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Acad Med. 2018 Feb 20. doi: 10.1097/ACM.0000000000002183. [Epub ahead of print]

Gamification in Action: Theoretical and Practical Considerations for Medical Educators.

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C. Rutledge is assistant professor, Department of Pediatrics, Division of Pediatric Critical Care, University of Alabama School of Medicine, and co-director, Children's of Alabama Pediatric Simulation Center, Birmingham, Alabama. C.M. Walsh is assistant professor, Department of Paediatrics, University of Toronto Faculty of Medicine, staff gastroenterologist, Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, and cross-appointed scientist, The Wilson Centre for Research in Education, Toronto, Ontario, Canada. N. Swinger is assistant professor, Department of Pediatrics, Riley Children's Hospital, Indianapolis, Indiana. M. Auerbach is associate professor, Department of Pediatrics and Emergency Medicine, director of pediatric simulation, Yale Center for Medical Simulation, and associate pediatric trauma medical director, Yale University School of Medicine, New Haven, Connecticut. D. Castro is assistant professor, Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Houston, Texas. M. Dewan is assistant professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. M. Khattab is assistant professor, Department of Pediatrics, Baylor College of Medicine, Houston, Texas. A. Rake is clinical assistant professor, Department of Pediatrics, Keck School of Medicine of the University of Southern California, and medical director, Children's Hospital Los Angeles Simulation Center and Las Madrinas Pediatric Simulation Research Laboratory, Los Angeles, California. I. Harwayne-Gidansky is assistant professor of clinical pediatrics, Stony Brook Children's Hospital, Stony Brook, New York. T.T. Raymond is professor, Department of Pediatrics, Division of Cardiac Critical Care, Medical City Children's Hospital, Dallas Texas. T. Maa is assistant clinical professor, Department of Pediatrics, The Ohio State University College of Medicine, and medical director, the In Situ Simulation Program, Nationwide Children's, Columbus, Ohio. T.P. Chang is associate professor of clinical pediatrics, Keck School of Medicine of the University of Southern California and also at Children's Hospital Los Angeles, Los Angeles, California.


Gamification involves the application of game design elements to traditionally non-game contexts. It is increasingly being used as an adjunct to traditional teaching strategies in medical education to engage the millennial learner and enhance adult learning. The extant literature has focused on determining whether the implementation of gamification results in better learning outcomes, leading to a dearth of research examining its theoretical underpinnings within the medical education context. The authors define gamification, explore how gamification works within the medical education context using self-determination theory as an explanatory mechanism for enhanced engagement and motivation, and discuss common roadblocks and challenges to implementing gamification.While previous gamification research has largely focused on determining whether implementation of gamification in medical education leads to better learning outcomes, the authors recommend that future research should explore how and under what conditions gamification is likely to be effective. Selective, purposeful gamification that aligns with learning goals has the potential to increase learner motivation and engagement and, ultimately, learning. In line with self-determination theory, game design elements can be used to enhance learners' feelings of relatedness, autonomy, and competence to foster learners' intrinsic motivation. Poorly applied game design elements, however, may undermine these basic psychological needs by the overjustification effect or through negative effects of competition. Educators must, therefore, clearly understand the benefits and pitfalls of gamification in curricular design, take a thoughtful approach when integrating game design elements, and consider the types of learners and overarching learning objectives.

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