Introduction
The rapid advances and revolutionary change during the 21st century with digitalization & globalization have changed how the students learn and think differently. Today's students have grown up with digital technologies that have broken traditional boundaries, thereby demanding a change from traditional lecture-based unilateral passive learning methodology to active techno-savvy experimental learning methodology (Cheng & Su, 2012; Deterding, O'Hara, Sicart, Dixon, & &nacke, 2011; Kanthan & Senger, 2011). Based on the present milieu of ongoing reform in dental education, it is of paramount importance to shape our students as critical thinkers with profound knowledge to perceive high order thinking intellectual abilities to develop curious minds leading to an innovative ecosystem in Indian education. This can be achieved by contextualizing games in academic curriculum with an entirely new approach of game-based teaching learning (GBL) methodologies. In this review, we have applied a concept centric synthesis matrix framework (SMF) to synthesize few evidence-based studies on game-based learning (GBL) & gamification in the discipline of health education with the aim to conceptualize theories and understand the hypothesis involved in game dynamics for increased students’ involvement in learning. The application of SMF can act as a guiding tool to identify the knowledge gap from the existing literature for future scope in research. Before initiating this framework, a brief summary on terminologies on game based learning & gamification, components of game pyramid, canonical theories involved in game dynamics are discussed for basic understanding on interlink between students learning abilities and their involvement.
What is Game-Based Learning (GBL) & Gamification?
Game-Based learning is defined as a new innovative method of teaching educational material in a playful lucid way. Contextualizing games in the academic curriculum can create an extra level of motivation and increase the learners' cognitive development (Bigdeli, 2016; Jui-Mei, 2011). GBL in dental education can be part of behavior change gamification wherein the students, being the players, are involved in learning by increasing their involvement in institutional libraries, thus solving the problem of most of the librarians who could not raise the student's attendance in using the library. In 2011, Sukovic et al. inferred that the application of games and its various tools used in library websites could improvise the more efficient functioning of libraries (Sukovic, Litting, & England, 2011). Radhakrishnan et al. in 2013 also inferred that utilizing gamify services in the library websites can increase and boost a greater number of students involvement. Hence, the institutes should now recognize its potential and incorporate them as “library gamification tools” (Radhakrishnan, 2013). The basic principles on which GBL works are intrinsic motivation, contextualized learning, and autonomy. The game mechanics involved should be simple with rules and clear goals and should have specific interactions (items) with progressively difficult levels and constructive feedback (Blascomolla, Vendrellribes, Bermúdez, Olga, & Sanchidriánpardo, 2015).
Deterding et al. in 2011 defined gamification as "a use of online and video game elements in non-game contexts to improve users' experience and increase their engagement" (Deterding et al., 2011). Nick Pelling first described this notion of gamification in 2002 (Kuutti, 2013). There are three types of gamifications: internal gamification, external gamification, and behavior change gamification. Internal gamification involves small organizations where games are designed to improve the efficiency of the organization. It is also known as "Enterprise Gamification." External gamification involves organizations' marketing goals, thus improving the relationship between the users & offered services. Behavior change gamification involves games that create useful atomic habits for the players, such as education systems, libraries, and health services (Bigdeli, 2016). To achieve these three forms, gamification experts Werbach & Hunter in 2012 have introduced the Game Pyramid.
Game Pyramid & its components
It involves three major elements, i.e., Game Dynamics, Game Mechanics, and Game Components. Game dynamics are located at the top area of the pyramid and forms the essential core of each gamified operation based on developing games' mechanics. It includes narration, emotions, limitations, and the relationship between different components (Kuutti, 2013; Schönen, 2014; Wu, 2011). Game mechanics lead to players' uniqueness and include emulation, competition, participation, collaboration, uncertainty, rewards, feedback, and interactions. (Wu, 2011) Game elements include the competencies such as levels, avatars, badges, leader board, points, etc., used by the game users (Kuutti, 2013) (Figure 1).
Canonical theories on GBL
Self Determination Theory
(Ryan & Deci, 2000) put forth the theory of self-determination (SDT). Based on three main characteristics, i.e., amotivation, intrinsic motivation, and extrinsic motivation. This concept emphasizes the idea that all humans are proactive and have a sincere wish to develop internally (our core self). However, external factors, like money or competition, lead to a separable outcome. Additionally, this theory also focuses on three basic physiological needs- autonomy, competence, and relatedness. The individual's tendency to do his/her activities freely is called autonomy, whereas competence alludes to the individual's ability to do a task. Relatedness is the beseech to interact with others as a form of social influences (Brühlmann, 2013; Csikszentmihalyi, 1990; Ryan & Deci, 2000) (Figure 2).
Flow Theory
In 1990, a psychologist named Csikszentmihaily proposed a theory based on flow. He defined flow theory as "an operation in which a person performing an activity is fully immersed in a feeling of energized focus, full involvement, and enjoyment in the process of that activity." He observed the work of painters who got immersed in their activity in depth who eventually ignored their need for food, water, sleep, etc (Csikszentmihalyi, 1990).
Table 1
The SMF is to synthesize evidence based empirical studies on Game based learning (GBL) & Gamification in discipline of health education. The framework involves rows and columns. Each row represents Source information (SI) element timecentred (Year of Publication), Role Centred (Author, Source/Citation) & Outcome of Each Paper. The column represents the Argument Matrix (AM) element.
Csikszentmihaily stated this flow as a buoyed experience, i.e., doing something for its own sake that was in concordance with Brühlmann in 2013 defined it as "the optimal experience, a state of mind and body with absorption and enjoyment” so when everything comes together, and we feel focused and involved in the task, we experience flow (Brühlmann, 2013). He hypothesized the theory based on three factors Personal factors based on causality orientation ; Situational factors based on rewards & Contextual factors based on goals (Figure 3).
We applied Synthesis Matrix Framework to synthesize evidence-based studies on game-based learning & gamification in the discipline of health education with the aim to conceptualize theories and understand the hypothesis involved in game dynamics for increased students’ involvement in learning (Table 1). The importance of applying this framework is to identify the research gap on existing literature so as to develop a conceptual framework based on the argument matrix (AM) element by accurately scoping empirical studies in an organized and systematic approach. This can lead to hypothesis generation and hypothesis testing and hence it should be considered as a preliminary exercise prior to the conduction of SLR or scoping review.
Conclusion
This SMF review can help researchers to explore the GBL as a new innovative teaching method that can be contextualized in the academic curriculum, thus creating a new platform for learning dentistry in a fun way. However, more experimental randomized control trial or quasi-experiment design should be conducted using various software, and its subsequent impact on learning performances should be evaluated.
Conflicts of interest
All the authors associated with the present manuscript declared no potential conflicts of interest concerning the research, authorship, and publication of this article.
Author contributions
Both authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
