1 Introduction

Lectures and master classes remain among the most widely used educational methods due to their efficiency in delivering large volumes of information to a broad audience. This approach can reduce cognitive load by organising content in a structured and systematic manner (Charlton 2006; Dietrich and Evans 2022; Kay et al. 2019). However, learners often struggle to maintain active attention during the lecture (Davis 2009), particularly Generation Z students (the majority of learners at dental schools), who prefer personalised and innovative learning methods over passive instruction (Ismail and Mohammad 2017), as well as technology-enhanced and interactive learning environments (Eckleberry-Hunt et al. 2018; Shorey et al. 2021) At the same time, while digital fluency may facilitate learning, excessive use of mobile devices has also been associated with reduced attention span and academic performance (Siyami et al. 2023).

Research suggests that active student engagement enhances understanding and can positively impact knowledge acquisition (Zheng and Ferreira 2021). Active learning is defined as any instructional method that requires students to meaningfully engage with activities while reflecting on their actions (Bonwell and Eison 1991). This is particularly effective in small-group settings, like postgraduate programmes with a limited number of students, where it promotes active student participation and fosters a collaborative partnership between professors/tutors and students in the educational process (Plasschaert et al. 2007).

In parallel, key principles of andragogy suggest that adult learners benefit most from instructional approaches that are self-directed, experience-based, goal-oriented and intrinsically motivating. Within this framework, gamification has emerged as a suitable instructional method that supports autonomy, motivation and meaningful learning (Bigdeli et al. 2023; Plass et al. 2015). Gamification is defined as the use of design elements characteristic of games in non-game contexts (Deterding et al. 2011). Unlike games, gamification is driven by a more serious objective. It involves the introduction of game-like aspects to non-game tasks and contexts. Game-based learning and serious games, on the other hand, refer to the application of full-featured games (Krath et al. 2021). The use of different game-based strategies adapted for educational activities has been implemented in dental education, positively impacting learning outcomes (Felszeghy et al. 2019; Nguyen et al. 2023; Sharmin and Chow 2023). In particular, game-based activities improved motivation (Griffith et al. 1983; Perez et al. 2023; Sharmin and Chow 2023), a fundamental precondition for effective learning as supported by constructivist learning theories (Krath et al. 2021; Rohman and Fauziati 2022). At the same time, several studies have reported that gamification is as efficient as other methods in achieving educational goals, allowing for the review and integration of knowledge through fun and engaging hands-on activities (Cooperride and Whitney 2000; Castro et al. 2019). Additionally, game-based strategies foster interactive learning environments that engage learners effectively while enhancing their knowledge, motivation and satisfaction (Cooperride and Whitney 2000; Ferreri and O'Connor 2013). Students prefer collaborative learning (Godwin-Jones 2014), and the open design of gaming strategies may accommodate this preference. All these benefits are particularly relevant in postgraduate education, where students are typically adults and digital native learners who may benefit from more autonomous and interactive approaches (Liu et al. 2020), although it must be acknowledged that students integrate knowledge in different ways and not all students may benefit the same from active learning strategies (Cassidy 2010).

At the same time, learning endodontic terminology can be a challenging task for students. While terminology acquisition is considered the lowest level of Bloom's taxonomy, it serves as the foundation for the development of higher-order cognitive processes (Ormell 1974; Adams 2015). In postgraduate education, mastery of domain-specific vocabulary is essential for effective clinical communication and advance learning; however, traditional memorization techniques using strategies like recitation can lead to boredom or anxiety and are associated with reduced long-term retention (Blondé et al. 2022; Urrizola et al. 2023). In contrast, game-based strategies for vocabulary learning have been shown to reduce anxiety while increasing student motivation and interest (Griffith et al. 1983; Wei et al. 2018; Zhonggen 2018; Zeybek and Saygı 2024).

Therefore, the aim of this pilot study was to assess the effectiveness of a game-based educational strategy for learning endodontic terminology and evaluate the satisfaction among postgraduate students.

