Abstract
<title>Abstract</title> <p>Background Gamification is increasingly used in health professions education, but many reports describe innovations without linking game mechanics to learning theory or evaluating outcomes beyond enjoyment. We evaluated a constructively aligned, multimodal gamified teaching programme embedded within an undergraduate graduate-entry geriatrics block. The study examined learner engagement, participation, collaborative learning and self-rated understanding, while explicitly distinguishing these proximal perceptions from objective learning outcomes. Methods A single-cohort post-intervention survey was conducted among first-year graduate-entry medical students who had participated in case-based tutorials incorporating team quizzes, staged clinical challenges and a bespoke turn-based discharge-planning game. The intervention was designed around retrieval practice, immediate feedback, social learning and the self-determination theory needs of competence, autonomy and relatedness. An anonymous 19-item questionnaire used five-point Likert scales. Descriptive statistics were calculated for all items. Paired self-ratings of understanding before and after the sessions were compared using the Wilcoxon signed-rank test. Internal consistency was explored for the 16 attitudinal items. The complete evaluation questionnaire is provided in Supporting Information1. Results Thirty-six students responded. All respondents agreed or strongly agreed that the gamified sessions increased overall engagement (mean 4.86, SD 0.35), encouraged participation in discussion (mean 4.81, SD 0.40), maintained attention (mean 4.69, SD 0.47), and made teaching more enjoyable than standard formats (mean 4.81, SD 0.40). Ninety-seven per cent agreed or strongly agreed that the activities promoted shared problem-solving, and all supported incorporation of gamification into the curriculum. Median self-rated understanding increased from 3 before to 4 after the sessions; the paired change was statistically significant (Wilcoxon signed-rank test, two-sided p < 0.001; effect size r = 0.74). The 16-item attitudinal scale showed good internal consistency (Cronbach alpha = 0.86; complete cases n = 34). Conclusions A theory-informed combination of gamification and case-based learning was associated with high engagement, active participation, collaborative problem-solving and improved self-rated understanding. The findings support the feasibility and acceptability of constructively aligned gamification within a formal medical curriculum. However, the uncontrolled, single-centre design and reliance on self-report mean that effectiveness for knowledge retention or clinical performance cannot be inferred. Future comparative studies should use objective, delayed and behaviourally relevant outcomes. Trial registration Not applicable. This was a postintervention educational evaluation without prospective allocation to an intervention or comparator group.</p>