Pharmacy Island: Surviving the Challenges of Gamification in the Classroom

By: Sidney M. Drake, PharmD, and David E. Matthews, PharmD, BCACP

Many consider reality television a “guilty pleasure.” Personally, I love it without guilt. Often, these shows involve overcoming obstacles and aligning toward a common goal, which offers lessons for everyday life. Thus, when I started a teaching rotation in a skills lab, I had an idea: incorporate elements of my favorite reality television show (Survivor) into a gamified lesson to increase engagement in the classroom. 

Why Gamification?

Gamification is the application of game elements to an activity that is not inherently a game.¹ Common examples used in pharmacy education include escape rooms and online simulations.^2,3 Proponents suggest gamification may increase motivation and engagement by requiring strategy and teamwork to overcome challenges. However, its use in higher education is often debated since most supporting evidence is anecdotal or based on student perception.¹ Despite the lack of objective data, current students may benefit from a unique approach to teaching in higher education. Generation Z learners tend to display a shorter attention span, desire instant gratification, and learn from dynamic environments that allow for critical thinking, frequent feedback, and the development of social skills.⁴ Gamification can be used to meet these needs. 

Our Activity

We used elements from Survivor to enhance a lab session on prioritization and documentation of medication-related problems for third-year PharmD students (Table 1). 

As we planned to gamify a lab session, we strove to achieve three key objectives: 

• Increase motivation and promote engagement
• Ensure learning objectives are met
• Create a game that appeals to all students

Table 1: Survivor Activity Overview
Activity	Description of Original Activity	How Gamification was Added
Introductory Lecture (20 minutes)	Overview of medication related-problems and severity classifications. Several case examples were provided.	N/A
Medication-Related Problems Prioritization (45 minutes)	Teams of four were asked to classify nine medication-related problems by severity. Answers were reviewed with a facilitator and feedback was provided.	N/A
Medication-Related Problems Documentation (45 minutes)	After discussion with their team, each teammate was required to write a rationale justifying their chosen severity classification for at least one medication-related problem. Immediate facilitator feedback was provided.	Each rationale that was appropriately written with supporting evidence earned one game point. Submitting additional medication-related problem rationales earned teams more points. A secret advantage* was within this portion of the activity.
Additional Challenges (20 min)	N/A (not included in original activity)	This included solving drug puzzles (e.g. brand vs. generic matching, crossword, or drug unscramble) and completing brief 5-minute live standardized patient interactions to identify medication-related problems in real-time. A hidden immunity† was embedded within one patient interaction.

*Secret advantage: If a key element of the patient’s past medical history was included in the rationale for one specific medication-related problem, teams were rewarded with a secret advantage; to deduct game points from an opposing team.  

†Hidden immunity: If a potential anaphylactic reaction was correctly identified during a live standardized patient encounter, a hidden immunity was rewarded. This protected a team from the effects of the secret advantage. 

Impact of the Activity

Approximately half the teams earned more than the required points, demonstrating increased engagement due to gamification. Students provided written feedback in an open-ended question during a later lab activity. Many noted an increase in their motivation to engage in the lab, while others expressed a preference for traditional labs. Knowing that student preferences vary, we expected this mixed feedback; but more importantly, did the activity accomplish its learning objectives? 

We reviewed performance between two cohorts (before and after gamification) on the exam that assessed this content. The class averages were similar (84% before vs. 82% after gamification). This direct comparison has obvious limitations: we did not account for differences between cohorts, establish any link between level of game engagement and exam performance, or use a standardized process to identify themes in student comments. 

Thoughts for the Future 

The impact gamification had on learning without completing a robust analysis is unclear. It is encouraging that gamification highlights many aspects of learning that cater to Generation Z learners, but objective evidence would guide how it should further be incorporated into higher education. Educators should consider planning robust analyses to measure impact of gamified lessons with consideration of sample size, time, and student impact. 

We offer one final consideration: learning is always our primary goal, but there is also value in injecting fun into the classroom irrespective of learning outcomes. Our simple cohort observation shows that students performed about as well as in previous years, but many reported having fun. Pharmacy students experience plenty of stressors, and we all recognize the importance of student well-being. While we continue to seek the data we all desire, let’s not overlook the value of having fun in the classroom. 

What experiences related to success and challenges with gamification can you share?

References

1. Hope DL, Grant GD, Rogers GD, King MA. Gamification in pharmacy education: a systematic quantitative literature review. Int J Pharm Practice. 2023;31(1):15-31. doi:10.1093/ijpp/riac099
2. Hintze TD, Samuel N, Braaten B. A systematic review of escape room gaming in pharmacy education. Am J Pharm Educ. 2023;87(5):100048. doi:10.1016/j.ajpe.2022.09.007
3. Hope DL, Grant GD, Rogers GD, King MA. Virtualized gamified pharmacy simulation during COVID-19. Pharmacy. 2022;10(2):41. doi:10.3390/pharmacy10020041
4. Shorey S, Chan V, Rajendran P, Ang E. Learning styles, preferences and needs of generation Z healthcare students: Scoping review. Nurse Educ Pract. 2021;57:103247. doi:10.1016/j.nepr.2021.103247 

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Author Bio(s):

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Pulses is a scholarly blog supported by a team of pharmacy education scholars.