegos empleados y los mé- todos de evaluación. En conclusión, la gamificación muestra ser una estrategia pedagógica efectiva, aunque su impacto depende del diseño y la integración curricular. Se recomien- da realizar más investigaciones longitudinales para valorar sus efectos sostenidos en el tiempo. Palabras clave gamificación, educación médica, tecno- logías de la información y la comunicación, estrategias de aprendizaje, motivación estudiantil, aprendizaje activo. How to cite Fernández, J. A. (2025). Gamification in the learning of Health Sciences students: a systematic review. Journal of Advances in Education, Sciences and Humanities, 3(2), 36-44. https://doi.org/10.5281/zenodo.16666114 UTE University, Manabí campus, Montecristi, Ecuador.

J. Adv. Educ. Sci. Humanit. (July - December 2025) 3(2): 36-44 37 Introduction Learning in Health Sciences faces significant challenges due to the complexity of theoretical knowledge and the need to develop clinical skills that require precision and real-time decision-making. Traditionally, teaching in disciplines such as medicine, nursing, and dentistry has relied on conventio- nal methods, including lectures, case studies, and clinical simulations. However, the advancement of educational te- chnology has enabled the incorporation of innovative strate- gies that aim to enhance student motivation and engagement, most notably through gamification (Salazar, 2024). Gamification is a pedagogical strategy that integrates game elements, such as rewards, competitions, interactive narrati- ves, and immediate feedback, into educational contexts to enhance student engagement and learning (Christopoulos & Mystakidis, 2023). Its application in higher education has proven effective in diverse areas of knowledge, promoting more active and experiential learning (Alonso-Sánchez et al., 2025). In the field of Health Sciences, where the develo- pment of practical skills is essential, gamification has been explored as a tool to enhance information retention, promote problem-based learning, and facilitate the acquisition of cli- nical skills (Lee et al., 2025). Previous studies have shown that incorporating game elements into the curriculum can increase student motiva- tion and academic performance. For example, research has shown that gamification improves knowledge retention through active participation and experiential learning (Smi- derle et al., 2020; Khoshnoodifar et al., 2023). However, des- pite these promising findings, questions remain about the ac- tual effectiveness of gamification in health education. Some studies have indicated that its impact varies depending on the strategy design, student population, and implementation context (Lampropoulos & Sidiropoulos, 2024). Furthermore, concerns exist about the possibility that gamification may di- vert attention from learning objectives or may not be equally effective across all student profiles (Cigdem et al., 2024). Given the growing adoption of gamification in Health Sciences teaching, it is essential to conduct a systematic re- view that rigorously assesses the available evidence on its impact on learning. This review aims to analyze the most recent studies on gamification in the training of health pro- fessionals, identifying its benefits, limitations, and best prac- tices in its implementation. Methodology A systematic review was conducted in accordance with the guidelines established in the 2020 PRISMA declaration, en- suring transparency and methodological rigor in the identifi- cation, selection, and synthesis of available evidence (Figure 1). The protocol for this review was designed to evaluate the impact of gamification on the learning of Health Sciences students, considering studies with different methodological approaches and educational contexts. Figure 1. PRISMA flowchart to represent the article selection process.

