Gamification With Progress Bars Improves Performance and Retention in Virtual Reality Simulation

Introduction: Simulation training is established as efficient for developing clinical and surgical skills, yet sustaining learner motivation during repeated practice remains challenging. Gamification has been proposed to enhance engagement, but evidence for specific, transferable gamification features in technical skills simulation is limited. This study investigates a gamification element, progress bars, on skill acquisition and retention in simulation-based surgical training. Methods: A prospective, randomized controlled trial involving 24 medical students with no prior experience in temporal bone surgery. Participants were stratified by gaming experience and randomized to virtual reality simulation training with or without progress bars in the visible ear simulator. Trainees completed 15 mastoidectomy procedures in a distributed training program, followed by retention testing after 2.5 months. Performance was assessed using a validated, simulator-integrated final-product score. Learning and retention outcomes were analyzed using linear mixed-effects models. Results: Training with progress bars resulted in significantly higher performance on a 26-point scale compared with training with standard learning supports (mean difference: 1.5 points; P < 0.002). Participants with gaming experience outperformed non-gamers overall (mean difference: 1.4 points; P < 0.002), particularly in early training. Among non-gamers, the intervention significantly improved performance both during training (mean difference: 2.1 points; P < 0.002) and at retention testing (mean difference: 2.5 points; P < 0.035), offsetting their non-gaming disadvantage. Conclusions: Progress bars were an effective gamified feedback mechanism that enhanced skill acquisition and supported retention, particularly for learners with limited gaming experience. This generalizable feature may improve the accessibility and effectiveness of technology-enhanced simulation-based surgical education.