Medical students' perceptions of gamified design elements in a self-directed radiology department visit

Gamification in medical education has typically meant adding badges, points, or leaderboards to existing content. This paper reports medical students' perceptions of five items evaluating a self-directed radiology department visit built around a themed storybook, a sticker system, a limited-access ID/passport, and a narrative "Kingdom" theme, alongside an overall rating of gamified understanding.

In this single-centre, cross-sectional observational survey, third-year medical students enrolled in RAD366 at King Saud University who had completed the Radiology Kingdom activity during the 2025-2026 academic year were invited to anonymously report their perceptions of its gamified design elements. Of approximately 270 eligible students, 112 submissions were received (submission rate approximately 41.5%); after exclusion of one probable duplicate, 111 responses were analysed (analytic response rate approximately 41.1%). Four items assessed specific design features and one assessed a global outcome (students' perceived understanding); differences across items were tested using a Friedman test with Bonferroni-corrected post-hoc comparisons, and between-group comparisons used Mann-Whitney U and Kruskal-Wallis tests. Internal consistency was assessed using Cronbach's alpha. The questionnaire was administered under Institutional Review Board approval (No. R26-IRB-510) and included an explicit consent statement.

Cronbach's α across the five items was 0.841, indicating substantial inter-item correlation; because the items assess conceptually distinct constructs, this coefficient was not interpreted as evidence of unidimensionality or instrument validity. A Friedman test identified a significant difference across items (χ²(4) = 32.353, p < 0.001): the ID/passport received significantly lower ratings than the other four items (all p ≤ 0.001, Bonferroni corrected), while no significant pairwise differences were detected among the Kingdom theme (4.63), gamified understanding (4.60), storybook (4.58), and sticker system (4.52) ratings. Female students gave significantly higher ratings than male students on the composite score (4.64 vs. 4.33; p = 0.023) and on three of five items, an exploratory finding. No significant difference in ratings was detected across visit months or prior radiology exposure groups.

In this single-centre, observational survey, students reported highly positive perceptions of the storybook, Kingdom theme, sticker system, and gamified elements' perceived contribution to their understanding, whereas the ID/passport item received significantly lower ratings; because the five items assessed different constructs, this difference reflects differences in student ratings rather than evidence of the comparative educational effectiveness of individual intervention components. These findings demonstrate the feasibility of implementing a resource-modest, narrative-based, self-directed clinical immersion activity within a busy radiology department, rather than evidence that gamification itself improved engagement, understanding, or learning, since the uncontrolled design does not support causal or comparative-effectiveness conclusions. The intervention offers a practical, replicable model for similar self-directed department visits that warrants evaluation in controlled, multi-institutional studies incorporating objective measures of learning and retention.