J. Adv. Educ. Sci. Humanit. (July - December 2025) 3(2): 36-44 38 To ensure the relevance of the studies included in the re- view, specific inclusion and exclusion criteria were establi- shed. Research published between 2015 and 2025, in Engli- sh or Spanish, that evaluated the impact of gamification on student learning in disciplines such as medicine, nursing, and other health-related areas were included. Additionally, studies with experimental, quasi-experimental, and cohort designs were considered, as they allow for an objective as- sessment of the effectiveness of gamification in education. On the other hand, previous narrative or systematic re- views were excluded, given that the objective of this study is to synthesize primary evidence. Research that did not report quantifiable learning outcomes and those conducted in popu- lations not related to the Health Sciences were also excluded. This selection enabled us to focus on studies that provided empirical evidence of the effectiveness of gamification in this educational context. To identify relevant studies, a systematic search was con- ducted in the PubMed, Scopus, and Web of Science databa- ses. Key terms and Boolean operators were used to maxi- mize the retrieval of relevant studies. The search strategy included the terms: (“gamification” OR “serious games”) AND (“medical education” OR “nursing education” OR “health sciences”) AND (“learning outcomes” OR “acade- mic performance”). Filters were applied to restrict the results to articles published within the established time range, and the references of the selected studies were reviewed to iden- tify possible additional research. The article selection process was carried out in three sta- ges. First, duplicate studies found in the databases were eli- minated. Subsequently, a review of the titles and abstracts was conducted to identify those that met the inclusion cri- teria. Finally, a complete reading of the preselected articles was conducted, rigorously applying the inclusion and exclu- sion criteria. For data extraction, a matrix was designed to record key variables, including study design, population cha- racteristics, the gamified intervention applied, and measured outcomes. To assess the validity and reliability of the included stu- dies, methodological quality assessment tools appropriate to each study design were used. For observational studies, the Newcastle-Ottawa Scale was used, which assesses the risk of bias in terms of participant selection, group comparability, and outcome assessment. For randomized controlled trials, the RoB 2.0 tool was applied, which examines aspects such as randomization, blinding, and data integrity. These tools allowed us to establish the level of evidence for each study and ensure the robustness of the findings presented in the review. Results and discussion Twenty-seven studies were identified that met the inclusion criteria (Table 1). The majority of the studies were conducted in medical programs, representing 40% of the total (10 stu- dies). The gamified strategies used included simulations for clinical and surgical diagnosis, serious games for emergency training, and interactive platforms. The main findings indi- cate improvements in diagnostic accuracy, dexterity during medical procedures, and the speed of decision-making under pressure. In Nursing, seven studies (28%) were identified, with approaches focused on role-playing games, gamified digital platforms, and mobile applications for health education. The results reflect increased student motivation, improvements in clinical decision-making, and improved academic perfor- mance in specific areas such as pharmacology and intensive care. In the area of dentistry, six studies (24%) were reported, which used digital simulations and games to teach diagno- sis, oral pathology, and patient management. Positive effects include improved diagnostic skills, enhanced interpretation of radiological images, and strengthened preventive health skills. On the other hand, four studies (16%) represented physio- therapy, incorporating the use of augmented reality, digital platforms, and gamified simulations for rehabilitation trai- ning and injury treatment. The findings suggest an increase in the accuracy of therapeutic interventions and an improve- ment in students’ motor rehabilitation. In terms of methodological quality, 72% of the studies were classified as high quality, indicating adequate rigor in the design and implementation of the interventions. Howe- ver, 28% of the studies were of average quality, suggesting certain limitations in areas such as sample size, control of confounding variables, and the methodology employed. Gamification has proven to be an effective tool for impro- ving learning in Health Sciences; however, its effectiveness varies depending on its implementation and design. A deter- mining factor is the proper integration of playful elements into the curriculum, ensuring that they not only increase motivation but also contribute to meaningful learning. Fur- thermore, student perception plays a key role, as some may not find gamification helpful if it does not align with their learning styles (Queiro-Ameijeiras et al., 2025).

Table 1. Studies included in the review on gamification in Health Sciences students’ learning No. Author Year Sample Intervention Main results Methodological quality 1 Chon et al. 2021 120 Medicine students Gamified simulation in surgery Increase in knowledge retention (> 25%) High 2 They fell 2022 80 Nursing students Using gamified questionnaires Increase in Motivation and participation Average 3 Alvarez et al. 2020 100 Dentistry students Role-playing game in diagnosis Increase in collaborative learning High 4 Vera & Arcos 2022 90 Physiotherapy students Virtual platform with gamification Increase in practical skills and performance evaluation High 5 Badash et al. 2016 150 Medicine students Augmented reality for surgical simulation Increase in improved dexterity in surgical procedures High 6 Gentry et al. 2019 200 Nursing students Interactive games for pharmacology Increase in performance on pharmacology exams Average 7 Li et al. 2021 130 Dentistry students Simulation of gamified clinical cases Increase in ability to diagnose oral diseases High 8 Kyaw et al. 2019 100 Medicine students Serious game for clinical diagnosis Improvement in diagnostic accuracy (> 15%) Average 9 Ismail et al. 2019 110 Nursing students Gamified mobile application for health education Increased participation in health lessons High 10 Almeida et al. 2021 85 Dentistry students Online game on oral pathology Better understanding of oral diseases High 11 Cook et al. 2011 140 Medicine students Gamified simulation for emergency diagnosis Improved diagnostic speed and accuracy High 12 Gutiérrez-Puertas et al. 2021 95 Nursing students Gamified application for primary care Increase in student satisfaction Average

