Actionable companion · Motivation & engagement

Learning with agency: Envisioning gamification in anesthesia, pain management, and critical care: basic principles, integration of artificial intelligence, and simulation strategies

AI-assisted editorial implementation guide, separate from the original research. Proposed actions are not claims or recommendations attributed to the source authors. No independent peer review of this guide is asserted.

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Evidence and context

Title and abstract screening; stage labels describe reported settings, not verified numerical ages. Design labels require full-text appraisal. Reported stage(s): Age / stage not established. Verify the participant population and task before transferring the findings.

Original authors’ abstract, reproduced under the linked source license:

Abstract Unlike traditional video games developed solely for entertainment purposes, game-based learning employs intentionally crafted approaches that seamlessly merge entertainment and educational content, resulting in captivating and effective learning encounters. These pedagogical methods include serious video games and gamification. Serious games are video games utilized as tools for acquiring crucial (serious) knowledge and skills. On the other hand, gamification requires integrating gaming elements (game mechanics) such as points, leaderboards, missions, levels, rewards, and more, into a context that may not be associated with video gaming activities. They can be dynamically (game dynamics) combined developing various strategic approaches. Operatively, gamification adopts simulation elements and leverages the interactive nature of gaming to teach players specific skills, convey knowledge, or address real-world issues. External incentives stimulate internal motivation. Therefore, these techniques place the learners in the central role, allowing them to actively construct knowledge through firsthand experiences. Anesthesia, pain medicine, and critical care demand a delicate interplay of technical competence and non-technical proficiencies. Gamification techniques can offer advantages to both domains. Game-based modalities provide a dynamic, interactive, and highly effective opportunity to learn, practice, and improve both technical and non-technical skills, enriching the overall proficiency of anesthesia professionals. These properties are crucial in a discipline where personal skills, human factors, and the influence of stressors significantly impact daily work activities. Furthermore, gamification can also be embraced for patient education to enhance comfort and compliance, particularly within pediatric settings (game-based distraction), and in pain medicine through stress management techniques. On these bases, the creation of effective gamification tools for anesthesiologists can present a formidable opportunity for users and developers. This narrative review comprehensively examines the intricate aspects of gamification and its potentially transformative influence on the fields of anesthesiology. It delves into theoretical frameworks, potential advantages in education and training, integration with artificial intelligence systems and immersive techniques, and also addresses the challenges that could arise within these contexts. Keywords: Gamification, Serious games, Education, Anesthesia, Pain medicine, Simulation, Artificial intelligence, Virtual reality, Training

What kind of evidence is this?

Supporting AI learning science · Design requires full-text appraisal

Stage: Age / stage not established. Screening labels describe reported context and study-design language. They are not a risk-of-bias rating or proof of effectiveness for an age band.

Study methods · source passage

Notably, gamification techniques place the user at the center of the learning process [16]. Participants become the architects of their own learning, acquiring knowledge through firsthand experiences. This approach enhances their motivation, enabling them to retain information in a meaningful and enduring manner. Since the learning process is typically intertwined with an enjoyable and rewarding experience, the integration of knowledge acquisition and participation in a positive and pleasurable interaction not only enhances understanding but also fosters a sense of satisfaction and enthusiasm for further experience [17].

Limitations and uncertainty · source passage

A fundamental aim of health professional education is to develop self-reliant advanced practitioners who possess the capacity to make independent decisions within their specialized practice area, such as emergency care [21]. Thus, the field of education has undergone a profound and captivating transformation with the infusion of gamification. No longer confined to the traditional constraints of textbooks and lectures, the process of learning has blossomed into a dynamic, interactive, and immersive experience. Leveraging the magnetic appeal of game elements, digital platforms have succeeded in kindling a heightened sense of student engagement. Moreover, through the implementation of gamified assessments, assignments, and quizzes, users are seamlessly drawn into a vibrant realm of knowledge acquisition [22]. Language learning is a typical example of a gamification application [23].

Design the system before the pilot

Use this study to inform a learning mechanism or implementation question. It is not direct evidence that autonomous agents improve learning. Keep the proposed agent behavior separate from what the source actually tested.

Measure engagement separately from achievement. Check whether novelty-driven participation persists and whether it translates to independent performance.

A 90-day district pilot

Days 1–15 · Appraise. Have the curriculum lead and a teacher read the methods and limitations. Record the study design, sample, comparator, outcomes and evidence gaps. Define a local question that the study can help inform.
Days 16–30 · Design. Treat the paper as background evidence until its population is verified in the full text. Do not assign an age-specific intervention or extend adult results to children. Name an accountable owner and set the baseline, success threshold and budget before implementation.
Days 31–60 · Test. Start with a small voluntary cohort, preserve an accessible non-AI route and require teacher review. Use synthetic or de-identified examples; approve data handling and tool terms through district processes.
Days 61–90 · Decide. Extract the participant ages or education stage, recruitment, task and comparator before selecting a local pilot. If these cannot be established, retain the paper for design discussion rather than age-band efficacy claims. Compare with baseline, document uncertainty and stop or revise if learning worsens, access is unequal or critical errors persist.

The board decision brief

Report the learning problem, evidence quality, participating population, total cost including review time, measured benefit, errors, access differences and remaining uncertainties. Make a dated recommendation to stop, revise or expand. A positive perception survey alone does not establish learning improvement.

Attribution and reuse

Marco Cascella; Andrea Cascella; Federica Monaco; Mohammed Naveed Shariff. Envisioning gamification in anesthesia, pain management, and critical care: basic principles, integration of artificial intelligence, and simulation strategies. Journal of Anesthesia, Analgesia and Critical Care (2023-09-11). https://doi.org/10.1186/s44158-023-00118-2

Companion prepared 2026-10-30. Original authorship and DOI are preserved. The abstract is an attributed source extract; the implementation plan is new AI-assisted editorial material, offered under the same CC BY 4.0 license. This guide has not undergone independent peer review.