Effectiveness of M-learning and Gamification in Undergraduate Medical Education in Southern Coastal Karnataka

Effectiveness of M-learning and Gamification in Undergraduate Medical Education in Southern Coastal Karnataka | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Effectiveness of M-learning and Gamification in Undergraduate Medical Education in Southern Coastal Karnataka Nishanth Krishna Kodyalamoole, Ankeeta Menona Jacob This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5265361/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Mobile(M)- Learning and Gamification have been shown to be effective in teaching. Quizizz is a platform which enables the use of these techniques. This study was done to assess the effectiveness and feasibility of the M-learning application Quizizz in undergraduate medical education. A quasi-experimental study was done among the medical students at a private medical college. Pre-test was conducted in the quiz mode of Quizizz, and integrated class and post-test was conducted in the lesson mode of Quizizz. Feedback was taken in the 5-point Likert scale regarding the Quizizz platform using a self-administered Google Form. The anonymised scored from the test and the feedback were analysed to meet the study objectives. Of the 91 students who answered both the pre-test and post-test, the mean score increased in the post-test compared to the pre-test and the mean time taken also reduced. The feedback received from the students also suggested that the platform was easy to use and increased the attentiveness of the students. The friendly competition made the learning fun and increased participation of the students. Hence, M-learning and Gamification are viable and beneficial ways to improve information acquisition in medical education Social science/Education Social science/Science technology and society M-learning Gamification Quizizz Medical education Figures Figure 1 Figure 2 Introduction Smartphones with high technical configurations are easily accessible now to most of the population. Studies have shown that around half of Gen Z use smartphones for nine hours or more in a typical day. The study also showed that around 66% of students use their smartphones for academic activities, such as assignments (Niaz Ahmed 2019 ). Another study done in Malaysia also showed that the mean score for mobile phone usage for academic reasons was high. Smartphones make learning easier as the students learn at a pace that is comfortable for them, answers are available faster, access to educational apps, availability of audio and video inputs and social learning. However, the students' performance was negatively affected, probably because they were unsupervised (Ng et al. 2017 ). Mobile learning (M-learning) is showing an increasing trend in medical education, as is seen in other educational fields (Kucuk et al. 2020 ). This has particularly increased following the COVID-19 pandemic, as many classes were restricted to online classes. M-learning can also be student-centric (Kucuk et al. 2020 ). A study also showed that online self-regulated learning, formative assessment, and physical attendance improved the students' performance (Chang and Cutumisu 2022 ). Hence, a properly guided m-learning session or use of mobile phones for educational purposes would help make learning a fruitful experience. A study among medical students showed that the ease of use, autonomy, perceived benefits and self-efficacy of m-learning were high (Kucuk et al. 2020 ). Studies have shown that individualizing learning experiences, which is possible in m-learning, facilitates learning (Nickl et al. 2022 ). Gamification refers to the use of gaming elements in non-gaming spaces. It is the use of the favourable aspects of gaming to improve engagement and the motivation to behave in a specific way to promote problem-solving abilities (Nadi-Ravandi and Batooli 2022 ). Various models have been tested, like LAPS-Talk-Ball (Asfar et al. 2021 ) and DEAPP framework (Khan et al. 2021 ) in gamification/ online teaching, and these have been shown to have improved student participation and outcomes. Quizizz is one such platform that integrates learning, gamification and assessment. Quizizz is free for students and does not require an app or an account. In a study done among English language teachers in Malaysia, teachers were favourable for using Quizizz due to its effectiveness, feasibility, ease of use, and motivating nature for learners (Lim and Yunus 2021 ). Another study that studied the feasibility of Quizizz as an assessment tool in Physics found that it was practical and fun and had a positive student outcome. It was also found to be valuable in the learning process (Hikmah et al. 2021 ). A study among undergraduate students from health-related and non-health-related fields found Quizizz an acceptable educational gamification tool. It helped the students identify their mistakes immediately after the quiz, was a friendly competition, and was an indicator of the student's competence (Noordin et al. 2023 ). This will also help the teachers identify a class's low and good performers. However, there are few studies done in India and among medical students regarding the effectiveness of Gamification and Quizizz in medical education. Aims and Objectives To assess the effectiveness and feasibility of the M-learning application Quizizz in undergraduate medical education. Materials and Methods Source of data, study setting The study used anonymized data obtained through multiple choice question (MCQ) scores to assess student knowledge before, during and at the end of the class in a medical college in southern Karnataka. Study subjects/participants The study was done on data from the MCQ scores of undergraduate students in a medical college in coastal Karnataka. Study Design A quasi-experimental study was conducted to meet the study objectives. Study duration The data was collected over 3 months, from January to March 2024. Inclusion and exclusion criteria The MCQ scores of the students who answered all the questions used in the pre-test and post-test were included in the data analysis. The data of the students who had attempted less than 50% of the questions were not included