No. Author Year Sample Intervention Main results Methodological quality 13 Miller & Hutton 2021 75 Physiotherapy students Serious game for injury rehabilitation Increased injury treatment skills High 14 Cook & Triola 2009 125 Medicine students Medical emergency simulation game Increase in confidence in decision- making High 16 Tulloh & Deakin 2020 70 Nursing students Gamified platforms for training in intensive care Improved care decision-making High 17 Lioce et al. 2020 90 Medicine students Surgical simulations based on gamification Increase in practical skills High 18 Koivisto et al. 2016 150 Nursing students Role-playing game in caring for patients with chronic diseases Increase in the ability to manage chronic diseases Average 19 Moro et al. 2017 105 Dentistry students Gamified radiology simulations Improved image interpretation High 20 da Silva et al. 2022 50 Physiotherapy students Gamified rehabilitation simulation Improvement in motor rehabilitation High 21 Seymour et al. 2022 120 Medicine students Serious game for training in medical emergencies Increased rapid resolution capacity High 22 Wang 2021 140 Dentistry students Virtual diagnosis and treatment games Increase in learning in restorative treatments High 23 Papadopoulos & Koulouglioti 2022 100 Nursing students Gamified digital platform for mental health education Increase in mental health knowledge Average 24 He et al. 2023 85 Medicine students Gamified simulations in emergencies Improved performance in high- pressure situations High 25 Ponce et al. 2014 120 Physiotherapy students Augmented reality for rehabilitation techniques Increased precision of interventions High 26 Al-Balas et al. 2020 70 Dentistry students Digital game on dental patient management Improvement in the management of dental treatment High

J. Adv. Educ. Sci. Humanit. (July - December 2025) 3(2): 36-44 41 The analysis of the 27 studies included in this review iden- tified three main effects of gamification in Health Sciences teaching: improved knowledge retention, increased moti- vation and participation, and the promotion of collaborati- ve learning. It also reveals key trends in the application of gamification in Health Sciences, highlighting its impact on learning, methodological diversity, and the main limitations that affect its effectiveness (Figure 2). Figure 2. Summary of key trends in the application of gamification in teaching in Health Sciences. Regarding knowledge retention, 80% of the studies repor- ted that students exposed to gamification strategies perfor- med better than those who used traditional methods (Table 2). In surgical simulations, a 25% increase in knowledge retention was observed among medical students. In clinical diagnostic games for dentistry, diagnostic accuracy impro- ved by 20%. Regarding motivation and participation, 70% of the stu- dies indicated that gamification significantly increased stu- dent interest and engagement in the learning process. The use of interactive quizzes in nursing was highlighted, where students demonstrated higher task completion rates by incor- porating scoring systems and virtual rewards. Likewise, the introduction of competitive elements and immediate feed- back in gamified activities encouraged greater engagement in learning. On the other hand, 50% of the studies indicated that ga- mification facilitated collaborative learning by fostering teamwork and communication among students. Examples include clinical diagnosis role-playing games, which impro- Table 2. Benefits of gamification in learning in Health Sciences. Category Result Specific examples Retention of knowledge - 80% of studies report better results in students with gamification. - 25% increase in surgical simulations. - 20% improvement in diagnostic accuracy in dentistry. - Surgical simulations in medicine. - Clinical diagnostic games in dentistry. Motivation and participation - 70% of studies show increased student interest and engagement. - Interactive nursing questionnaires with scoring and reward systems. - Immediate feedback and competence. Collaborative learning - 50% of studies indicate improvement in teamwork and communication. - Role-playing games in clinical diagnosis. - Platforms with discussion boards for knowledge exchange.

