Abstract
<sec> <title>BACKGROUND</title> <p>Gamified learning has shown promise in radiology education, but evidence regarding the implementation of immersive virtual-world educational interventions in residency training remains limited.</p> </sec> <sec> <title>OBJECTIVE</title> <p>To evaluate the implementation and feasibility of a gamified virtual-world learning program for radiology residents, focusing on recruitment, retention, learner perceptions, cognitive load, game performance, and barriers influencing implementation.</p> </sec> <sec> <title>METHODS</title> <p>This prospective single-arm observational implementation study evaluated a 6-week gamified learning program delivered in the immersive virtual world Second Life® for radiology residents. Participants completed weekly asynchronous educational modules followed by individual image-based assessments, collaborative team-based diagnostic tasks, and role-based virtual challenges performed within and between allied teams. Primary outcomes were implementation and feasibility, participant retention, learner perceptions assessed through a post-intervention evaluation questionnaire, cognitive load measured using the Paas 9-point mental effort scale, and barriers and facilitators to implementation. Secondary outcomes included game performance, qualitative analysis of open-ended participant feedback, and an exploratory post-intervention knowledge assessment.</p> </sec> <sec> <title>RESULTS</title> <p>A total of 68 radiology residents from 16 teaching hospitals were allocated to 17 teams. Twenty-five residents (36.8%) completed the 6-week program, 35 (51.5%) completed the post-intervention evaluation questionnaire, and 19 (27.9%) completed the exploratory post-intervention knowledge assessment. Among the 35 residents who completed the evaluation questionnaire, 91% considered the educational content appropriate for their level, 87% positively rated the program organization, and 83% reported learning radiology through the program. On the 10-point evaluation scale, faculty/organizers (mean 9.2), educational content (8.6), and program organization (8.5) received the highest ratings, whereas interaction with other teams (5.1), platform connectivity (5.4), and the alliance system (5.5) received the lowest. Navigation within the virtual world generated consistently high extraneous cognitive load, while weekly assessments required the greatest mental effort. Qualitative feedback identified teamwork, collaborative learning, and faculty feedback as key facilitators of implementation, whereas clinical workload, limited time availability, technical difficulties, and unequal team participation emerged as the principal barriers. Mean accuracy was 81.4% (SD 13.1%) in individual assessments and 78.9% (SD 5.9%) in collaborative team tasks. Findings from the exploratory post-intervention knowledge assessment should be interpreted cautiously because of the absence of baseline measurements and the low response rate.</p> </sec> <sec> <title>CONCLUSIONS</title> <p>A gamified learning program delivered in an immersive virtual world was feasible and well accepted by radiology residents. Although participants valued the educational content, faculty support, and collaborative learning experience, implementation was challenged by attrition, clinical workload, platform-related cognitive load, and technical barriers. These findings provide a foundation for future implementation research and controlled evaluations of immersive gamified learning in postgraduate health professions education.</p> </sec>