Game-Based Learning and Gamification in Laparoscopic Skills Education: Meta-Analysis and Systematic Review.
7 affiliations
- 1Department of Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, 253 Gongye Avenue, Haizhu District, Guangzhou, 510280, China, 86 186 6466 3051.
- 2Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- 3Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
- 4State Key Laboratory of Multi-organ Injury Prevention and Treatment, Southern Medical University, Guangzhou, Guangdong, China.
- 5Department of Gastroenterology, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
- 6College of Medicine, Dubai Medical University, Dubai, United Arab Emirates.
- 7Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
Abstract
Background
Gamification, the integration of game elements into education and game-based learning, is increasingly applied to laparoscopic skills training. However, systematic evidence on its effectiveness and practical feasibility remains limited and fragmented.Objective
This study aimed to evaluate the effectiveness and feasibility of gamified interventions and game-based learning in improving laparoscopic skills education.Methods
We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials from January 1, 2000, to July 1, 2026, for studies evaluating gamification and game-based learning in laparoscopic skills education. Eligible studies included interventional and observational studies involving medical students, residents, or surgeons, with measurable performance outcomes. Study quality was assessed using ROBINS-I (Risk of Bias In Non-randomized Studies-of Interventions), RoB 2 (Cochrane Risk of Bias Tool 2), and NIH quality assessment tools. Standardized mean differences (SMDs) were pooled using random-effects models; between-study heterogeneity was quantified by τ² and described by the I² statistic (inconsistency), while the Cochran Q test tested homogeneity. Certainty of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results
A total of 39 studies involving 2102 participants were included. Video game-based interventions served mainly as training tools or assessments, whereas gamified contexts incorporated competitive or collaborative motivational elements. Three subgroup meta-analyses were performed. Game-based learning vs no training yielded a pooled Hedges g of -0.04 (95% CI -7.14 to 7.06; I²=96.7%; 95% prediction interval -13.95 to 13.61), game-based learning vs conventional laparoscopic training yielded 0.49 (95% CI -1.39 to 2.36; I²=79.4%; prediction interval -3.60 to 4.51), and gamified vs nongamified training yielded 0.87 (95% CI -5.08 to 6.81; I²=61.6%). None of the 3 comparisons reached statistical significance, and all prediction intervals crossed the null, indicating that true effects may range from beneficial to harmful across settings. Risk of bias was mostly moderate, and certainty of evidence ranged from very low to moderate. Leave-one-out analysis showed that pooled estimates in the first 2 subgroups were driven largely by individual studies and were not robust.Conclusions
Both game-based learning and gamified contexts are feasible adjuncts for basic laparoscopic skills training and may enhance motivation and deliberate practice; however, meta-analytic evidence did not demonstrate a statistically significant advantage over no training or conventional laparoscopic training, and the results were not robust to leave-one-out analysis. Generic video games showed limited efficacy for advanced, procedure-specific skills, and the evidence is constrained by heterogeneous outcome measures, small numbers of studies, moderate risk of bias, and a lack of long-term follow-up. As the first synthesis to compare video game-based and gamified context-based approaches within a unified framework, this review provides educators with guidance for integrating task-aligned gamified modules into existing curricula, while highlighting that robust efficacy and sustained operative transfer remain to be demonstrated by larger, standardized studies.
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BibTeX
@article{meng2026gamebased,
title = {{Game-Based Learning and Gamification in Laparoscopic Skills Education: Meta-Analysis and Systematic Review.}},
author = {Xiangqing Meng and Zhanshuo Wan and Wei Li and Yao Lu and Meixuan Su and Youness Zidoun and Hongliang Xian and Jing Tian and Xiaobo Xie},
journal = {JMIR serious games},
year = {2026},
month = oct,
doi = {10.2196/81331},
url = {https://europepmc.org/article/MED/42956019},
note = {CC BY},
}
RIS
TY - JOUR
TI - Game-Based Learning and Gamification in Laparoscopic Skills Education: Meta-Analysis and Systematic Review.
AU - Xiangqing Meng
AU - Zhanshuo Wan
AU - Wei Li
AU - Yao Lu
AU - Meixuan Su
AU - Youness Zidoun
AU - Hongliang Xian
AU - Jing Tian
AU - Xiaobo Xie
PY - 2026
DA - 2026/10/29
JO - JMIR serious games
DO - 10.2196/81331
UR - https://europepmc.org/article/MED/42956019
AB - Background Gamification, the integration of game elements into education and game-based learning, is increasingly applied to laparoscopic skills training. However, systematic evidence on its effectiveness and practical feasibility remains limited and fragmented.Objective This study aimed to evaluate the effectiveness and feasibility of gamified interventions and game-based learning in improving laparoscopic skills education.Methods We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials from January 1, 2000, to July 1, 2026, for studies evaluating gamification and game-based learning in laparoscopic skills education. Eligible studies included interventional and observational studies involving medical students, residents, or surgeons, with measurable performance outcomes. Study quality was assessed using ROBINS-I (Risk of Bias In Non-randomized Studies-of Interventions), RoB 2 (Cochrane Risk of Bias Tool 2), and NIH quality assessment tools. Standardized mean differences (SMDs) were pooled using random-effects models; between-study heterogeneity was quantified by τ² and described by the I² statistic (inconsistency), while the Cochran Q test tested homogeneity. Certainty of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results A total of 39 studies involving 2102 participants were included. Video game-based interventions served mainly as training tools or assessments, whereas gamified contexts incorporated competitive or collaborative motivational elements. Three subgroup meta-analyses were performed. Game-based learning vs no training yielded a pooled Hedges g of -0.04 (95% CI -7.14 to 7.06; I²=96.7%; 95% prediction interval -13.95 to 13.61), game-based learning vs conventional laparoscopic training yielded 0.49 (95% CI -1.39 to 2.36; I²=79.4%; prediction interval -3.60 to 4.51), and gamified vs nongamified training yielded 0.87 (95% CI -5.08 to 6.81; I²=61.6%). None of the 3 comparisons reached statistical significance, and all prediction intervals crossed the null, indicating that true effects may range from beneficial to harmful across settings. Risk of bias was mostly moderate, and certainty of evidence ranged from very low to moderate. Leave-one-out analysis showed that pooled estimates in the first 2 subgroups were driven largely by individual studies and were not robust.Conclusions Both game-based learning and gamified contexts are feasible adjuncts for basic laparoscopic skills training and may enhance motivation and deliberate practice; however, meta-analytic evidence did not demonstrate a statistically significant advantage over no training or conventional laparoscopic training, and the results were not robust to leave-one-out analysis. Generic video games showed limited efficacy for advanced, procedure-specific skills, and the evidence is constrained by heterogeneous outcome measures, small numbers of studies, moderate risk of bias, and a lack of long-term follow-up. As the first synthesis to compare video game-based and gamified context-based approaches within a unified framework, this review provides educators with guidance for integrating task-aligned gamified modules into existing curricula, while highlighting that robust efficacy and sustained operative transfer remain to be demonstrated by larger, standardized studies.
SN - 2291-9279
ER -