in the final analysis. Method/study procedure Small group classes were taken on the "Quizizz" platform, which was used to assess the objectives to improve student engagement in the class. On the Quizizz platform, multiple choice questions can be embedded into the presentation, and the students can access the presentation on their mobile phones and view it on the projection/ smart screen in class. This method can be used for both offline and online modes of education. For this study, the class was taken offline. For this study, the quiz consisted of 10 questions, including the "Multiple choice question" and the "Fill in the blank" types of questions. Figure 1 shows the sequence of events in the preparatory phase of the class. During the class, the students can access the quiz or the lesson by entering the joining code shared by the teacher. Figure 2 shows the sequence of events during the class using the Quizizz platform. A friendly competition is fostered during the class, thus promoting active participation through the timed quiz, which provides more points and "power-ups" for the students to answer the quiz faster. Also, the points of the students and the top scorers are displayed on the large screen and on the students' mobile screens, which motivates them to try harder. Each question can be discussed soon after or at the end of the class to clear up any misconceptions or doubts, thus promoting learning. We used the anonymized scores of the MCQs used as the pre-test and post-test to assess the effectiveness of M-learning and Gamification in undergraduate medical education. The feasibility of using Quizizz was assessed based on the feedback taken from the students on a 5-point Likert scale. The feedback was taken on the Google Forms platform. Statistical analysis Data collected using the Quizizz application was downloaded into the Microsoft Excel format. After data cleaning, the data was analysed using SPSS software version 21. Measures of central tendency and deviation were calculated for the scores and the timings of the tests. The means were compared using the paired t-test. Results Effectiveness of M-learning and Gamification: Test scores and time A total of 128 students attempted all the questions in the pre-test. However, in the post-test, 33 students did not attempt more than half of the questions. Also, 4 students attempted the post-test without attempting the pre-test. Hence, for the final analysis, the scores and timings of the 91 students who had attempted both the pre-test and the post-test were considered. The minimum Pre-test and post-test scores were 1 and 3, respectively. The maximum pre and post-test scores were 10. The minimum and maximum pre-test timings were 59s and 7m26s, and the post-test timings were 26s and 2m24s. Descriptive statistics of the test scores, the timings, and the results of the paired t-test are shown in Table 1 . Table 1 Descriptive statistics and comparison of means. Pre-test Mean (SD) Post-test Mean (SD) Paired test difference Mean (SD) 95% CI t value, p-value Score 6.18 (1.786) 7.33 (1.446) -1.154 (2.211) -1.614- (-0.693) -4.979, < 0.001 Time (H:mm: ss) 0:03:35 (0:01:12) 0:01:36 (0:00:21) 0:01:59 (0:01:09) 0:01:44 − 0:02:13 16.387, < 0.001 Feasibility of M-learning and Gamification: Student feedback Seventy-six students gave feedback on the Google forms. Most of the students were satisfied with the ease and use of the Quizizz platform. Most students felt that the friendly competition encouraged them to participate in the class better and fostered quick thinking. The feedback given by the students is depicted in Table 2 . Table 2 Students' feedback on M-learning and Gamification on the Quizizz platform. (N = 75) FEEDBACK RELATED QUESTIONS Median score (IQR) Likert scale n (%) 1 2 3 4 5 My overall satisfaction is very good 4(1) 2 (2.6) 1 (1.3) 10 (13.2) 26 (34.2) 37 (48.7) The availability on my mobile screen helped me participate in the class better 4(1) 3 (3.9) 2 (2.6) 12 (15.8) 22 (28.9) 37 (48.7) The Quizizz platform is easy to use 5(1) 2 (2.6) 1 (1.3) 8 (10.5) 21 (27.6) 44 (57.9) Quizizz is user-friendly 5(1) 2 (2.6) 2 (2.6) 11 (14.5) 19 (25) 42 (55.3) I do not feel bored when I use Quizizz 4(1) 3 (3.9) 2 (2.6) 9 (11.8) 25 (32.9) 37 (48.7) I stay motivated to answer all questions and learn when doing assessments 5(1) 2 (2.6) 1 (1.3) 11 (14.5) 21 (27.6) 41 (53.9) Quizizz provides clear graphics and images. 4.50 (1) 2 (2.6) 3 (3.9) 10 (13.2) 23 (30.3) 38 (50) I will retain the topic of the class better than a traditional lecture class 4(1) 2 (2.6) 2 (2.6) 11 (14.5) 25 (32.9) 36 (47.4) I like the friendly competition in Quizizz 5(1) 2 (2.6) 2 (2.6) 8 (10.5) 23 (30.3) 41 (53.9) Quizizz reveals the real competence of the students 4 (2) 1 (1.3) 7 (9.2) 23 (30.3) 19 (25) 26 (34.2) I can reflect on my errors after the game 4(1) 1 (1.3) 3 (3.9) 14 (18.4) 25 (32.9) 33 (43.4) Prompt responses help me to identify my mistakes instantly 4(1) 2 (2.6) 5 (6.6) 8 (10.5) 28 (36.8) 33 (43.4) I tend to think quickly when answering due to the friendly competition 4(1) 2 (2.6) 5 (6.6) 7 (9.2) 26 (34.2) 36 (47.4) Discussion Overview of Findings The current study sought to assess the efficacy and feasibility of mobile learning (M-learning) and Gamification in medical education. Our findings show a considerable improvement in students' knowledge before and after the intervention, demonstrating the potential of these new instructional methodologies to improve learning outcomes in medical training. Furthermore, the feasibility study indicated that M-learning and Gamification may be successfully integrated into the curriculum, promising future educational practices. Implications for Medical Education The favourable impact of M-learning on knowledge acquisition is consistent with prior research supporting the use of technology in education (Hikmah et al. 2021 ; Noordin et al. 2023 ). The accessibility and flexibility of mobile platforms allow students to interact with content at their own pace, which is especially useful in the demanding field of medical education (Kucuk et al. 2020 ; Hikmah et al. 2021 ). This adaptation can result in better retention of difficult material, which is critical for future therapeutic practice. As found