Evaluation of the Effectiveness of Serious Games on the Learning of Clinical Skills in Health Science Students: A Systematic Review

Purpose: To evaluate the effectiveness of serious games, including virtual reality-based interventions, in improving clinical skills acquisition among undergraduate and postgraduate health science students. Methods: This systematic review was prospectively registered in PROSPERO (CRD42024589035) and conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and ScienceDirect were searched from inception to 31 August 2025. Eligible studies examined serious games, simulation-based platforms, or immersive and non-immersive virtual reality interventions designed to support clinical skills development. Outcomes were classified using a predefined hierarchical framework aligned with Miller’s pyramid, distinguishing performance-based clinical competence, clinical reasoning, and secondary educational outcomes. Owing to substantial heterogeneity in interventions, comparators, and assessment methods, a narrative synthesis was performed. Results: Thirteen studies involving 892 participants were included. Serious games and virtual reality-based interventions were associated with generally favorable outcomes for knowledge acquisition, self-efficacy, motivation, satisfaction, and anxiety reduction. Improvements in clinical reasoning were reported in several studies, and some studies demonstrated benefits in performance-based clinical competence, particularly in simulation and virtual reality settings. However, findings for objective performance-based outcomes were mixed, with some studies reporting no statistically significant between-group differences. Heterogeneity in outcome definitions and limited reporting of standardized effect sizes reduced cross-study comparability. Conclusions: Serious games, including virtual reality-based interventions, may serve as complementary, scenario-based learning strategies in health sciences education. The most consistent effects were observed for cognitive and learner-centered outcomes, whereas evidence for objective gains in performance-based clinical competence remains variable. Further high-quality studies using standardized outcome frameworks, validated performance-based assessments, effect sizes, confidence intervals, and longer follow-up are needed.