Medical education is a continuously evolving discipline that requires the integration of effective teaching strategies to develop competent healthcare professionals capable of applying theoretical knowledge in clinical practice. The educational programs of undergraduate medical students include much science, intricate concepts and rigorous assessment, which necessitates the use of suitable pedagogical methods for effective learning. Traditional approaches to medical education have been based on lectures, small group discussions and tutorials. These methods offer chances for the planned transfer of knowledge and the clarification of difficult concepts, but they can be affected by student involvement, teaching quality, and opportunities for formative feedback. With the shifting focus of students as the main object of teaching, more and more medical institutions are adopting an interactive teaching model to cultivate students' learning ability, critical thinking, and concentration.The emphasis on student-centered education has given rise to the emergence of an interactive teaching model involving active learning, independent reasoning, and long-term concentration. Gamification, as a new learning strategy, has been drawing the interest of researchers as a method of introducing game-related elements into learning activities to increase motivation and participation [1-3].

Gamification is the use of game design elements like points, rewards, competition, progress tracking, and feedback in the learning context. Gamified quizzes can be used in undergraduate medical education to support the classroom, tutorial sessions, and digital learning environments to reinforce important concepts and assess student knowledge. These activities facilitate the recall of previously learned information and the recognition of errors, as well as repeated formative assessment to help build conceptual understanding. Learning through an interactive quiz might also be helpful to self-directed preparation, as students will be able to track their learning and identify gaps. The learning value of gamification is closely related to aspects of active learning, retrieval practice, and timely feedback, all of which are key processes for consolidating knowledge. But careful alignment of the content of the quiz and the learning objectives, appropriate design of the level of quiz question difficulty and meaningful feedback instead of overemphasis on competition and entertainment are key factors in the successful implementation [4-6].

Academic achievement is associated with student engagement and motivation, especially in medical education where students need to focus and be motivated for a long period of time during intense training sessions. Gamified learning environments can be used to awaken interest in learning by making the assessment activities interactive and more participative and collaborative. Immediate scoring, constructive competition and progress indicators can help learners to feel a sense of achievement and maintain their engagement in educational activities. But traditional tutorials still have a lot of useful benefits in terms of the interaction between teacher and student, discussion, clinical reasoning, and clarification. Both methods have their own educational merits, and they can differ in effectiveness based on students' learning styles, prior experience, the difficulty of the course and the teaching method used. Moreover, just because students enjoy or feel good about their learning does not mean that learning is better, as the objective results of learning are important to consider along with their perceptions of quality education [7, 8].

Assessment of educational effectiveness should extend beyond immediate examination performance to include knowledge retention, motivation, confidence, and sustained engagement. Although interactive quiz-based teaching has demonstrated potential advantages in different educational contexts, variations in intervention design, assessment methods, duration of exposure, and participant characteristics make it difficult to establish its consistent superiority over conventional tutorials. Comparative evidence remains particularly important in undergraduate medical colleges where digital learning resources, institutional infrastructure, and teaching practices may differ. The need for context-specific evaluation of gamified quizzes and conventional tutorials provides the rationale for investigating their relative educational effectiveness among MBBS students. Therefore, the present study was designed to compare gamified quizzes and traditional tutorials in terms of academic performance, knowledge retention, student engagement, learning motivation, and satisfaction among MBBS students at Bannu Medical College, Bannu [9].