in our study, Gamification, on the other hand, adds a level of involvement that traditional instructional techniques frequently lack (Gue et al. 2022 ). We found that integrating game-like aspects such as points, levels, and challenges enhanced student motivation (Ding et al. 2017 ; Faiza et al. 2022 ; Martínez-Jiménez et al. 2021 ). Gamification supports the findings of Deterding et al. (Deterding et al. 2011 ), who hypothesized that it could improve user engagement and learning outcomes. Gamification is both competitive and collaborative. Feasibility of Implementation Participants rated the feasibility of incorporating M-learning and Gamification positively, indicating that these strategies can be effortlessly integrated into the medical curriculum. Factors contributing to this possibility include students' broad access to cell phones and tablets and their growing familiarity with digital learning tools. However, a study by Rodrigues and others suggests that familiarity may negate the novelty effect of Gamification and reduce learning, suggesting intermittent use of such teaching approaches (L. Rodrigues et al. 2022 ). Furthermore, the low cost of mobile applications, some being freely available, and gamified platforms make them an appealing option for educational organizations wishing to improve their teaching approaches without making large financial investments. Challenges and Limitations Despite the positive results, various hurdles must be overcome before widespread deployment. Technical difficulties, such as software compatibility and internet availability, can undermine the effectiveness of M-learning. Students who are not technologically adept may find it difficult to participate in the class, as found by a study among Nursing students in Karnataka (D. E. Rodrigues et al. 2022 ). Additionally, faculty training is required to guarantee that educators are properly trained to enable these new learning modes. Future research should investigate measures to address these barriers, such as professional development programs and institutional support in subscribing to digital teaching tools. Another drawback of our study is its small sample size, which may impair the findings' generalizability. Future studies should include bigger, more diverse populations to validate these findings and investigate the long-term effects of M-learning and Gamification on knowledge retention and clinical performance. Future Directions Given the positive findings of our study, additional research is needed to investigate the long-term benefits of M-learning and Gamification in medical education. Longitudinal studies could show how these methods affect knowledge retention and application in clinical settings. Furthermore, evaluating the integration of these tactics with other instructional approaches may provide a more thorough understanding of their efficacy. Conclusion In conclusion, our findings show that M-learning and Gamification are viable and beneficial ways to improve information acquisition in medical education. As the landscape of medical training evolves, adopting these creative approaches can result in more interesting, effective, and accessible learning experiences for future healthcare professionals. By resolving the stated obstacles and continuing to research these approaches, we can dramatically improve educational results in medical training. Declarations Competing interest and Funding- The authors received no funds, grants, or other support for the conduct, preparation or publishing this study. Ethics approval- Ethics approval was obtained from the Institutional Ethics Committee of the institute where the study was conducted. Author Contribution Both authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Nishanth Krishna Kodyalamoole and Ankeeta Menona Jacob. The first draft of the manuscript was written by Nishanth Krishna Kodyalamoole and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgement The authors acknowledge the participation of the students of the 2021 batch of MBBS of the college where the corresponding author is affiliated. Data Availability Anonymised data may be made available on request from the corresponding author. References Asfar, A. M. I. T., Asfar, A. M. I. A., & Sulastri, S. (2021). Improving student’s complex problem solving through LAPS-Talk-Ball learning integrated with interactive games. Journal of Physics: Conference Series , 1722 (1). https://doi.org/10.1088/1742-6596/1722/1/012105 Chang, L., & Cutumisu, M. (2022). Online engagement and performance on formative assessments mediate the relationship between attendance and course performance. International Journal of Educational Technology in Higher Education , 19 (1). https://doi.org/10.1186/s41239-021-00307-5 Deterding, S., Dixon, D., Khaled, R., & Nacke, L. (2011). From Game Design Elements to Gamefulness: Defining Gamification. In Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments, MindTrek 2011 (Vol. 11, p. 15). Presented at the Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments, Association for Computing Machinery, New York, NY, United States. https://doi.org/10.1145/2181037.2181040 Ding, L., Kim, C., & Orey, M. (2017). Studies of student engagement in gamified online discussions. Computers & Education , 115 , 126–142. https://doi.org/10.1016/j.compedu.2017.06.016 Faiza, T., Antonija, M., & Valerie, S. (2022). Investigating the causal relationships between badges and learning outcomes in SQL-Tutor. Research and Practice in Technology Enhanced Learning , 17 (1). https://doi.org/10.1186/s41039-022-00180-4 Gue, S., Ray, J., & Ganti, L. (2022). Gamification of graduate medical education in an emergency medicine residency program. International Journal of Emergency Medicine (Online) , 15 (1). https://doi.org/10.1186/s12245-022-00445-1 Hikmah, N., Putri, N. A., Nisa’, K., & Jauhariyah, M. N. R. (2021). Using Quizizz to Develop an Assessment of Physics Learning: An Alternative Way for Physics Learning Assessment in the Covid-19 Pandemic Era. Journal of Physics: Conference Series , 1805 (1). https://doi.org/10.1088/1742-6596/1805/1/012021 Khan, A. M., Patra, S., Vaney, N., Mehndiratta, M., & Chauhan, R. (2021). Rapid transition to online practical classes in