Game-based learning in orthopaedics: A comprehensive review

Game-based learning (GBL) has emerged as a transformative approach in medical education. It has a useful role in orthopaedic education, where the acquisition of both complex knowledge and technical skills is paramount. This comprehensive literature review explored the current modalities of GBL in orthopaedic training, including gamified knowledge review and formative assessment, gamification of surgical training tasks, simulation-based training game, and virtual and augmented reality (VR/AR) games. Gamification of knowledge review and formative assessment platforms incorporates game elements such as leaderboards and challenges into educational activities, fostering learners' engagement during knowledge acquisition. Gamification of surgical training tasks provides an alternative to traditional mode of learning inside operating theatres via gamified approaches such as timed practice, puzzle games and escape rooms. Simulation-based games provide structured environments for practicing surgical techniques, offering objective assessments and feedback to identify areas for improvement. VR/AR technologies further enhance orthopaedic education by creating immersive, interactive simulations that mimic clinical scenarios, enabling trainees to build foundational surgical skills in a safe, controlled environment. Furthermore, this article discusses the benefits and limitations of GBL, and the future directions of development in the context of orthopaedics. GBL modalities have demonstrated significant benefits, including improved psychomotor skills, cognitive engagement, and motivation among trainees. However, barriers such as high costs, technical challenges, and the ceiling effect, where additional training yields diminishing returns, limit widespread adoption. Additionally, long-term outcomes such as skill retention and transferability to live surgery require further investigation. Future advancements in GBL are expected to integrate cutting-edge technologies like artificial intelligence and haptic feedback into VR/AR systems, enhancing realism and effectiveness. With wider adoption, more accessible innovations and development of standardized orthopaedic training frameworks incorporating GBL modalities, GBL can be an important adjunct in preparing the next generation of orthopaedic surgeons in the modern era of orthopaedic education.