Serious games and gamification in emergency and critical care training: Implications for health professions education

Serious games and gamification are increasingly used in emergency and critical care training, but the literature is heterogeneous and often overlaps conceptually with digital simulation. For medical education, it remains unclear how these interventions are being designed and how deeply their outcomes are being evaluated.

We conducted a scoping review following PRISMA-ScR guidance and registered the protocol on the Open Science Framework. PubMed, Web of Science Core Collection, and EBSCOhost (CINAHL Plus with Full Text and ERIC) were searched from inception to 22 February 2026 without language restrictions. We included empirical studies of serious games, gamification, or game-based learning in emergency, resuscitation, trauma, intensive care, and related high-acuity training contexts. Outcomes were mapped to the highest reported Kirkpatrick level.

Fifty-two unique studies were included from 669 records, with marked growth in recent years. Interventions were grouped into six primary modality families: digital serious games and virtual-patient environments (27/52, 51.92%), gamification-enhanced teaching or platform-based interventions (9/52, 17.31%), escape rooms (6/52, 11.54%), gamified simulation competitions or deliberate-practice formats (4/52, 7.69%), analogue board or card games (3/52, 5.77%), and virtual reality or augmented reality gamified simulations (3/52, 5.77%). Evaluation remained predominantly proximal: the highest reported Kirkpatrick level was Level 2b in 29 studies (55.77%), Level 2a in nine (17.31%), Level 1 in six (11.54%), and Level 3 in eight (15.38%); no study reported Level 4 outcomes.

The field is expanding rapidly, but most evaluations remain focused on engagement and short-term learning rather than behavioural transfer or downstream clinical impact. In high-acuity health professions education, game-based approaches appear most useful as adjuncts for pretraining, reinforcement, and distributed practice. Future research should improve conceptual clarity and align educational objectives, mechanisms, game mechanics, and outcome measures more explicitly.