This quasi-experimental comparative study was designed to evaluate the effectiveness of gamified quizzes versus traditional tutorials in improving academic performance, knowledge retention, student engagement, motivation, and learning satisfaction among undergraduate medical students. The study was conducted at Bannu Medical College, Bannu, Pakistan, over six months, from January 2025 to June 2025. The primary objective was to compare changes in academic performance following the two teaching approaches, while secondary objectives included evaluating knowledge retention and students' perceptions of the learning experience. The total number of students included in the study were 77 MBBS students. A total of 39 students were to be allocated to the gamified quiz group (Group A) and 38 to the traditional tutorial group (Group B). The study involved students (MBBS) of Bannu Medical College of Primary Medical Science and Students, who were attending selected academic teaching sessions of the college and gave their informed consent to participate in the study. Students who missed the baseline evaluation, didn't engage in the teaching activity, or couldn't complete the assessments were not included in the complete case analysis. The curricular content and learning outcomes taught were planned to be identical to reduce variability due to educational content, with both groups given the same instruction. The students assigned to Group A (gamified quizzes) took part in the interactive quiz-based learning sessions, where multiple choice questions were asked, and immediate feedback, scores, performance ranking and competition were used to stimulate active participation. The quizzes were targeted to critical concepts, clinical applications and problem solving skills pertaining to the chosen MBBS curriculum. The participants responded to structured questions and were given immediate feedback about their responses so that they could identify learning gaps and consolidate their learning. In Group B (traditional tutorials), students attended standard tutorials delivered by their tutor(s) on the same academic material. It was an active series of sessions, in which topics were explained, the instructors interacted with the students and students had an opportunity to ask questions and clarify difficult topics. Planned content to be taught, planned learning outcomes to be achieved and planned instruction to be experienced were to be similar for both groups. Structured pre-intervention and post-intervention tests, designed around the teaching topics, were used to measure academic performance. The pre-test was designed to provide baseline academic information prior to exposure to the mandated teaching approach. After intervention, participants completed a post-intervention assessment to assess academic achievement changes. The scores were reported as percentages and changes in academic scores were done by subtracting the pre-intervention score from the post-intervention score. A pre-determined academic criteria of 70% and 80% was then used to classify academic performance. A delayed assessment was carried out two to four weeks after the intervention to assess knowledge retention. The purpose of the retention assessment was to see how much students remembered about the material they had just acquired as a result of the instructional sessions. The percentage of retention might be obtained by dividing the delayed assessment score by the immediate post-intervention score and multiplying by 100. The questionnaire was structured in a five-point Likert scale of strongly disagree (SD) to strongly agree (SA), and assessed students' engagement in learning, students' motivation in learning, attention, enjoyment, confidence, and overall satisfaction. The questionnaire covered the following aspects: the participants' feeling of being actively involved, of concentrating while learning, of being motivated to learn, of educating the content they learned, and of being satisfied with the teaching method, and their preference for the next teaching session. Demographic and academic data, such as age, gender, prior academic achievements, study length, attendance, and previous interaction with the gamified learning environment were also collected. This was designed to be applied to both groups to make their educational outcomes comparable. IBM SPSS Statistics version 26.0 were used for data analysis. Means and standard deviations were used to present continuous variables such as age, academic scores, attendance and questionnaire scores, and frequencies and percentages were used to present categorical variables. Continuous variables were tested for normality using Shapiro–Wilk test. Normally distributed continuous variables would be compared between two groups by independent-samples t-tests and non-normally distributed variables would be compared between the two groups using the Mann–Whitney U test. Within group changes in academic scores were assessed with paired-samples t-tests or Wilcoxon signed-ranked tests. Pearson's chi-square test or Fisher's exact test, as appropriate, was used to compare categorical outcomes. To assess differences in post-intervention academic performance analysis of covariance (ANCOVA) was planned, with baseline test scores used as a covariate. Academic improvement, attendance, motivation and student engagement were analyzed using Pearson or Spearman correlation analysis. All statistical tests were two-sided, and a p-value <0.05 was considered statistically significant.

The total of 77 MBBS students were analysed out of which 39 students were given the gamified quiz group and 38 students the traditional tutorial group. The mean age was 21.38 ± 1.52 years, and 42 students (54.5%) were female. There were no statistically significant age, gender differences, or differences in academic scores among the groups, and the groups did not differ in their demographic characteristics.

Table 1. Demographic and Academic Characteristics of MBBS Students

There was a higher improvement in the academic performance comparison of the gamified quiz group. The means scores before and after intervention were comparable, but the score for the students who received the gamified quizzes (post-intervention: 82.46 ± 8.12) was higher than the score for the students who received the traditional tutorials (post-intervention: 73.18 ± 9.24). The mean improvement was greater for the gamified group than for the traditional group, being 26.84 points in the former and 17.42 points in the latter. Additionally, a greater number of the participants in the gamified quizzes scored a 'high level' of 80% or more.

Table 2. Comparison of Academic Performance Between Gamified Quizzes and Traditional Tutorials

Scores are expressed as mean ± SD or frequency (%).

The analysis showed that the students in the gamified quiz group had higher scores on the delayed retention assessment than the students who were assigned to the traditional quiz group. The mean scores for the delayed retention were found to be 76.38 ± 8.74 for the gamified group and 66.92 ± 9.62 for the traditional group. The knowledge retention was also greater in the gamified quiz group compared with the immediate post-test score. The gamified quiz had a higher percentage of students who scored satisfactory delayed retention.

Table 3. Comparison of Knowledge Retention and Learning Outcomes

In the students' reported learning experiences responded positively to gamified quizzes for multiple educational domains. The mean scores for active participation, learning motivation, concentration, enjoyment and overall satisfaction were higher for the gamified group. From these patterns, it is assumed that interactive assessment can improve the learning process, but this is just an assumption that needs to be confirmed through valid questionnaires and responses from participants during the learning process.

Table 4. Comparison of Student Engagement, Motivation, and Satisfaction

Values are means ± SD on a five-point Likert scale, except teaching-method preference, expressed as n (%).

The analysis indicated positive relationships between academic achievement and the engagement, motivation, and attendance of students. Motivation (r=0.43) and engagement (r=0.48) had the highest correlation with improvement in academic performance. These relationships would be analysed using Pearson or Spearman correlation depending on the distribution of the observed data.

