Effect of gamification applications on success of dentistry students

Abstract

BACKGROUND

Gamification, the use of game materials in education, has been used in several scientific fields, and studies have demonstrated its effectiveness in student comprehension.

AIM

To evaluate whether the success of 4^th- and 5^th-grade dentistry students increases when using the gamification applications Kahoot! and Mentimeter.

METHODS

An experimental design was used to measure the effect of gamification applications on students who were taught using the traditional method. For this purpose, Mentimeter and Kahoot! applications were used in this experimental study. Three groups of 4^th- and 5^th-grade students were formed: Mentimeter, Kahoot!, and control groups. The effect of gamification applications on achievement was evaluated by administering a post-test to these groups after the instructional process. One-way analysis of variance and t-tests were used for statistical analyses.

RESULTS

A total of 35.5% of the students were in the Mentimeter group, 29.8% in the Kahoot! group, and 34.6% in the control group. Of the total number of students, 54.8% were female and 45.2% were male, while 52.2% were 5^th-grade students and 47.8% were 4^th-grade students. The overall grade point average was found to be 66.65 (range, 24-100). There was a statistically significant difference in average success scores between students of different groups (P = 0.003 < 0.05) and grades (P = 0.036 < 0.05). The average success score was the highest in the Mentimeter group (71.64) and the lowest in the Kahoot! group (62.15). In the control group, this score was 65.41. The average success score was higher for students in the 5^th-grade (68.16) and for female students (68.84).

CONCLUSION

Gamification has a great potential in the education of dentomaxillofacial radiology students. Mentimeter outperformed both the Kahoot! and the traditional method in terms of average student success rates.

Key Words: Gamification; Mentimeter; Kahoot!; Education; Dentistry

Core Tip: Gamification, the use of game materials in education, is used in several scientific fields and studies have demonstrated its effectiveness in student comprehension. Our study aimed to evaluate the impact of two different gamification applications, Mentimeter and Kahoot!, on the success of dentistry students. Gamification has a great potential in the education of dentomaxillofacial radiology students. In addition, the implementation structure has an impact on success.

INTRODUCTION

The digitalization that comes with the rapid technological development has created the need for game-based learning and technology methods that capture students' attention and accelerate their learning, instead of the traditional teaching methods[1]. To keep up with this changing technological environment, innovation and changes to basic teaching models are gaining momentum[2]. Gamification is the combination of entertainment and work to increase the participants’ motivation, i.e., using games for educational purposes. In recent years, the fact that the educational process has become more exciting and interesting for students through the use of games has popularized this term[3]. Gamification has been used in scientific fields such as medicine and engineering, and various studies have demonstrated its effectiveness in student learning[4-9]. Through the use of gamification, benefits such as improved participation, problem solving, and collaborative teamwork can be achieved[10-12].

A common problem is how to integrate these technological developments into dentomaxillofacial radiology education. Therefore, educational researchers need to test the versatility and efficiency of computer-mediated learning to clarify when and how technology-enhanced learning methods can best be used. In addition, whether these learning methods are at least as effective as traditional teaching methods should be shown[13,14]. The role of computers in dentomaxillofacial radiology is relatively more important than in other areas of dentistry. This is because modern diagnostic imaging increasingly uses digital images that can be managed, stored, and transmitted to different locations via computer networks. The advancement of internet applications in radiology makes the number of images that can be included in a computer file virtually unlimited compared to a traditional book[15,16].

Radiographic examinations are necessary for the diagnosis of oral diseases and the preparation of treatment plans. The use of panoramic radiography and cone beam computed tomography in addition to intraoral radiography has increased in recent years[17]. Audiovisual materials are frequently used in dental education, especially in clinical radiology practice. Therefore, to promote group discussions with educators in the classroom, the use of various teaching materials is preferred[18-20].

Kahoot! and Mentimeter are game-based student response systems in which the classroom is temporarily transformed into a playground, the teacher is the host of the competition, and the students are the participants[21]. Kahoot! and Mentimeter are complementary tools that help teachers create a fun learning environment and engage students in effective learning[22]. Considering the possible differences between the different tools used and the traditional methods, we aimed to use the exam scores to investigate whether 4^th- and 5^th-year dentistry students' learning capacity increases when they use the gamification applications Kahoot! and Mentimeter.

MATERIALS AND METHODS

Ethical approval

In the present study, we followed the guidelines of the Declaration of Helsinki and approval was obtained from the Clinical Research Ethics Committee of Ankara University Faculty of Dentistry with Ethical Committee (No. 36290600/01 and Decision No. 13/5 dated November 20, 2019). The students were assured that their performance in the gamification applications would not be exchanged for grades, thus avoiding any anxiety that might affect their academic performance.

Study design

In this study, an experimental design was used to determine the effect of gamification practices in classrooms where subjects were taught using the traditional method. For this purpose, Mentimeter and Kahoot! applications were used.

