Paper-based gamification to enhance competency-based education in an obstetrics clerkship

Clinical clerkships are essential for competency-based medical education (CBME). However, students' learning opportunities often vary by case availability, rotation timing, and supervisory practices. Gamification may support learner engagement, but many interventions rely on digital platforms that can be difficult to implement in busy clinical environments. This study evaluated whether a low-resource, paper-based gamification tool could support structured learning in an undergraduate obstetrics and gynecology clerkship.

This quasi-experimental study included 102 fifth-year medical students who completed a required obstetrics and gynecology clerkship at Saga University between October 2023 and September 2024. Students were assigned by the institutional rotation schedule to either a conventional clerkship group (n = 50) or an intervention group using a paper-based "stamp rally" (n = 52). The intervention consisted of 20 observable clinical tasks mapped to clerkship competencies and requiring instructor verification. Outcomes included self-reported satisfaction, sense of achievement, self-efficacy, self-directed learning, task completion rate, written examination score, and free-text comments.

Compared with the conventional group, the intervention group reported higher satisfaction (4.3 ± 0.6 vs. 3.6 ± 0.7, p < 0.01), sense of achievement (4.4 ± 0.5 vs. 3.5 ± 0.6, p < 0.01), self-efficacy (4.2 ± 0.6 vs. 3.7 ± 0.7, p < 0.05), and self-directed learning (4.3 ± 0.5 vs. 3.6 ± 0.7, p < 0.01). The intervention group also had a higher documented task completion rate (92.3% ± 7.3% vs. 75.9% ± 10.5%, p < 0.01) and higher short-term written examination scores (85.0 ± 5.9 vs. 78.2 ± 6.8, p < 0.05). Free-text comments suggested that the intervention clarified expectations, promoted proactive engagement, and provided visible progress feedback.

A paper-based gamification tool was associated with higher motivation-related outcomes, greater documented completion of listed clinical tasks, and higher short-term written examination scores in an undergraduate obstetrics and gynecology clerkship. By translating clerkship objectives into visible and verifiable activities, this low-resource approach may help operationalize CBME-oriented clinical learning. Further multicenter and longitudinal studies are needed to evaluate whether improvements in engagement and task completion translate into durable competency development and workplace-based performance.