Emerging trends in gamification for clinical reasoning education: a scoping review

Clinical reasoning is a fundamental skill in healthcare education, crucial for diagnosing and managing patient care effectively. Traditional pedagogical techniques often fall short in fully engaging students or simulating real-life medical decision-making complexities. Gamification, which applies game-design elements in educational settings, has emerged as a promising strategy to enhance learning outcomes by making the educational process more interactive and engaging. This scoping review aims to comprehensively map the existing literature on gamification techniques used to enhance clinical reasoning education, identifying trends, gaps, and opportunities for future research.

The review followed the Joanna Briggs Institute (JBI) methodology and the Arksey and O'Malley framework for scoping reviews. A systematic search of Medline, Scopus, and Web of science, complemented by hand-searching reference lists. Studies published between 2014 and 2023, focusing on gamification applied to clinical reasoning education for healthcare professionals and trainees, were eligible for inclusion. Two independent reviewers screened and selected studies, and data were extracted using a pre-defined tool. Findings were synthesized using both quantitative summaries and qualitative thematic analysis.

Fifty-three studies met the inclusion criteria, representing research from 20 countries, with the United States contributing the largest proportion (28.3%), followed by Germany (9.4%) and France (7.6%). The majority of studies were cross-sectional (28.3%) or pilot studies (22.6%). Gamification was most frequently applied in university and academic settings (37.7%), followed by clinical and hospital-based training (18.9%), and digital platforms and simulations (17.0%). Medicine (28.3%) and nursing (22.6%) were the most targeted disciplines, with pharmacy (13.2%) following. Serious games were the most common gamification technique (45.3%), with additional strategies including escape rooms (11.3%), board and card games (7.5%), and branching case-based games (5.7%). Most studies (88.7%) referenced at least one theoretical framework, predominantly game-based learning theories (34.0%), followed by constructivist learning (13.2%) and experiential learning theories (13.2%). However, cognitive theories, directly relevant to clinical reasoning, were referenced in only 11.3% of studies, highlighting a theoretical gap.

Amification offers diverse and flexible strategies for enhancing clinical reasoning education across healthcare disciplines and settings. However, significant gaps remain, including limited longitudinal evidence, inconsistent use of validated reasoning assessments, underutilization of cognitive reasoning theories, and a lack of standardized design and reporting frameworks. Moreover, research predominantly focuses on medicine and nursing, with limited attention to interprofessional reasoning and underrepresented fields such as dentistry, rehabilitation, and allied health. Future research should prioritize theoretically informed gamification design, apply robust reasoning outcome measures, and explore emerging technologies such as AI-enhanced adaptive gamification and immersive virtual reality simulations to support clinical reasoning development. Addressing these gaps will ensure that gamification evolves from a promising innovation into a rigorously evidence-based strategy for enhancing clinical reasoning competence in healthcare education.