preclinical subjects during COVID-19: Experience from a medical college in North India. Medical Journal, Armed Forces India , 77 (Suppl 1), S161–S167. https://doi.org/10.1016/j.mjafi.2020.12.030 Kucuk, S., Baydas Onlu, O., & Kapakin, S. (2020). A Model for Medical Students’ Behavioral Intention to Use Mobile Learning. Journal of Medical Education and Curricular Development , 7 , 2382120520973222. https://doi.org/10.1177/2382120520973222 Lim, T. M., & Yunus, M. M. (2021). Teachers’ Perception towards the Use of Quizizz in the Teaching and Learning of English: A Systematic Review. Sustainability , 13 (11), 6436. https://doi.org/10.3390/su13116436 Martínez-Jiménez, R., Pedrosa-Ortega, C., Licerán-Gutiérrez, A., Ruiz-Jiménez, M. C., & García-Martí, E. (2021). Kahoot! as a Tool to Improve Student Academic Performance in Business Management Subjects. Sustainability , 13 (5), 2969. https://doi.org/10.3390/su13052969 Nadi-Ravandi, S., & Batooli, Z. (2022). Gamification in education: A scientometric, content and co-occurrence analysis of systematic review and meta-analysis articles. Education and Information Technologies , 27 (7), 10207–10238. https://doi.org/10.1007/s10639-022-11048-x Ng, S. F., Hassan, N. S. I. C., Nor, N. H. M., & Malek, N. A. A. (2017). The Relationship Between Smartphone Use and Academic Performance: A Case of Students in a Malaysian Tertiary Institution. Malaysian Online Journal of Educational Technology , 5 (4), 64–76. Niaz Ahmed. (2019). Generation Z’s Smartphone and Social Media Usage: A Survey. Journalism and Mass Communication , 9 (3). https://doi.org/10.17265/2160-6579/2019.03.001 Nickl, M., Huber, S. A., Sommerhoff, D., Codreanu, E., Ufer, S., & Seidel, T. (2022). Video-based simulations in teacher education: the role of learner characteristics as capacities for positive learning experiences and high performance. International Journal of Educational Technology in Higher Education , 19 (1). https://doi.org/10.1186/s41239-022-00351-9 Noordin, Z. M., Adnan, N. N. S., Usir, E., & Loganathan, M. (2023). Quizizz for Teaching and Learning About Adherence to Antipsychotics: A Pilot Study of Students’ Perception and Their Level of Knowledge. Journal of Higher Education Theory and Practice , 23 (3). https://doi.org/10.33423/jhetp.v23i3.5843 Rodrigues, D. E., Kamath, N., & Souza, R. P. D. (2022). Challenges at Technology Adoption in Academic Learning among Students during the COVID-19 Lockdown. Journal of Health and Allied Sciences NU , 12 (4), 369–375. https://doi.org/10.1055/s-0041-1741507 Rodrigues, L., Pereira, F. D., Toda, A. M., Palomino, P. T., Marcela, P., Galvão, C. L. S., et al. (2022). Gamification suffers from the novelty effect but benefits from the familiarization effect: Findings from a longitudinal study. International Journal of Educational Technology in Higher Education , 19 (1). https://doi.org/10.1186/s41239-021-00314-6 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5265361","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":381589928,"identity":"4147e6b6-6488-4ac9-a393-bd1f395f9ea1","order_by":0,"name":"Nishanth Krishna Kodyalamoole","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDACZgY2BoYDDDwMEkDOxwaQEGPjAaK1MM5sAFMN+LUwQLQwgNQy84K1QPg4gTk7+7PHPGfuycjP7j342XaHTZ1u+2GgLTU20bi0WDbzmBvz3CjmMbhzLlk690yahNmZRKCWY2m5DTi0GBzmYZPm+ZDAYyCRYyCd23ZYwuwAUAtjw2E8WtifgbXIz8gx/m0J0nL+ISEtDGbSPDcSeBhu5JhJM4K03CBoC4+Z5JwzQIcBtVj2tqVJbrsBtCUBn1/OH38m8eZYgj3IYTd+ttnwm51Pf/jgQ40NTi04QAJpykfBKBgFo2AUoAEAQOpeFpvqTqkAAAAASUVORK5CYII=","orcid":"","institution":"Father Muller Medical College Hospital","correspondingAuthor":true,"prefix":"","firstName":"Nishanth","middleName":"Krishna","lastName":"Kodyalamoole","suffix":""},{"id":381589929,"identity":"39c8421c-52fe-413c-847c-61afc1e2b197","order_by":1,"name":"Ankeeta Menona Jacob","email":"","orcid":"","institution":"K S Hegde Medical Academy","correspondingAuthor":false,"prefix":"","firstName":"Ankeeta","middleName":"Menona","lastName":"Jacob","suffix":""}],"badges":[],"createdAt":"2024-10-15 05:46:44","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5265361/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5265361/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71154967,"identity":"19653962-f0cd-4806-9be0-42f64b72c46d","added_by":"auto","created_at":"2024-12-11 15:27:14","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74652,"visible":true,"origin":"","legend":"\u003cp\u003ePreparatory activities for class on the Quizizz platform\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5265361/v1/472805fb12ff7d155d47083f.jpg"},{"id":71154968,"identity":"e57fecfb-bd31-421e-9f49-49d083b7a4b1","added_by":"auto","created_at":"2024-12-11 15:27:14","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":111910,"visible":true,"origin":"","legend":"\u003cp\u003eActivities during the class on the Quizizz platform\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5265361/v1/b12590deee53576868d031f1.jpg"},{"id":72016730,"identity":"f223db3e-3987-4bf0-bac3-9d76248b491e","added_by":"auto","created_at":"2024-12-20 16:08:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":571301,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5265361/v1/4d4212f3-f632-4135-a340-1949f6a1865c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effectiveness of M-learning and Gamification in Undergraduate Medical Education in Southern Coastal Karnataka","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSmartphones with high technical configurations are easily accessible now to most of the population. Studies have shown that around half of Gen Z use smartphones for nine hours or more in a typical day. The study also showed that around 66% of students use their smartphones for academic activities, such as assignments (Niaz Ahmed \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Another study done in Malaysia also showed that the mean score for mobile phone usage for academic reasons was high. Smartphones make learning easier as the students learn at a pace that is comfortable for them, answers are available faster, access to educational apps, availability of audio and video inputs and social learning. However, the students' performance was negatively affected, probably because they