Do games work? A meta-analytic synthesis of gamified learning for clinical reasoning in medical and allied health education

Gamification is increasingly adopted in health professions education to enhance clinical reasoning, a core competency essential for safe patient care. Although many interventions report positive outcomes, the magnitude and consistency of these effects remain uncertain. This meta-analytic review synthesizes quantitative findings on the effectiveness of gamified learning on clinical reasoning in medical and allied health learners across diverse contexts. Following PRISMA 2020 guidelines, we searched MEDLINE, Scopus, and Web of Science (2010-2023) for randomized and non-randomized studies evaluating gamified interventions targeting clinical reasoning. Eligible populations included pre- and post-licensure learners, with traditional or non-gamified instruction as comparators. Quantitative measures of clinical reasoning were required. Risk of bias was assessed using RoB 2.0 and ROBINS-I, and standardized mean differences (SMDs) were pooled using a random-effects model. From 713 records, 26 studies met inclusion criteria and 10 contributed to the meta-analysis. Gamified interventions were associated with improved clinical reasoning compared with traditional instruction (SMD = 1.11; 95% CI: 0.69-1.52). Substantial heterogeneity was observed (I² = 85%). Assessment of publication bias suggested possible overestimation of effects, with an adjusted pooled estimate of 0.75 (95% CI: 0.24-1.27). The certainty of evidence was rated as low due to heterogeneity, risk of bias, and potential publication bias. Gamified learning may support the development of clinical reasoning in health professions education; however, considerable variability across studies and low certainty of evidence warrant cautious interpretation. Future research should employ theory-informed designs, validated reasoning measures, and rigorous methodologies to clarify when and how gamification is most effective.