Gamification refers to using game attributes in a non-gaming context. Health professions educators increasingly turn to gamification to optimize students' learning outcomes. However, little is known about the concept of gamification and its possible working mechanisms. This review focused on empirical evidence for the effectiveness of gamification approaches and theoretical rationales for applying the chosen game attributes. We systematically searched multiple databases, and included all empirical studies evaluating the use of game attributes in health professions education. Of 5044 articles initially identified, 44 met the inclusion criteria. Negative outcomes for using gamification were not reported. Almost all studies included assessment attributes (n = 40), mostly in combination with conflict/challenge attributes (n = 27). Eight studies revealed that this specific combination had increased the use of the learning material, sometimes leading to improved learning outcomes. A relatively small number of studies was performed to explain mechanisms underlying the use of game attributes (n = 7). Our findings suggest that it is possible to improve learning outcomes in health professions education by using gamification, especially when employing game attributes that improve learning behaviours and attitudes towards learning. However, most studies lacked well-defined control groups and did not apply and/or report theory to understand underlying processes. Future research should clarify mechanisms underlying gamified educational interventions and explore theories that could explain the effects of these interventions on learning outcomes, using well-defined control groups, in a longitudinal way. In doing so, we can build on existing theories and gain a practical and comprehensive understanding of how to select the right game elements for the right educational context and the right type of student.

中文翻译：

---

卫生职业教育的游戏化：系统评价

游戏化是指在非游戏环境中使用游戏属性。卫生专业教育工作者越来越多地转向游戏化以优化学生的学习成果。然而，人们对游戏化的概念及其可能的工作机制知之甚少。本综述重点关注游戏化方法有效性的经验证据和应用所选游戏属性的理论依据。我们系统地搜索了多个数据库，并纳入了所有评估游戏属性在卫生职业教育中使用的实证研究。在最初确定的 5044 篇文章中，44 篇符合纳入标准。没有报告使用游戏化的负面结果。几乎所有研究都包括评估属性（n = 40），主要结合冲突/挑战属性（n = 27）。八项研究表明，这种特定组合增加了学习材料的使用，有时会改善学习成果。进行了相对少量的研究来解释游戏属性使用的潜在机制（n = 7）。我们的研究结果表明，可以通过使用游戏化来改善卫生专业教育的学习成果，尤其是在采用游戏属性来改善学习行为和学习态度时。然而，大多数研究缺乏明确的对照组，并且没有应用和/或报告理论来理解潜在的过程。未来的研究应该阐明游戏化教育干预背后的机制，并探索可以解释这些干预对学习成果的影响的理论，使用定义明确的对照组，以纵向方式。这样做，我们可以建立在现有理论的基础上，并对如何为正确的教育背景和正确的学生类型选择正确的游戏元素有一个实用而全面的理解。