The use of gamification in higher education context has become popular in recent years with one aim of enhancing learning motivation, yet, it is unknown how physiotherapy students perceive gamified education experience. Using gamification together with multi-media patient case studies, this study explored whether and how gamified education motivated physiotherapy students’ learning. It also investigated how other factors such as class design and mechanics affected gamified experience.
Six case studies in the subject Neurological Physiotherapy were transformed from paper-based cases to multi-media cases built by iSpring suite 8.1. Simulated, real or animated clients were used. Gamification mechanics such as leaderboards, scoring and prioritisation were embedded in the case studies. These gamified case studies were used in classes with Year-3 students enrolled in this subject. After taking these classes, 10 students participated in two focus groups and 32 students responded to a survey to share their experiences and perceptions on this pedagogy.
Results showed that students perceived gamified education as motivating since this satisfied their competence and social needs and enhanced their self-efficacy. In addition, authentic patient videos, class activities that allowed conflict resolution and reflection, and the use of leaderboards were enablers in this gamified experience.
Future gamified education in physiotherapy can provide authentic experience through class designs and gamification mechanics to foster learning motivation. A suggested mapping of gamified lessons for physiotherapy education is provided based on the results of this study.
Learning is an inherently human activity that involves many complex active and interactive processes. Motivation appears to be a key driver to both initial and ongoing learning, as well as improved learning outcomes [1, 2, 3, 4]. Gamification, or the use of game elements in non-game contexts , promotes achievement, challenge, goal, competition and collaboration to learning , which in turn motivates learners . Gamification is thought to enhance motivation and engagement through three levels of processes: cognitive, psychological/emotional and social [8, 9]. At the cognitive level, learners experience processes such as problem-solving and decision-making . At the psychological/emotional level, learners’ positive emotions (e.g. feeling competent) with certain experiences would wire into their memories to enhance further learning of similar experiences [11, 12]. At the social level, interactions with other learners facilitate knowledge constructions . Gamified education should be structured to promote these processes.
To promote the aforementioned processes, better conceptualisations of gamification are needed. Gamification mechanics are often classified by reward or process-tracking types; namely leaderboards, badges, points (or scores), feedback and prizes [7, 9]. Some educational gamification systems use one type of mechanics while others use a mix-and-match approach. Pedersen and Poulsen  found that feedback and points showed an increase in positive outcomes in terms of learning motivations, while other mechanics warrant further investigations. In addition, it is important to differentiate between game-based learning, gamification and serious game. Game-based learning is the use of games (digital or non-digital) as learning tools , while gamification does not necessarily include a game but embed game elements (such as competitions) in learning tasks . The term serious game is sometimes used interchangeably with game-based learning as it applies to any game with a purpose other than pleasure; here learning fits into this rationale [8, 15, 16]. The focus of this study is on gamification rather than game-based learning and serious game.
Gamification has been applied across different disciplines in higher education, such as computer science, mathematics, language and health education [17, 18, 19]. Currently, there is a lack of literature describing or studying gamification in physiotherapy education. In a recent systematic review on gamification in health care education by Wang, DeMaria , only two out of 48 reviewed studies included physiotherapy students as participants. This paucity warrants investigation in the use of gamification in physiotherapy education given its reported benefits on learning.[…]