Exploring the potential of gamified virtual patients for military trauma care training: a systematic text condensation analysis

Gamified VPs can support military trauma training by enhancing engagement, building confidence, and supporting reflection and learning. However, the inclusion of game elements requires careful consideration. Elements that contribute to realism and immersion, such as narrative, multimedia, and tactical challenges, were viewed as valuable for maintaining authenticity and contextual relevance. Hints and progressive difficulty levels were also perceived as beneficial for supporting gradual skill development. Features such as scoring, competition, rewards and time-pressure elicited mixed responses. While some participants found these elements engaging, others perceived them as distracting or misaligned with the goal of acquiring life-saving skills. Instructors were critical of mechanisms that induced artificial stress or rewarded speed over reasoning, warning that such features could shift focus from learning to performance. Therefore, rather than adopting gamification features uncritically, designers and educators should carefully evaluate which elements enhance learning in high-stakes environments and which risk undermining it.