Enhancing Nursing Students' Engagement and Critical Thinking in Anatomy and Physiology Through Gamified Teaching: A...

Background: Gamification may enhance engagement and higher-order learning in health-care profession education, but evidence from undergraduate nursing programs-particularly in the Middle East-is limited. We evaluated whether integrating structured gamified activities into an anatomy and physiology course improves class engagement and knowledge-based critical thinking. Methods: In this pragmatic, nonrandomized, section-allocated quasi-experimental study at a single Saudi institution, 121 first-year female nursing students were assigned by existing cohorts to traditional instruction (control; n = 61) or instruction enhanced with gamified elements (intervention; n = 60) groups. The intervention (introduced mid-semester) comprised time-limited competitive quizzing with immediate feedback and aligned puzzle tasks. Outcomes were measured at baseline, mid-semester, and end-semester using a four-item Class Engagement Rubric (CER; scale 1-5) and a 40-item high-cognitive multiple-choice (MCQ) assessment mapped to course objectives. Analyses used paired and independent t-tests with effect sizes and 95% confidence intervals. Results: No attrition occurred. From baseline to end-semester, the intervention group had a mean CER increase of 0.59 points (95% CI, 0.42 to 0.76; p < 0.001)-approximately a 15% relative gain-and a mean MCQ increase of 0.30 points (95% CI, 0.18 to 0.42; p < 0.001), an ~8% relative gain. The control group showed no material change over the same interval. Between-group differences in change favored the intervention across CER items and for the MCQ outcome. Semester grade-point average did not differ significantly between groups (p = 0.055). Conclusions: Embedding a brief, structured gamification package within an undergraduate nursing anatomy and physiology course was associated with measurable improvements in classroom engagement and modest gains in knowledge-based critical thinking, with no detectable effect on overall semester GPA. Given the nonrandomized, single-site design, causal inference is limited. Multi-site randomized trials using validated critical-thinking instruments are warranted to confirm effectiveness and define dose, durability, and generalizability.