Evaluating Gamification of Antimicrobial Resistance as an Educational Tool: A Systematic Review

BACKGROUND: Antimicrobial resistance (AMR) poses a serious threat to global healthcare, and inadequate education has been identified as a major challenge by the World Health Organization. Gamification has emerged as an innovative tool to improve knowledge and change behaviours at the grassroots level. This scoping review provides an overview of existing games in prescribers’ education across the One Health sectors, with a particular focus on the impact of gamification in learning. METHODS: Using the PRISMA guidelines, we searched Cochrane, PubMed, Scopus, and Google Scholar for articles related to gamification for future prescribers’ of AMR until March 28, 2023. Retrieval and screening of articles was done using a structured search protocol with strict inclusion/exclusion criteria. RESULTS: A total of 120 articles were retrieved, of which 6 articles met the inclusion criteria for final analysis. Brazil, UK and France were the sites of almost all the gamification trials, with an additional global study incorporating low-middle income countries. All studies were tested in the human healthcare sector only. Board and card games were the most common types of games, with scoring and point systems as the most common game elements. All games focused on improving knowledge and prescribing behaviours of undergraduate students, with bacteria or antibiotics being the only content. Many studies highlight the significant role gamification can play in mitigating AMR, promoting antimicrobial stewardship (AMS), and improving retention of information compared to conventional lectures. CONCLUSIONS: Our review highlights a lack of standardised content and gameplay across games addressing AMR for future prescribers of antibiotics, and a gap in assessing gamification of AMR as a tool to promote AMS across all three sectors. Our findings will guide the development of a game in the next phase of the project, as a longitudinal study across Norway and Zambia, focused on the One Health approach. KEY MESSAGES: • Tackling AMR requires improved education and awareness of healthcare workers, veterinarians, and agriculture workers around AMR stewardship issues. • The One Health approach is necessary to mitigate AMR, and the foundation of future prescribers’ is vital. Innovative learning tools like gamification can play a pivotal role in this fight.