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      Feasibility of Kahoot! as a Real-Time Assessment Tool in (Histo-)pathology Classroom Teaching

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          Abstract

          Purpose

          New technologies like gamification are continuously integrated into medical education during the last years. However, the benefit and implementation of such gaming platforms are not clearly studied. This analysis assesses the feasibility of Kahoot! regarding simplicity and low-cost performance as a learning/teaching tool for medical education in (histo-)pathology.

          Materials and Methods

          In this feasibility pilot study, we developed 36 modules for different benign and malignant tumors, covering four major topics: gastrointestinal tract, dermatology, urogenital tract, and hematology. Each module included histomorphological text-based questions for education of 2nd-year medical students. The online gaming-platform Kahoot! was anonymously implemented before and after “classical” medical education which included discussions of histological slides for each tumor entity using Microsoft PowerPoint-based presentations in combination with microscopical demonstrations. Participating students were invited to a seven-questions evaluation about the online educational approach.

          Results

          Overall, 23 of 51 students of the study class completed the pre- and the post-evaluation of Kahoot! in one or more organ systems. The percentage of correct answers increased from the initial mean/median of 47.2/45% to 77.2/76.3%. Simultaneously, the time for answering questions decreased by roughly 50% (from mean/median time of 9.1/8.3 seconds to 5.1/4.3 seconds) from pre- to post-assessment. The results were independent of gender; however, there were scoring differences between the different organ systems. Students positively evaluated the routine implementation of the gaming-platform Kahoot! within medical education.

          Conclusion

          Kahoot! is as a simple, direct, and low-cost application in medical teaching improving learning outcomes of pathomorphological topics with high acceptance by students. Kahoot!-based evaluations should be also performed in more advanced topics in the field of histopathology.

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          Most cited references33

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          Gamification for health and wellbeing: A systematic review of the literature

          Background Compared to traditional persuasive technology and health games, gamification is posited to offer several advantages for motivating behaviour change for health and well-being, and increasingly used. Yet little is known about its effectiveness. Aims We aimed to assess the amount and quality of empirical support for the advantages and effectiveness of gamification applied to health and well-being. Methods We identified seven potential advantages of gamification from existing research and conducted a systematic literature review of empirical studies on gamification for health and well-being, assessing quality of evidence, effect type, and application domain. Results We identified 19 papers that report empirical evidence on the effect of gamification on health and well-being. 59% reported positive, 41% mixed effects, with mostly moderate or lower quality of evidence provided. Results were clear for health-related behaviours, but mixed for cognitive outcomes. Conclusions The current state of evidence supports that gamification can have a positive impact in health and wellbeing, particularly for health behaviours. However several studies report mixed or neutral effect. Findings need to be interpreted with caution due to the relatively small number of studies and methodological limitations of many studies (e.g., a lack of comparison of gamified interventions to non-gamified versions of the intervention).
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            Does gamification increase engagement with online programs? A systematic review

            Background Engagement in online programs is difficult to maintain. Gamification is the recent trend that offers to increase engagement through the inclusion of game-like features like points and badges, in non-game contexts. This review will answer the following question, ‘Are gamification strategies effective in increasing engagement in online programs?’ Method Eight databases (Web of Science, PsycINFO, Medline, INSPEC, ERIC, Cochrane Library, Business Source Complete and ACM Digital Library) were searched from 2010 to the 28th of October 2015 using a comprehensive search strategy. Eligibility criteria was based on the PICOS format, where “population” included adults, “intervention” involved an online program or smart phone application that included at least one gamification feature. “Comparator” was a control group, “outcomes” included engagement and “downstream” outcomes which occurred as a result of engagement; and “study design” included experimental studies from peer-reviewed sources. Effect sizes (Cohens d and 95% confidence intervals) were also calculated. Results 1017 studies were identified from database searches following the removal of duplicates, of which 15 met the inclusion criteria. The studies involved a total of 10,499 participants, and were commonly undertaken in tertiary education contexts. Engagement metrics included time spent (n = 5), volume of contributions (n = 11) and occasions visited to the software (n = 4); as well as downstream behaviours such as performance (n = 4) and healthy behaviours (n = 1). Effect sizes typically ranged from medium to large in direct engagement and downstream behaviours, with 12 out of 15 studies finding positive significant effects in favour of gamification. Conclusion Gamification is effective in increasing engagement in online programs. Key recommendations for future research into gamification are provided. In particular, rigorous study designs are required to fully examine gamification’s effects and determine how to best achieve sustained engagement.
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              The effect of using Kahoot! for learning – A literature review

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                Author and article information

                Journal
                Adv Med Educ Pract
                Adv Med Educ Pract
                amep
                amep
                Advances in Medical Education and Practice
                Dove
                1179-7258
                05 October 2020
                2020
                : 11
                : 695-705
                Affiliations
                [1 ]Institute of Pathology, Paracelsus Medical University/Salzburger Landeskliniken (SALK) , Salzburg, Austria
                [2 ]Cancer Cluster Salzburg, Institute of Pathology, Paracelsus Medical University/Salzburger Landeskliniken (SALK) , Salzburg, Austria
                [3 ]Department of Internal Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK) , Salzburg, Austria
                [4 ]Institute of Physiology and Pathophysiology, Paracelsus Medical University , Salzburg, Austria
                Author notes
                Correspondence: Daniel NeureiterInstitute of Pathology, Paracelsus Medical University/Salzburger Landeskliniken (SALK) , Salzburg, AustriaTel +43 (0)5 7255 29027Fax +43 (0)5 7255 29099 Email d.neureiter@salk.at
                Article
                264821
                10.2147/AMEP.S264821
                7547141
                33117039
                499665e2-29c9-43de-b4b5-a46af5cf178f
                © 2020 Neureiter et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 05 June 2020
                : 20 August 2020
                Page count
                Figures: 6, References: 33, Pages: 11
                Categories
                Original Research

                education assessment,medical education,online-tools,kahoot!,pathology

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