2 Materials and Methods

Approval for the study (CE_20230413-03_SAL) was sought from the Institutional Review Board (IRB) of Complutense University, and exemption was granted to allow the study to be carried out on first- and second-year students on the postgraduate programme in Endodontology.

2.3 Intervention

Students were not informed of the activity beforehand to ensure that no prior preparation or study could influence the outcome. To maintain the element of surprise and avoid drawing attention to the activity, a separate set of lectures was scheduled for the session. Upon arrival in the classroom, students were invited to participate and were presented with an informed consent form outlining the nature of the activity and the potential use of anonymized aggregated data for publication. The rules of the game were then explained, and the activity was carried out after students had voluntarily agreed to participate and demonstrated understanding of how the game worked.

Students in the same cohort were then randomly allocated to different groups. The two teams composed of first-year students played first. Each team was given a maximum of 2 min to answer the set of questions. A coin toss determined which team would start.

Teams alternated turns, with one contestant representing each team in each round. As shown in Figure 1, a hula-hoop displaying all the letters of the alphabet was used as a visual and functional aid. The contestant currently playing held the hula-hoop to be distinguished from the other team members. Definitions were read aloud by an instructor in a clear and comprehensible manner, beginning with the letter A and proceeding sequentially through the alphabet. Contestants were required to identify the correct term corresponding to each definition. A correct answer allowed the team to continue; if a contestant passed or answered incorrectly, the timer was paused and control passed to the opposite team. When play resumed, the team continued from the letter immediately following the one on which they had previously passed or erred. Play continued until teams completed all 26 questions or exhausted their allocated time. If one team ran out of time, the other continued playing alone, with the option to pass, although the timer no longer stopped for passes. The winning team was determined by the highest number of correct answers. In the event of a tie, the team that completed their set of questions faster won. Figure 2 represents a schematic representation of the game-based educational activity.

3 Results

A total of 12 students participated in the study (16.7% males and 83.3% females).

4 Discussion

This study investigated the potential utility of applying constructivist principles to a postgraduate endodontic programme in relation to teaching endodontic terminology. Gamified classroom dynamics transforms passive lessons into interactive sessions with visual and audio stimuli. In these sessions, students become active participants, while the instructor takes on the role of a facilitator, motivating students' interaction (Wang and Tahir 2020). This plays into the constructivist theory by promoting learners' autonomy, active engagement and knowledge construction through personal experience, with the teacher serving as a facilitator in the students' journey toward deeper understanding (Rohman and Fauziati 2022). In fact, motivation is influenced by factors such as control, challenge, curiosity and self-determination. The use of game-based strategies that track personal scores and rank participants enhance intrinsic motivation by encouraging students to perform well in competitive environments (Castro et al. 2019).

Contemporary students are strongly influenced by digital technology and tend to prefer interactive and technology-enhanced learning environments over traditional methods (Shorey et al. 2021; Siyami et al. 2023). The results of the present study showed that students were able to recall challenging terminology, even the terms that they had failed to identify during the educational session, even 1 year after the game-based learning activity. Furthermore, these students demonstrated a significantly higher level of knowledge acquisition compared to a prior cohort used as retrospective controls. Therefore, this research suggests that game-based learning can effectively support educational plans as it increases students' engagement and their interest. This can be attributed to the fact that gamification provides a fun and entertaining incentive, leading to high student satisfaction (Rodrigez-Andres et al. 2017; Sipiyaruk et al. 2018). However, the results of the study should be interpreted with caution, since this educational strategy was piloted within a postgraduate programme; and hence, with a small sample size. At the same time, the limited number of enrolled students made it feasible to conduct an initial evaluation and collect preliminary data for an adequate power analysis before implementing the strategy with undergraduate students in a future study.

Some other limitations were identified during the design of the educational activity. First, by including two different cohorts of students (first- and second-year), the instructor needed to classify endodontic terminology into two different levels of difficulty, which was a challenging task. Second, the set of questions was built randomly, and students might have preferred the other set of questions. However, as demonstrated during the assessment, students benefited equally from questions assigned to their own team, to opposing teams, and even to other cohorts. In fact, efforts were made to ensure an equal representation of questions from each set in the tests.