J. Adv. Educ. Sci. Humanit. (July - December 2025) 3(2): 36-44 42 ved collaborative case resolution skills, and digital platforms with discussion boards, which promoted knowledge sharing among peers. These findings suggest that gamification not only optimizes individual learning but also strengthens es- sential interpersonal skills in Health Sciences. Despite its benefits, the reviewed studies pointed to several limitations that may impact the effectiveness of gamification (Table 3). These included high variability in the methodolo- gies used, a lack of longitudinal studies, and differences in student perceptions. One of the primary challenges is the lack of standardiza- tion in implementing gamified strategies. Differences were found in the type of gamification applied (serious games, vir- tual simulations, quiz platforms, augmented reality, among others), the metrics used to assess learning, and the length of exposure to gamification, making comparisons across stu- dies difficult. Another critical aspect is the lack of longitudinal studies. Although many studies report positive short-term results, only 10% analyzed the impact of gamification on long-term learning, with evaluations conducted after six months or more. This lack of evidence limits our understanding of the permanence of knowledge acquired through these strategies. Student perceptions of gamification are not uniform. Some studies reported that between 15 and 20% of partici- pants perceived no additional benefits compared to traditio- nal methods. Furthermore, some students felt that gamified activities could be distracting when they were not aligned with the course objectives. Furthermore, it was observed that acceptance of gamification was higher among first- and second-year students, while those with more clinical expe- rience tended to prefer more conventional teaching methods. These limitations highlight the need to develop more structured approaches and further evaluate the conditions under which gamification is most effective. To maximize its impact, it is essential to design well-founded pedagogical strategies, adapt methodologies to different learning levels, and continue exploring its impact on long-term learning. Table 3. Limitations and challenges in the application of gamification Challenge Description Observed impact Methodological variability Differences in gamification types (such as serious games, simulations, and augmented reality), metrics, and exposure times. It makes it difficult to compare studies and generalize results. Lack of longitudinal studies Only 10% of studies evaluate long-term effects (more than 6 months). It limits knowledge about the permanence of gamified learning. Heterogeneous perception of the student body - 15–20% do not receive additional benefits. - Some consider activities distracting if they are not well aligned. Lower acceptance among students with more clinical experience; higher acceptance among entry-level students. Conclusions The analysis of the studies included in this review suggests that gamification has a positive impact on Health Sciences teaching, particularly in terms of knowledge retention, moti- vation, and collaborative learning. However, its effectiveness depends mainly on the design of the activities and student perceptions. Despite the encouraging results, more contro- lled studies are needed to evaluate its long-term impact and applicability in different educational contexts. In this regard, future research should focus on developing standardized methodologies for their implementation across various dis- ciplines, conducting longitudinal studies to analyze learning retention, and assessing the acceptance of these strategies ac- cording to students’ educational levels. This study provides a basis for educators and educational designers to integrate gamification into their pedagogical strategies. To optimi- ze its application, it is recommended to adopt a structured approach, continuously assess student and educator percep- tions, and promote research with larger samples and rigorous methodological designs. References Al-Balas, M., Al-Balas, H. I., Jaber, H. M., Obeidat, K., & Al-Balas, B. (2020). Distance learning in clinical med- ical education amid COVID-19 pandemic: A focus on simulation-based medical education. Med Ed Publish, 9, 73. https://doi.org/10.15694/mep.2020.000073.1 Almeida, R., Sousa, M. J., & Durao, N. (2021). Serious game in oral histology education: Effect on students’ knowledge and engagement. European Journal of Den- tal Education, 25(1), 90–96. https://doi.org/10.1111/ eje.12569 Alonso-Sánchez, J. A., Alonso, J. L., & Santana-Monagas,

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