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Game Elements in Military Trauma Care Education: Systematic Review
Natalia Stathakarou1, Andrzej A Kononowicz2, Maxine G Harjani1
1Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
JMIR Serious Games
|March 17, 2026
Summary
This systematic review synthesizes the use of game elements in military trauma training simulations. While common elements like narrative and scoring are prevalent, their link to specific educational outcomes remains underexplored, necessitating targeted research.
Area of Science:
- Medical Education
- Simulation-Based Training
- Serious Games & Gamification
Background:
- Game elements are increasingly used in simulations, but their specific application and educational purpose in military trauma training lack comprehensive evidence.
- Existing research offers limited insight into how individual game elements influence the design and effectiveness of military trauma training simulations.
Purpose of the Study:
- To systematically review the game elements incorporated into educational simulations for military trauma management.
- To analyze the implementation methods, pedagogical purposes, and reported outcomes associated with these game elements.
Main Methods:
- A systematic review following PRISMA guidelines, including qualitative, quantitative, and mixed-methods studies on military trauma simulations with game elements.
- Searches across multiple databases (Medline, PubMed, IEEE Xplore, ERIC, Web of Science, ACM Digital Library, CINAHL) from inception to October 2025.
- Thematic synthesis of results, with methodological quality assessed using MERSQI and Côté and Turgeon grid.
Main Results:
- Forty-two studies (1986-2025) identified 16 game elements, with narrative, sensation, imposed choice, time pressure, and scoring being most common.
- Game elements were rarely justified pedagogically; justifications often cited realism, engagement, adaptive learning, and feedback.
- No studies explicitly linked specific game elements to defined educational outcomes, and elements like badges and competition were seldom used.
Conclusions:
- This review provides the first comprehensive synthesis of game elements in military trauma simulations, focusing on pedagogical purposes.
- The lack of explicit links between game elements and learning outcomes highlights a need for more intentional research and transparent reporting.
- Future research should focus on targeted gamification design choices and their motivational impact on military trauma training, rather than viewing gamification as a monolithic strategy.