Table 5. Association of Academic Improvement With Learning-Related Factors

Fig. 1: Comparison of Mean Academic Performance Scores Between Gamified Quiz and Traditional Tutorial Groups Among MBBS Students (n=77).

Gamification has emerged as an innovative educational approach in undergraduate medical education, offering opportunities to promote active learning, improve student engagement, and strengthen academic performance. The integration of game-based elements, including interactive quizzes, immediate feedback, competitive challenges, and performance-based rewards, may transform conventional learning activities into more participatory educational experiences. Unlike traditional tutorials, which commonly emphasize instructor-guided explanation and discussion, gamified quizzes encourage students to retrieve previously acquired knowledge, apply concepts, and recognize learning deficiencies through repeated formative assessment. The educational value of gamification lies not only in its ability to increase interest but also in its potential to reinforce knowledge through active recall and continuous feedback. However, the effectiveness of gamified learning depends on instructional design, alignment with curriculum objectives, and the appropriate selection of assessment strategies. Gamification should therefore be regarded as a complementary educational method rather than a complete replacement for established teaching approaches [5, 10, 11]. Academic performance is an important measure of educational effectiveness and for undergraduate medical training, the students might need to absorb a lot of theory and also be able to apply them in clinical situations. Gamified quizzes can help improve learning by allowing students to repeatedly access key learning, practise on their own and also enable them to correct misconceptions as soon as they occur. The integration of formative assessment in the interactive learning space can also assist students in determining what areas they need to focus on further development, which can help to facilitate self-directed learning and student learning. Another factor is the way information is retained; medical students need to retain and recall information over long periods of time during their education. The continual use of questions can enhance memory consolidation and aid information recall in future testings. However, gains in immediate assessment scores cannot be used to infer long-term retention, and assessment for educational effectiveness needs to be based on delayed assessment scores measured by suitable instruments. The use of interactive learning strategies can help in the acquisition of knowledge, but its effect may differ depending on the complexity of the learning material, student's previous academic skills and competence of learning materials [12-14]. Student engagement, motivation, and learning satisfaction are key elements of good medical education as achievement of the learning outcomes relies on both cognitive and participation in learning. Gamified quizzes can be used to enable interaction, stimulate interest and add a bit of fun to challenging topics. Conductive activities like instant scoring, progress check, collaborative participation and constructive competition could motivate students to be more active in learning than in normal teaching sessions. Providing immediate feedback can also boost confidence because learners will have the chance to check their understanding and track their learning improvement. But overemphasizing competition, speed or performance rankings can create anxiety or discourage students who need more time to reflect on information. Likewise, the feasibility of the gamification approach, the lack of experience with digital platforms and student's learning style might affect the acceptance of gamified teaching practices. Implementation will only be effective if there is careful planning, inclusive participation, appropriate feedback and a balance of educational challenge, psychological comfort. It is possible that using quizzes that are interactive as well as having tutor-guided explanations can give a more holistic learning experience since the motivational aspect of gamification can be combined with the conceptual learning aspect of the tutor's explanations [15-17]. The potential of gamified learning goes beyond test performance to other areas of learning such as participation, performance self-assessment, co-learning, and independent learning practices. Structured gamified quizzes can be integrated into tutorials, lectures, revision sessions and formative assessment in medical institutions to support learning activities that set up learning outcomes. However, an educational approach needs to be judged by its effectiveness for enhancing the meaningful learning process and not simply participation or fun. Comparative educational research has some advantages, such as studying academic results as well as students' perceptions and knowledge retention. An important limitation is that relatively small numbers of students were involved in the studies, and the studies were conducted within a single institution, which may create selection bias, and that prior academic achievement may be different across studies and that enthusiasm for a newly introduced teaching method may initially impact students' responses. Other methodological issues are brief intervention durations, subjectivity around engagement variables, and challenges to providing equal instructional content across comparison groups. Multicentre randomised trials in larger student cohorts with longer follow-up, assessment of clinical reasoning and practical skills with validated questionnaires are recommended to confirm the continued effectiveness of gamified learning in various phases of undergraduate medical training [18-20].

Gamified quizzes represent a promising educational approach for promoting active participation, academic engagement, motivation, and formative learning among MBBS students. By incorporating interactive assessment, immediate feedback, and repeated knowledge retrieval, gamification may complement traditional tutorials and support the acquisition and retention of medical knowledge. However, its effectiveness depends on appropriate instructional design, equitable participation, and alignment with curriculum objectives. Integrating gamified quizzes with conventional tutor-led teaching may offer a balanced approach to undergraduate medical education. Further comparative research with rigorous assessment of academic performance and long-term knowledge retention is required to determine the extent of its educational benefits.