A total of 228 4^th- and 5^th-grade students were selected at random and divided into three groups for this research. The first group, designated as the Mentimeter group, consisted of 81 students (group 1). The second group, designated as the Kahoot! group, consisted of 68 students (group 2). Lastly, the third group, designated as the control group, consisted of 79 students (group 3). The control group included students to whom no gamification method was applied. After the teaching process, a post-test was administered to these groups to evaluate the effect of gamification on success. The post-test was a written exam with 10 questions. It is scored out of 100 points and each question is worth 10 points. The questions in the test included artifacts seen on periapical and panoramic radiographs, periapical landmarks, and topics from the 3^rd- and 4^th- year curriculum.

Proceedings

The students participating in the study were divided into three groups, and prior to the final exam, a quiz based on anatomical landmarks and pathological images was administered using Mentimeter (group 1) and Kahoot! (group 2) applications. The questions were created in a multiple choice format and using radiographic images and/or photographs. The questions were presented to the students using a projector, and they were asked to answer the relevant questions on the mobile phone versions of the application within a limited amount of time. After the quiz, the students were shown their correct answers. The control group (group 3) did not use any application other than the traditional training. The exam grades at the end of year exams were compared between the gamification and control groups to check their success.

Statistical analysis

Data analyses were performed using SPSS 26.0, with a confidence level of 95%. Frequencies (n) and percentages (%) for categorical (qualitative) variables are given. In addition, mean, standard deviation (SD), and minimum and maximum statistics for numerical (quantitative) variables are given. The skewness and kurtosis values were used to examine the conformity of quantitative variables to the normal. The kurtosis and skewness values obtained from the quantitative variables between + 3 and -3 were considered sufficient for normal distribution[23]. Accordingly, the success grade showed a normal distribution (skewness/kurtosis within limits) Parametric methods were used in the analysis.

In the present study, independent samples t-test, one-way analysis of variance (ANOVA), and LSD test were used. For the post hoc test, the LSD test was used because the group frequencies were not equal.

RESULTS

The average grade of the students at the end of the year was 66.65 ± 17.45, ranging from 24 to 100 (Figure 1).

Figure 1  Graphical display of success grade statistics.

The distribution of demographic characteristics of students by group is shown in Table 1.

Table 1 Distribution of demographic characteristics by group.

		n	%
Group	Group 1	81	35.5
	Group 2	68	29.8
	Group 3	79	34.6
	Total	228	100.0
Gender	Female	125	54.8
	Male	103	45.2
	Total	228	100.0
Grade	4th-grade	109	47.8
	5th-grade	119	52.2
	Total	228	100.0

There was a statistically significant difference in the final exam results among students whose groups (P = 0.003 < 0.05) and grades (P = 0.036 < 0.05) were different. The final exam result was the highest in group 1 (71.64), and the lowest in group 2 (62.15). Females (68.84) had a higher final exam score (Table 2).

Table 2 Comparison of success grade by group, class, and gender.

		Final exam success grade			Analysis		Within-group difference (LSD)
		n	Average	SD	Statistic	P value
Group (F)	Group 1	81	71.64	17.12	6.039	0.003	1-2
	Group 2	68	62.15	16.82			1-3
	Group 3	79	65.41	17.23
Gender (t)	Female	125	68.84	16.81	2.105	0.036
	Male	103	63.99	17.92
Grade (t)	4th-grade	109	65.00	19.39	-1.355	0.177
	5th-grade	119	68.16	15.38

F: One-way analysis of variance; t: t tests.

The difference in the final grades among the three groups was not significant (P > 0.05) (Table 3).

Table 3 Comparison of success grade by class in group separation.

Group	Grade	Exam result			Analysis
		n	Average	SD	Statistic	P value
Group 1	4th-grade	28	69.39	13.66	-0.944	0.349
	5th-grade	53	72.83	18.71
Group 2	4th-grade	40	63.35	20.28	0.782	0.485
	5th-grade	28	60.43	10.13
Group 3	4th-grade	41	63.61	21.68	-0.985	0.329
	5th-grade	38	67.34	10.50

Regarding the final exam scores, there was a statistically significant difference between males and females in group 2 (P = 0.002 < 0.05). The grade of female students was higher. In groups 1 and 3, the difference in final exam results between males and females was not statistically significant (P > 0.05) (Table 4).

Table 4 Comparison of success grade by gender in group separation.

Group	Gender	Exam result			Analysis
		n	Average	SD	Statistic	P value
Group1	Female	48	72.48	18.60	0.550	0.584
	Male	33	70.42	14.92
Group 2	Female	31	68.77	13.74	3.169	0.002
	Male	37	56.59	17.31
Group 3	Female	46	65.09	16.21	-0.193	0.848
	Male	33	65.85	18.81

DISCUSSION

The use of game design elements in non-game contexts is referred to as gamification[24]. Literature has shown that education supported by gamification practices contributes to student success in terms of participation, learning, and retention of information[25]. The radiology specialty contains a very rich source of learning material in the internet[15,16]. The fact that dentomaxillofacial radiology has many audiovisual materials, such as radiographs, made it possible to use gamification to teach this specialty[17-20].

