The integration of gamification strategies within competency-based otorhinolaryngology residency training: a comprehensive analysis of pedagogical shifts, technological implementations and professional outcomes in the U. S. medical education system
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20262386Keywords:
Gamification, Competency-based medical education, Otolaryngology, Virtual reality, Entrustable professional activitiesAbstract
Postgraduate medical education is transitioning toward a structured competency-based medical education (CBME) framework, utilizing ACGME Milestones 2.0 and Entrustable Professional Activities (EPAs) to objectively measure resident progression from novice to expert. Objectives were to evaluate the integration of gamification strategies, applying game-design elements within non-game settings, in otorhinolaryngology residency, specifically analyzing their impact on learner engagement, operative technical proficiency, and professional outcomes. A comprehensive analysis evaluated the implementation of digital pedagogy (e.g., podcasts, microblogging), workplace-based assessment platforms (EMYWAY), cognitive judgment tools (SICKO), and immersive simulations (VR/AR/MR) for core surgical skills acquisition. Educational preferences are shifting toward digital resources; notably, residents engaging in gamified discussions on platforms like Twitter increased their ABSITE percentile rank by an average of 13.7%. Digital assessment tools such as EMYWAY foster a shared understanding of competency between faculty and trainees (r=0.531). Furthermore, VR simulations for emergency procedures and temporal bone surgery significantly enhance procedural accuracy, with VR cricothyrotomy improving performance in 92% of participants. Tools like SICKO also effectively differentiate surgical expertise levels (p=0.001). Gamification effectively modernizes surgical training by bridging the gap between theoretical knowledge and operative mastery. Strategic recommendations emphasize integrating validated simulators and AI-driven adaptive learning into weekly training to support objective entrustment decisions.
References
Calaman S, Hepps J, Zia Bismilla, Carraccio C, Englander R, Feraco AM, et al. The Creation of Standard-Setting Videos to Support Faculty Observations of Learner Performance and Entrustment Decisions. Acad Med. 2016;91(2):204-9.
Vannaprathip N, Haddawy P, Suebnukarn S. A preliminary analysis of tutorial intervention strategies for teaching decision making in dental surgery, In Proc. of the Second International Conf. on Innovation in Education (ICIE 2015), Nakhon Pathom, Thailand. 2015.
Chen JX, Thorne MC, Galaiya D, Campisi P, Gray ST. Competency-based medical education in the United States: What the otolaryngologist needs to know. Laryngoscope Investig Otolaryngol. 2023;8(4):827-31.
Ghafouri R, Shiva GN, Banafshe K. The effect of gamification on the medication knowledge, performance and satisfaction of nurses in continued medical education: A quasi-experimental study. PLoS ONE. 2025;20(9):e0331372-2.
Rutledge C, Walsh CM, Swinger N, Auerbach M, Castro D, Dewan M, et al. Gamification in Action: Theoretical and Practical Considerations for Medical Educators. Acad Med. 2018;93(7):1014-20.
Wang YF, Hsu YF, Fang KT, Kuo LT. Gamification in medical education: identifying and prioritizing key elements through Delphi method. Med Educ Online. 2024;29(1):2302231.
van Gaalen AEJ, Brouwer J, Schönrock-Adema J, Bouwkamp-Timmer T, Jaarsma ADC, Georgiadis JR. Gamification of health professions education: a systematic review. Adv Health Sci Educ Theory Pract. 2021;26(2):683-711.
Content-Do the Milestones Represent my Specialty/Program? Milestones Bibliography -December 2022 Readers’ Guide. Available at: https://www.acgme.org/globalassets/pdfs/milestones/content-2022.pdf. Accessed on 12 June 2026.
Guo FC, Chen YT, Hsu WC, Wang PC, Chen M, Chen JW. EMYWAY Workplace-Based Entrustable Professional Activities Assessments in Otolaryngology Residency Training: A Nationwide Experience. Otolaryngol Head Neck Surg. 2025;172(4):1242-53.