were unsupervised (Ng et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMobile learning (M-learning) is showing an increasing trend in medical education, as is seen in other educational fields (Kucuk et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This has particularly increased following the COVID-19 pandemic, as many classes were restricted to online classes. M-learning can also be student-centric (Kucuk et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). A study also showed that online self-regulated learning, formative assessment, and physical attendance improved the students' performance (Chang and Cutumisu \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Hence, a properly guided m-learning session or use of mobile phones for educational purposes would help make learning a fruitful experience. A study among medical students showed that the ease of use, autonomy, perceived benefits and self-efficacy of m-learning were high (Kucuk et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Studies have shown that individualizing learning experiences, which is possible in m-learning, facilitates learning (Nickl et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGamification refers to the use of gaming elements in non-gaming spaces. It is the use of the favourable aspects of gaming to improve engagement and the motivation to behave in a specific way to promote problem-solving abilities (Nadi-Ravandi and Batooli \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Various models have been tested, like LAPS-Talk-Ball (Asfar et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and DEAPP framework (Khan et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) in gamification/ online teaching, and these have been shown to have improved student participation and outcomes.\u003c/p\u003e \u003cp\u003eQuizizz is one such platform that integrates learning, gamification and assessment. Quizizz is free for students and does not require an app or an account. In a study done among English language teachers in Malaysia, teachers were favourable for using Quizizz due to its effectiveness, feasibility, ease of use, and motivating nature for learners (Lim and Yunus \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Another study that studied the feasibility of Quizizz as an assessment tool in Physics found that it was practical and fun and had a positive student outcome. It was also found to be valuable in the learning process (Hikmah et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). A study among undergraduate students from health-related and non-health-related fields found Quizizz an acceptable educational gamification tool. It helped the students identify their mistakes immediately after the quiz, was a friendly competition, and was an indicator of the student's competence (Noordin et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This will also help the teachers identify a class's low and good performers. However, there are few studies done in India and among medical students regarding the effectiveness of Gamification and Quizizz in medical education.\u003c/p\u003e\n\u003ch3\u003eAims and Objectives\u003c/h3\u003e\n\u003cp\u003eTo assess the effectiveness and feasibility of the M-learning application Quizizz in undergraduate medical education.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eSource of data, study setting\u003c/p\u003e \u003cp\u003eThe study used anonymized data obtained through multiple choice question (MCQ) scores to assess student knowledge before, during and at the end of the class in a medical college in southern Karnataka.\u003c/p\u003e \u003cp\u003eStudy subjects/participants\u003c/p\u003e \u003cp\u003eThe study was done on data from the MCQ scores of undergraduate students in a medical college in coastal Karnataka.\u003c/p\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003eA quasi-experimental study was conducted to meet the study objectives.\u003c/p\u003e \u003cp\u003eStudy duration\u003c/p\u003e \u003cp\u003eThe data was collected over 3 months, from January to March 2024.\u003c/p\u003e \u003cp\u003eInclusion and exclusion criteria\u003c/p\u003e \u003cp\u003eThe MCQ scores of the students who answered all the questions used in the pre-test and post-test were included in the data analysis. The data of the students who had attempted less than 50% of the questions were not included in the final analysis.\u003c/p\u003e \u003cp\u003eMethod/study procedure\u003c/p\u003e \u003cp\u003eSmall group classes were taken on the \"Quizizz\" platform, which was used to assess the objectives to improve student engagement in the class. On the Quizizz platform, multiple choice questions can be embedded into the presentation, and the students can access the presentation on their mobile phones and view it on the projection/ smart screen in class. This method can be used for both offline and online modes of education. For this study, the class was taken offline. For this study, the quiz consisted of 10 questions, including the \"Multiple choice question\" and the \"Fill in the blank\" types of questions. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the sequence of events in the preparatory phase of the class.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDuring the class, the students can access the quiz or the lesson by entering the joining code shared by the teacher. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the sequence of events during the class using the Quizizz platform.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA friendly competition is fostered during the class, thus promoting active participation through the timed quiz, which provides more points and \"power-ups\" for the students to answer the quiz faster. Also, the points of the students and the top scorers are displayed on the large screen and on the students' mobile screens, which motivates them to try harder. Each question can be discussed soon after or at the end of the class to clear up any misconceptions or doubts, thus promoting learning.