Gamified Formative Assessment in a First-Year Medical Morphology Course: Qualitative Study

Formative assessment plays a central role in medical education by offering low-risk practice and timely feedback, particularly in visually and practically demanding courses, such as morphology. Gamified digital tools can foster active learning; however, their educational value relies on pedagogical integration rather than technology alone. The Technological Pedagogical Content Knowledge (TPACK) model provides a framework for understanding this relationship.

This study explored students' and a teacher's perceptions of Kahoot! as a gamified formative assessment tool in a first-year medical morphology course, identifying facilitators, tensions, and perceived educational value through the TPACK framework.

This qualitative, exploratory study adopted an interpretive phenomenological orientation. It was conducted within the framework of the RAÍCES 2 (Red de ayudantes de investigación comprometidos con la educación en salud; Network of Student Researchers Committed to Health Professions Education) educational research project at Universidad San Sebastián (Valdivia, Chile). Kahoot! was implemented at the end of class sessions to simulate the visual and time demands of authentic practical examinations. Data collection included 2 online focus groups with first-year medical students (n=14) and 1 semistructured interview with the course teacher (n=1). Transcripts were analyzed using deductive coding informed by the TPACK framework and the project's analytical axes, combined with reflexive thematic analysis following Braun and Clarke. ATLAS.ti was used to support the analysis.

Six interrelated themes emerged: (1) techno-disciplinary alignment, reflecting the value of authentic, high-resolution anatomical images and time constraints mirroring practical examinations; (2) Kahoot! as a formative closure, serving as an exit check that guided self-assessment and the identification of learning gaps; (3) from score to learning, highlighting the importance of immediate postquestion instructor feedback explaining both correct and incorrect answers; (4) motivation and socioemotional climate, whereby gamification enhanced engagement but triggered evaluative anxiety and leaderboard frustration, which were buffered by participant anonymity; (5) implementation conditions, mediated by connectivity, device availability, and time allocation; and (6) projection and improvement, highlighting the need for institutional question repositories and systematic curriculum integration.

Kahoot! effectively functions as a formative assessment strategy when intentionally aligned with disciplinary and practical evaluative demands. Its educational value is not inherent to the software but is determined by explicit pedagogical mediation and careful attention to students' socioemotional dynamics.