Augmented Reality and Gamification vs. Traditional Surgical Instrument Training on Knowledge and Skills of Medical Students: A 2×2 Factorial Randomized Study.

INTRODUCTION: Augmented reality (AR) and gamification have shown promise in medical education. This study aimed to examine their combined application in surgical instrument training for medical students. METHODS: This 2×2 factorial randomized assignment involved 164 operating room students from two universities. Participants were categorized by university and randomly allocated to four intervention groups: Group A (AR + game-based learning; n = 41), Group B (AR only; n = 41), Group C (game only; n = 41), or Group D (traditional instruction; n = 41). The 3-week intervention comprised one 30-minute session per week. Outcomes included knowledge retention (assessed at baseline, 1 week, 1 month, and 3 months) and Objective Structured Clinical Examination (OSCE) performance, evaluating surgical suite recognition, instrument arrangement, instrument use, and time efficiency. RESULTS: Group A (AR + game) showed better knowledge retention, with scores increasing from 44.7 ± 2.2 at baseline to 84.4 ± 2.7 at 1 week and remaining stable at 3 months (71.6 ± 1.9). Group D (traditional instruction) performed worst (56.7 ± 6.8 at 1 week; 48.6 ± 6.7 at 3 months). Total OSCE scores showed a similar trend: Group A scored 86.5 ± 4.3 out of 97, compared with Group D (62.7 ± 6.2). Factorial analysis confirmed significant benefits for AR versus non-AR (knowledge gain: 76.4 ± 9.1 vs. 62.3 ± 8.7; p < 0.001) and game versus non-game interventions (75.7 ± 8.9 vs. 63.0 ± 9.3; p < 0.001). Gender effects were sporadic and explained minimal variance. CONCLUSIONS: The integration of AR and gamification appeared to be the most effective approach in this study for improving knowledge retention and procedural proficiency in surgical instrument training. Gamification alone showed stable long-term retention and may serve as a cost-effective alternative when AR integration is not feasible.