\u003c/p\u003e \u003cp\u003eWe used the anonymized scores of the MCQs used as the pre-test and post-test to assess the effectiveness of M-learning and Gamification in undergraduate medical education. The feasibility of using Quizizz was assessed based on the feedback taken from the students on a 5-point Likert scale. The feedback was taken on the Google Forms platform.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData collected using the Quizizz application was downloaded into the Microsoft Excel format. After data cleaning, the data was analysed using SPSS software version 21. Measures of central tendency and deviation were calculated for the scores and the timings of the tests. The means were compared using the paired t-test.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eEffectiveness of M-learning and Gamification: Test scores and time\u003c/p\u003e \u003cp\u003eA total of 128 students attempted all the questions in the pre-test. However, in the post-test, 33 students did not attempt more than half of the questions. Also, 4 students attempted the post-test without attempting the pre-test. Hence, for the final analysis, the scores and timings of the 91 students who had attempted both the pre-test and the post-test were considered.\u003c/p\u003e \u003cp\u003eThe minimum Pre-test and post-test scores were 1 and 3, respectively. The maximum pre and post-test scores were 10. The minimum and maximum pre-test timings were 59s and 7m26s, and the post-test timings were 26s and 2m24s. Descriptive statistics of the test scores, the timings, and the results of the paired t-test are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics and comparison of means.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePaired test difference\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003et value, p-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.18 (1.786)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.33 (1.446)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.154 (2.211)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.614- (-0.693)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-4.979, \u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003cp\u003e(H:mm: ss)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0:03:35 (0:01:12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0:01:36 (0:00:21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0:01:59 (0:01:09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0:01:44\u0026thinsp;\u0026minus;\u0026thinsp;0:02:13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16.387, \u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFeasibility of M-learning and Gamification: Student feedback\u003c/p\u003e \u003cp\u003eSeventy-six students gave feedback on the Google forms. Most of the students were satisfied with the ease and use of the Quizizz platform. Most students felt that the friendly competition encouraged them to participate in the class better and fostered quick thinking. The feedback given by the students is depicted in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudents' feedback on M-learning and Gamification on the Quizizz platform. (N\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFEEDBACK RELATED QUESTIONS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedian score (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eLikert scale n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy overall satisfaction is very good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37 (48.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe availability on my mobile screen helped me participate in the class better\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37 (48.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe Quizizz platform is easy to use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e44 (57.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuizizz is user-friendly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42 (55.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI do not feel bored when I use Quizizz\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37 (48.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI stay motivated to answer all questions and learn when doing assessments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41 (53.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuizizz provides clear graphics and images.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.50 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23 (30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI will retain the topic of the class better than a traditional lecture class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36 (47.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI like the friendly competition in Quizizz\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23 (30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41 (53.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuizizz reveals the real competence of the students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23 (30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26 (34.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI can reflect on my errors after the game\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33 (43.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrompt responses help me to identify my mistakes instantly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33 (43.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI tend to think quickly when answering due to the friendly competition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36 (47.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOverview of Findings\u003c/p\u003e \u003cp\u003eThe current study sought to assess the efficacy and feasibility of mobile learning (M-learning) and Gamification in medical education. Our findings show a considerable improvement in students' knowledge before and after the intervention, demonstrating the potential of these new instructional methodologies to improve learning outcomes in medical training. Furthermore, the feasibility study indicated that M-learning and Gamification may be successfully integrated into the curriculum, promising future educational practices.