Exploring the potential of gamified virtual patients for military trauma care training: a systematic text
Natalia Stathakarou1, Andrzej A Kononowicz2, Maxine Harjani1
1Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
Background:
Gamified virtual patients (VPs) can enhance motivation and learning in military trauma management. However, there is a need to better understand design preferences and expectations regarding VP features and game elements. This study explores how such elements are experienced and interpreted by military trauma care professionals.
Methods:
This qualitative study applied systematic text condensation to analyze the shared experiences of 17 participants, consisting of military medics and instructors, who interacted with a gamified VP system.
Results:
Five main themes were identified: Feeling Challenged; Supporting Reflection and Learning; Realism Matters; Developing Confidence; and Balancing Learning and Playing. Participants expressed mixed views on game rewards, competition, and time-pressure, with instructors warning that such features could detract from learning objectives. Instructors emphasized the value of feedback that explains consequences, while both instructors and medics highlighted the importance of immediate corrective feedback.
Discussion:
Gamified VPs can support military trauma training by enhancing engagement, building confidence, and supporting reflection and learning. However, the inclusion of game elements requires careful consideration. Elements that contribute to realism and immersion, such as narrative, multimedia, and tactical challenges, were viewed as valuable for maintaining authenticity and contextual relevance. Hints and progressive difficulty levels were also perceived as beneficial for supporting gradual skill development. Features such as scoring, competition, rewards and time-pressure elicited mixed responses. While some participants found these elements engaging, others perceived them as distracting or misaligned with the goal of acquiring life-saving skills. Instructors were critical of mechanisms that induced artificial stress or rewarded speed over reasoning, warning that such features could shift focus from learning to performance. Therefore, rather than adopting gamification features uncritically, designers and educators should carefully evaluate which elements enhance learning in high-stakes environments and which risk undermining it.