Otolaryngology-Head and Neck Surgery Milestones The Accreditation Council for Graduate Medical Education. Available at: https://www.acgme.org/globalassets/pdfs/milestones/otolaryngologymilestones.pdf. Accessed on 12 June 2026.
Hamari J, Koivisto J, Sarsa H. Does Gamification Work?-A Literature Review of Empirical Studies on Gamification. 2014 47th Hawaii International Conference on System Sciences. 2014;1(1530-1605):3025-34.
Gamification of CME at the 2025 Annual Meeting. AAO-HNS Bulletin. 2025 Available at: https://bulletin.entnet.org/aaohns-programs/article/22933210/gamification-of-cme-at-the-2025-annual-meeting. Accessed on 12 June 2026.
Pangandaman HK, Datumanong NT, Diamla MRL, Raki-in RM, Hayudini MAA, Amil JH, et al. Gamification in Nursing Education: A Systematic Review of Its Impact on Knowledge Retention and Skill Development Among Novice Nursing Students. Cuest fisioter. 2025;54(5):275-93.
Westenhaver ZK, Africa RE, Zimmerer RE, McKinnon BJ. Gamification in otolaryngology: A narrative review. Laryngoscope Investig Otolaryngol. 2021;7(1):291-8.
Speck I, Merk A, Burkhardt V, Huber C, Widder A, Everad F, et al. Virtual reality cricothyrotomy - a case-control study on gamification in emergency education. BMC Med Educ. 2024;24(1):148.
Lin DT, Park J, Liebert CA, Lau JN. Validity evidence for Surgical Improvement of Clinical Knowledge Ops: a novel gaming platform to assess surgical decision making. Am J Surg. 2015;209(1):79-85.
Piromchai P. Virtual Reality Surgical Training in Ear, Nose and Throat Surgery. Int J Clin Med. 2014;5:558-66.
Huang WD, Loid V, Sung JS. Reflecting on gamified learning in medical education: a systematic literature review grounded in the Structure of Observed Learning Outcomes (SOLO) taxonomy 2012-2022. BMC Med Educ. 2024;24(1):20.
Coelho F, Rando B, Aparício D. The impact of educational gamification on cognition, emotions, and motivation: a randomized controlled trial. J Comput Educ. 2025;13:537-84.
Shah G, Zier C, Reich A, Johnson R, Dang QL, Agan A, Isaacson B, Mitchell R. Medical Education Strategies for Otolaryngology in the Online World and the Role of Podcasting. Laryngoscope Investig Otolaryngol. 2025;10(4):e70231.
Alexander D, Thrasher M, Hughley B, Woodworth BA, Carroll W, Willig JH, Cho DY. Gamification as a tool for resident education in otolaryngology: A pilot study. Laryngoscope. 2019;129(2):358-61.
Lamb LC, DiFiori MM, Jayaraman V, Shames BD, Feeney JM. Gamified Twitter Microblogging to Support Resident Preparation for the American Board of Surgery In-Service Training Examination. J Surg Educ. 2017;74(6):986-991.
Team B. OncoBlast: The World’s First Gamified Learning App CME-Accredited Oncology Courses for Oncology Professionals. Binaytara. 2024. Available at: https://binaytara.org/news/tech/onco-blast-the-world-s-first-gamified-learning-app-cme-accredited-oncology-courses-for-oncology-professionals. Accessed on 12 June 2026.
ENT and Audiology News. ENT and Audiology News. 2025. Available at: https://www.entandaudiologynews.com/features/ent-features/post/training-reinvented-nhs-staff-embrace-free-vr-education-platform. Accessed on 12 June 2026.
Education Management Solutions. Beyond the Manikin: How Virtual and Augmented Reality Are Reshaping Clinical Simulation-Education Management Solutions. Education Management Solutions - Integrated Solutions. Elevated Healthcare. 2025. Available at: https://ems-works.com/blog/content/beyond-the-manikin-how-virtual-and-augmented-reality-are-reshaping-clinical-simulation. Accessed on 12 June 2026.
