Gamification of dermatology diagnostics training: a nationwide, randomized, controlled trial of 34,556 cases.

BACKGROUND: Skin cancer incidence is rising, as is the focus on efficient, evidence-based diagnostic training. However, proficiency in skin cancer diagnosis requires years of practice, and methods to accelerate learning are therefore necessary. Gamification-integration of game-like mechanics-is a promising method. OBJECTIVES: Evaluating the effects of gamification-in the form of leaderboards showing participants' ranking-on training amount and skills acquisition in medical students, through directed, self-regulated, virtual training. METHODS: In a nationwide randomized controlled trial, participants were randomized to either the gamification or control group, both of which had access to a quiz-based dermatology diagnosis training platform. The gamification group received a daily leaderboard showing rank, based on points earned through training. Diagnostic skills were assessed via validated 12-case pre- and posttests. Data were analyzed using linear mixed models and t-tests. RESULTS: Seventy-one participants were included; 34,556 assessments were completed. The gamification group trained 3.3 times as many cases as the control group (785 [95% CI: 437-1,134] vs. 240 cases [95% CI: 154-325], p<0.01). There was no significant difference in diagnostic skill improvement (0.12 points of 12 [95% CI: -0.7-1.3] vs. 0.65 points of 12 (2.2% and 14.3% relative to baseline, respectively) [95% CI: -0.2-1.5], p=0.40). CONCLUSIONS: Gamification led to substantially increased training volume, without improving skills acquisition. This may be explained by a shift in focus towards leaderboard placement, diminishing motivation to internalize learning content. Improved understanding of evidence-based dermatology training-i.e., the most efficient methods for reaching proficiency-is needed and requires further large, randomized trials.