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.