Ünsaler S, Meriç Hafiz A, Gökler O, Özkaya YS. Virtual reality simulation-based training in otolaryngology. Virtual Real. 2023;27:2561-7.
Favier V, Ayad T, Blanc F, Fakhry N, Andersen SAW. Use of simulation-based training of surgical technical skills among ENTs: an international YO-IFOS survey. Eur Arch Otorhinolaryngol. 2021;278(12):5043-50.
Bolton L, Young K, Ray J, Chawdhary G. Virtual temporal bone simulators and their use in surgical training: a narrative review. J Laryngol Otol. 2024;138(4):356-60.
Riddle EW, Kewalramani D, Narayan M, Jones DB. Surgical Simulation: Virtual Reality to Artificial Intelligence. Curr Probl Surg. 2024;61(11):101625.
Andersen SAW, Frithioff A, von Buchwald JH, Sørensen MS, Frendø M. Am I doing this right? Structured self-assessment during simulation training of mastoidectomy improves cadaver dissection performance: a prospective educational study. Eur Arch Otorhinolaryngol. 2023;280(1):97-103.
34. Vannaprathip N, Haddawy P, Schultheis H. Intelligent Tutoring for Surgical Decision Making: a Planning-Based Approach. Int J Artif Intell Educ. 2022;32:350-81.
Peng CR, Schertzer KA, Caretta-Weyer HA, Sebok-Syer SS, Lu W, Tansomboon C, et al. Assessment of Entrustable Professional Activities Using a Web-Based Simulation Platform During Transition to Emergency Medicine Residency: Mixed Methods Pilot Study. JMIR Med Educ. 2021;7(4):e32356.
Razdan O, Chilamakuri D. AI-Powered AR/VR for Augmenting Patient Education and Empowerment in Chronic Disease Management. J Neonatal Surg. 2025;14(4):41-54.
Faizan Siddiqui M, Jabeen S, Alwazzan A, Vacca S, Dalal L, Al-Haddad B, et al. Integration of Augmented Reality, Virtual Reality, and Extended Reality in Healthcare and Medical Education: A Glimpse into the Emerging Horizon in LMICs-A Systematic Review. J Med Educ Curric Dev. 2025;12:23821205251342315.
Puri A, Yang SC, Kozower BD. Gamification in cardiothoracic surgical education: Time to learn more. J Thorac Cardiovasc Surg. 2024;168(1):175-81.
Milestones Bibliography-ACGME. 2021. Available at: https://www.acgme.org/globalassets/pdfs/milestones/milestones-bibliography---december-2021-final.pdf. Accessed on 25June 2026.
Vaidyanathan A, van der Lubbe MFJA, Leijenaar RTH, van Hoof M, Zerka F, Miraglio B, et al. Deep learning for the fully automated segmentation of the inner ear on MRI. Sci Rep. 2021;11(1):2885.
Hamilton A. Artificial Intelligence and Healthcare Simulation: The Shifting Landscape of Medical Education. Cureus. 2024;16(5):e59747.
Krishnamurthy K, Selvaraj N, Gupta P, Cyriac B, Dhurairaj P, Abdullah A, et al. Benefits of gamification in medical education. Clin Anat. 2022;35(6):795-807.
Macnamara AF, Bird K, Rigby A, Sathyapalan T, Hepburn D. High-fidelity simulation and virtual reality: an evaluation of medical students' experiences. BMJ Simul Technol Enhanc Learn. 2021;7(6):528-35.
Nanu DP, Tiwana HS, Akella DS, Nguyen SA, Khan S, Carr MM. Navigating the Discrepancy: How Cost of Living (COL) Adjustments Impact Otolaryngology Residents' Salaries. Otolaryngol Head Neck Surg. 2025;172(2):475-82.