\u003c/p\u003e \u003cp\u003eImplications for Medical Education\u003c/p\u003e \u003cp\u003eThe favourable impact of M-learning on knowledge acquisition is consistent with prior research supporting the use of technology in education (Hikmah et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Noordin et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The accessibility and flexibility of mobile platforms allow students to interact with content at their own pace, which is especially useful in the demanding field of medical education (Kucuk et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Hikmah et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This adaptation can result in better retention of difficult material, which is critical for future therapeutic practice. As found in our study, Gamification, on the other hand, adds a level of involvement that traditional instructional techniques frequently lack (Gue et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). We found that integrating game-like aspects such as points, levels, and challenges enhanced student motivation (Ding et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Faiza et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Mart\u0026iacute;nez-Jim\u0026eacute;nez et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Gamification supports the findings of Deterding et al. (Deterding et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), who hypothesized that it could improve user engagement and learning outcomes. Gamification is both competitive and collaborative.\u003c/p\u003e \u003cp\u003eFeasibility of Implementation\u003c/p\u003e \u003cp\u003eParticipants rated the feasibility of incorporating M-learning and Gamification positively, indicating that these strategies can be effortlessly integrated into the medical curriculum. Factors contributing to this possibility include students' broad access to cell phones and tablets and their growing familiarity with digital learning tools. However, a study by Rodrigues and others suggests that familiarity may negate the novelty effect of Gamification and reduce learning, suggesting intermittent use of such teaching approaches (L. Rodrigues et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Furthermore, the low cost of mobile applications, some being freely available, and gamified platforms make them an appealing option for educational organizations wishing to improve their teaching approaches without making large financial investments.\u003c/p\u003e \u003cp\u003eChallenges and Limitations\u003c/p\u003e \u003cp\u003eDespite the positive results, various hurdles must be overcome before widespread deployment. Technical difficulties, such as software compatibility and internet availability, can undermine the effectiveness of M-learning. Students who are not technologically adept may find it difficult to participate in the class, as found by a study among Nursing students in Karnataka (D. E. Rodrigues et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Additionally, faculty training is required to guarantee that educators are properly trained to enable these new learning modes. Future research should investigate measures to address these barriers, such as professional development programs and institutional support in subscribing to digital teaching tools. Another drawback of our study is its small sample size, which may impair the findings' generalizability. Future studies should include bigger, more diverse populations to validate these findings and investigate the long-term effects of M-learning and Gamification on knowledge retention and clinical performance.\u003c/p\u003e \u003cp\u003eFuture Directions\u003c/p\u003e \u003cp\u003eGiven the positive findings of our study, additional research is needed to investigate the long-term benefits of M-learning and Gamification in medical education. Longitudinal studies could show how these methods affect knowledge retention and application in clinical settings. Furthermore, evaluating the integration of these tactics with other instructional approaches may provide a more thorough understanding of their efficacy.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our findings show that M-learning and Gamification are viable and beneficial ways to improve information acquisition in medical education. As the landscape of medical training evolves, adopting these creative approaches can result in more interesting, effective, and accessible learning experiences for future healthcare professionals. By resolving the stated obstacles and continuing to research these approaches, we can dramatically improve educational results in medical training.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eCompeting interest and Funding-\u003c/strong\u003e The authors received no funds, grants, or other support for the conduct, preparation or publishing this study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval-\u003c/strong\u003e \u003cp\u003e Ethics approval was obtained from the Institutional Ethics Committee of the institute where the study was conducted.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eBoth authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Nishanth Krishna Kodyalamoole and Ankeeta Menona Jacob. The first draft of the manuscript was written by Nishanth Krishna Kodyalamoole and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors acknowledge the participation of the students of the 2021 batch of MBBS of the college where the corresponding author is affiliated.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAnonymised data may be made available on request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAsfar, A. M. I. T., Asfar, A. M. I. A., \u0026amp; Sulastri, S. (2021). Improving student\u0026rsquo;s complex problem solving through LAPS-Talk-Ball learning integrated with interactive games. \u003cem\u003eJournal of Physics: Conference Series\u003c/em\u003e, \u003cem\u003e1722\u003c/em\u003e(1). https://doi.org/10.1088/1742-6596/1722/1/012105\u003c/li\u003e\n\u003cli\u003eChang, L., \u0026amp; Cutumisu, M. (2022). Online engagement and performance on formative assessments mediate the relationship between attendance and course performance. \u003cem\u003eInternational Journal of Educational Technology in Higher Education\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(1). https://doi.org/10.1186/s41239-021-00307-5\u003c/li\u003e\n\u003cli\u003eDeterding, S., Dixon, D., Khaled, R., \u0026amp; Nacke, L. (2011). From Game Design Elements to Gamefulness: Defining Gamification. In \u003cem\u003eProceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments, MindTrek 2011\u003c/em\u003e (Vol. 11, p. 15). 