Gamification of dermatology diagnostics training: a nationwide, randomized, controlled trial of 34,556 cases
In brief
Leaderboard gamification triples case training volume without improving diagnostic scores
In a nationwide trial of 71 medical students, daily leaderboards caused participants to complete about three times more dermatology cases than controls (785 vs 240). However, post-test scores rose only marginally and did not differ between groups, suggesting that competition boosted activity but not learning. Further research is needed to find training methods that translate effort into skill.
- Journal
- Clinical and experimental dermatology (Q2)
- Published
- 17 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Sigrid I P Kristensen, Niels K Ternov, Gustav G Nervil, Steven A W Andersen, Pascale Guitera, Ralph P Braun, et al.
- PMID
- 42752589
- DOI
- 10.1093/ced/llag384
Why clinicians should know about it
- Picked for Dermatology (top studies of the week, 20 September 2026): High-quality evidence in a top journal
Abstract
BACKGROUND: Skin cancer incidence is rising, as is the focus on efficient, evidence-based diagnostic training. However, proficiency in skin cancer diagnosis requires years of practice, and methods to accelerate learning are therefore necessary. Gamification-integration of game-like mechanics-is a promising method. OBJECTIVES: Evaluating the effects of gamification-in the form of leaderboards showing participants' ranking-on training amount and skills acquisition in medical students, through directed, self-regulated, virtual training. METHODS: In a nationwide randomized controlled trial, participants were randomized to either the gamification or control group, both of which had access to a quiz-based dermatology diagnosis training platform. The gamification group received a daily leaderboard showing rank, based on points earned through training. Diagnostic skills were assessed via validated 12-case pre- and posttests. Data were analyzed using linear mixed models and t-tests. RESULTS: Seventy-one participants were included; 34,556 assessments were completed. The gamification group trained 3.3 times as many cases as the control group (785 [95% CI: 437-1,134] vs. 240 cases [95% CI: 154-325], p<0.01). There was no significant difference in diagnostic skill improvement (0.12 points of 12 [95% CI: -0.7-1.3] vs. 0.65 points of 12 (2.2% and 14.3% relative to baseline, respectively) [95% CI: -0.2-1.5], p=0.40). CONCLUSIONS: Gamification led to substantially increased training volume, without improving skills acquisition. This may be explained by a shift in focus towards leaderboard placement, diminishing motivation to internalize learning content. Improved understanding of evidence-based dermatology training-i.e., the most efficient methods for reaching proficiency-is needed and requires further large, randomized trials.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.