This study aimed to investigate the impact of two distinct gamification applications on the examination performance of 4^th- and 5^th-year dentistry students. The test group exhibited the highest scores when using the Mentimeter application, while the control group demonstrated the second-highest scores. The Kahoot! group exhibited the lowest scores. The disparate effects of gamification on test success observed between the Mentimeter and Kahoot! applications may be attributed to the distinct interfaces of these applications. In the Mentimeter application, the questions and options could be simultaneously viewed on the viewer screen (Figure 2), whereas in the mobile version of the Kahoot! application, only the options were visible (Figure 3). In the case of the Kahoot! application, it was hypothesized that the inability of students to fully perceive the questions and answer options, due to the presentation screen being the only location for the questions, resulted in a significant performance drop. All inquiries posed in the applications were presented in the form of visuals. The image absence on the phone screen may have hindered the students' comprehension of the question, particularly given the limited time allotted. Furthermore, the interface of Kahoot! is more complex than that of Mentimeter, which may prove distracting for some students. Furthermore, Kahoot! presents a leaderboard among the questions, thereby fostering competition among students. While this may enhance performance for some students, it may result in decreased performance for many students. It is also noteworthy that the Kahoot! application necessitates a more robust technical infrastructure, which may result in connectivity issues. It is our contention that these interface differences contributed to the results obtained.

Figure 2 Interfaces of the Mentimeter application. A: Presentation screen; B: Audience screen.

Figure 3 Interfaces of the Kahoot! application. A: Presentation screen; B: Audience screen.

Upon examination of the study's findings, it was determined that the traditional teaching model was more effective than the teaching model utilizing the Kahoot! application. Students have different learning styles[26]. Consequently, it can be posited that non-traditional learning methods, such as gamification, may not be efficacious for all students. Nevertheless, this does not imply that gamification is ineffective. It can be said that the effective educational model may vary depending on the specific needs of the students and the course content. Consequently, it can be posited that more favorable outcomes may be attained by the integration of disparate educational techniques. Upon formation of the groups, the students were randomly assigned to their respective groups. The lack of knowledge regarding the overall success level of the students prior to the use of these applications could be considered a reason for these results and a limitation of the study. Nevertheless, the results of the Mentimeter group demonstrated the beneficial effects of gamification in education.

Rondon et al[27] compared students who received traditional training and computer-based gamification training on anatomy and physiology questions. They found that gamification increased the success rate in the short term and that there was no difference in success between the two teaching methods in the long term. Lameris et al[28] used a smartphone-based application for formative testing and investigated the impact of the application on students. As a result, they found that those who used this application achieved higher exam grades, similar to our study, and had a positive impact on learning behavior.

Aboalshamat et al[29] evaluated the effect of gamification on knowledge of antimicrobial resistance using board games. Both the results of this study and those of our study showed that the visuals in the gamification applications improved information recall compared to the control groups, and test scores increased accordingly[29]. In the study by Sandoval-Hernández et al[30] investigating the effect of different gamification resources on teaching, gamification resources such as Kahoot!, Physiotherapy Party, and Escape Room were used. According to the results of their study with 33 physiotherapy students, the Kahoot! application proved to be less effective than the other two applications[30]. Felszeghy et al[2] in their study asked medical and dentistry students questions about histologic specimens using a written questionnaire and the Kahoot! application. Contrary to our results, they reported that the use of the Kahoot! application in training increased the success rate. Given the results of previous studies and ours, it seems that gamification has a significant potential to improve learning. At this point, we believe that the features of the gamification application used play a very important role, especially the interface, and more detailed studies should be done on the effect of the differences between these applications on learning.

In their study, de Oliveira et al[31] aimed to evaluate the feasibility and effectiveness of a mobile application used by dentistry students as a complementary tool in the radiographic diagnosis of endodontic complications. This study showed that the use of the mobile application with reference images improved students' ability to diagnose endodontic complications and that it could be a valuable complementary tool in dental education. Based on the results of this study and ours, it seems that gamification applications in dentistry may have an important place in the education and development of students[31]. Therefore, gamification can be effective in the field of dentomaxillofacial radiology, though the design of the application used for this purpose and the exam design are important.

The limitations of this study include the following: The examinations required students to respond to questions pertaining to anatomical landmarks, artifacts, and oral pathology, which can only be observed on radiographs. Moreover, the content of our study was incomplete in terms of comparability due to the limited number of studies on this topic. Another limitation of this study is that the opinions and suggestions of the students were not included in the two applications. A further limitation of the study is that it only evaluated the short-term impact of gamification. It is also important to note that the study is limited by the fact that the study groups were formed without pre-testing or stratified random assignment, and the homogeneity of the groups was not known.

CONCLUSION

The results indicated that Mentimeter yielded superior outcomes in terms of student test score success compared to both Kahoot! and the traditional technique. The potential of gamification in the field of dentistry is considerable, particularly in the context of the education of students in dentomaxillofacial radiology. Nevertheless, further and more detailed studies are required to gain a full understanding of this potential and to enable the proper design, development, and implementation of gamification in real-world clinical education. It is of the utmost importance that future studies employ pre-testing or gradual random assignment in order to ensure the integrity of the data. To gain a more comprehensive understanding of the long-term effects of gamification, further studies are recommended.