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Gamification of graduate medical education in an emergency medicine residency program. \u003cem\u003eInternational Journal of Emergency Medicine (Online)\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(1). https://doi.org/10.1186/s12245-022-00445-1\u003c/li\u003e\n\u003cli\u003eHikmah, N., Putri, N. A., Nisa\u0026rsquo;, K., \u0026amp; Jauhariyah, M. N. R. (2021). Using Quizizz to Develop an Assessment of Physics Learning: An Alternative Way for Physics Learning Assessment in the Covid-19 Pandemic Era. \u003cem\u003eJournal of Physics: Conference Series\u003c/em\u003e, \u003cem\u003e1805\u003c/em\u003e(1). https://doi.org/10.1088/1742-6596/1805/1/012021\u003c/li\u003e\n\u003cli\u003eKhan, A. M., Patra, S., Vaney, N., Mehndiratta, M., \u0026amp; Chauhan, R. (2021). 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Gamification in education: A scientometric, content and co-occurrence analysis of systematic review and meta-analysis articles. \u003cem\u003eEducation and Information Technologies\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(7), 10207\u0026ndash;10238. https://doi.org/10.1007/s10639-022-11048-x\u003c/li\u003e\n\u003cli\u003eNg, S. F., Hassan, N. S. I. C., Nor, N. H. M., \u0026amp; Malek, N. A. A. (2017). The Relationship Between Smartphone Use and Academic Performance: A Case of Students in a Malaysian Tertiary Institution. \u003cem\u003eMalaysian Online Journal of Educational Technology\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(4), 64\u0026ndash;76.\u003c/li\u003e\n\u003cli\u003eNiaz Ahmed. (2019). Generation Z\u0026rsquo;s Smartphone and Social Media Usage: A Survey. \u003cem\u003eJournalism and Mass Communication\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(3). https://doi.org/10.17265/2160-6579/2019.03.001\u003c/li\u003e\n\u003cli\u003eNickl, M., Huber, S. A., Sommerhoff, D., Codreanu, E., Ufer, S., \u0026amp; Seidel, T. (2022). Video-based simulations in teacher education: the role of learner characteristics as capacities for positive learning experiences and high performance. \u003cem\u003eInternational Journal of Educational Technology in Higher Education\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(1). https://doi.org/10.1186/s41239-022-00351-9\u003c/li\u003e\n\u003cli\u003eNoordin, Z. M., Adnan, N. N. S., Usir, E., \u0026amp; Loganathan, M. (2023). Quizizz for Teaching and Learning About Adherence to Antipsychotics: A Pilot Study of Students\u0026rsquo; Perception and Their Level of Knowledge. \u003cem\u003eJournal of Higher Education Theory and Practice\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(3). https://doi.org/10.33423/jhetp.v23i3.5843\u003c/li\u003e\n\u003cli\u003eRodrigues, D. E., Kamath, N., \u0026amp; Souza, R. P. D. (2022). Challenges at Technology Adoption in Academic Learning among Students during the COVID-19 Lockdown. \u003cem\u003eJournal of Health and Allied Sciences NU\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(4), 369\u0026ndash;375. https://doi.org/10.1055/s-0041-1741507\u003c/li\u003e\n\u003cli\u003eRodrigues, L., Pereira, F. D., Toda, A. M., Palomino, P. T., Marcela, P., Galv\u0026atilde;o, C. L. S., et al. (2022). Gamification suffers from the novelty effect but benefits from the familiarization effect: Findings from a longitudinal study. \u003cem\u003eInternational Journal of Educational Technology in Higher Education\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(1). https://doi.org/10.1186/s41239-021-00314-6\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"M-learning, Gamification, Quizizz, Medical education","lastPublishedDoi":"10.21203/rs.3.rs-5265361/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5265361/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMobile(M)- Learning and Gamification have been shown to be effective in teaching. Quizizz is a platform which enables the use of these techniques. This study was done to assess the effectiveness and feasibility of the M-learning application Quizizz in undergraduate medical education. A quasi-experimental study was done among the medical students at a private medical college. Pre-test was conducted in the quiz mode of Quizizz, and integrated class and post-test was conducted in the lesson mode of Quizizz. Feedback was taken in the 5-point Likert scale regarding the Quizizz platform using a self-administered Google Form. The anonymised scored from the test and the feedback were analysed to meet the study objectives. Of the 91 students who answered both the pre-test and post-test, the mean score increased in the post-test compared to the pre-test and the mean time taken also reduced. The feedback received from the students also suggested that the platform was easy to use and increased the attentiveness of the students. The friendly competition made the learning fun and increased participation of the students. Hence, M-learning and Gamification are viable and beneficial ways to improve information acquisition in medical education\u003c/p\u003e","manuscriptTitle":"Effectiveness of M-learning and Gamification in Undergraduate Medical Education in Southern Coastal Karnataka","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-11 15:27:10","doi":"10.21203/rs.3.rs-5265361/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f2abde02-a8fb-4f3e-badf-28c4386ea9ca","owner":[],"postedDate":"December 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":40647501,"name":"Social science/Education"},{"id":40647502,"name":"Social science/Science technology and society"}],"tags":[],"updatedAt":"2024-12-20T16:08:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-11 15:27:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5265361","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5265361","identity":"rs-5265361","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}