The feedback received from the satisfaction survey was also very insightful. All students completed the survey. Notably, 91.7% of students rated their overall satisfaction as 10, and 100% and 83.3% of first- and second-year participants (respectively) strongly agreed that they learned terminology that they did not know previously. When inquired about their best perceptions of the activity, students shared highly positive comments. One student described the activity as both didactic and fun, noting that it helped reinforce concepts and allowed them to learn from their own mistakes. Another student expressed surprise at the large amount of terminology covered in a single session, while another highlighted the eagerness to learn with the method and the enthusiasm of both participants and instructors. The students also reported that this pilot educational game was a valuable experience, helping them recall and apply knowledge while promoting teamwork. Finally, one student characterised the game-based activity as clear, concise, and consistent.

The meta-analysis published by Baptista and Oliveira (2019) identified that perceived usefulness, enjoyment and attitude were key predictors of engagement in gamified learning activities. Similarly, Krath et al. (2021) systematically reviewed the theoretical foundations of gamification and concluded that its effectiveness is linked to mechanisms such as feedback, autonomy and adaptive complexity, all of which are aligned with self-determination and constructivist learning principles. Thus, broader theoretical principles of effective instructional design might explain the success of the present intervention and the high levels of satisfaction observed in the participants. However, dental-specific research remains comparatively underrepresented. Most publications are centered on medical and nursing educational environments, with only 3.77% of reviewed articles studying gamification in dental education (Lee et al. 2025). Moreover, there is a high heterogeneity between published articles, mainly regarding games design and outcomes (Lee et al. 2025). Therefore, further studies are needed to confirm that gamification has enough benefits over other methods since educators might need to be trained before game-based learning is institutionalised in educational programmes (Godwin-Jones 2014).

On the other hand, the negative feedback primarily concerned the unexpected nature of the activity. In order to prevent students from preparing in advance, they were not informed about the activity beforehand, and the evaluation dates were deliberately omitted from the informed consent. This approach was clearly described in the protocol submitted to the IRB, which did not raise any objections and granted an exemption. Students likely expected the test to occur at the end of the academic year and might have achieved better results had they been explicitly informed about the activity beforehand or the evaluation schedule. However, from the authors' perspective, it seemed interesting to isolate the potential effect of the educational strategy. Moreover, given that terminology is essential for everyday interactions with both peers and patients, evaluating casual retention was deemed important. In fact, the results of the tests demonstrated a positive impact of the game-based strategy in short- and long-term retention of endodontic terminology. The questions included in the tests were drawn from the pool of those used during the session, so good results shortly after the activity were expected. Students learned thorough simple competition with their peers. A positive finding emerged in the follow-up test 1 year after the initial activity, students also demonstrated retention over a longer period, indicating the lasting impact of the game-based learning strategy. However, while the human need to self-assess and compare to others can have a motivational effect in the learning experience, it can also be a negative motivator and have detrimental effects depending on the context (Krath et al. 2021).

Moreover, it must be acknowledged that participants' broader clinical and didactic experiences over the programme period may also have contributed to their knowledge acquisition. This limitation is common in gamification research where long-term, isolated outcome assessment is challenging (Lee et al. 2025) and prevents attributing all learning gains solely to the gamified intervention. Future studies trying to isolate the effect of the intervention with extended follow-ups are needed.

Although incorporating games as a learning method has proven significant advantages, it is still not a tool commonly used. This may be due to a lack of knowledge about its benefits and the substantial effort required to organise an educational game, which demands significant involvement from both students and instructors. However, despite the more complicated preparation process, the non-presential workload for students could be reduced, as they may need less time to achieve the same learning outcome (Scott 2003).

The present study supports findings from previous research. Aubeux et al. (2020) conducted an endodontic-themed escape game activity with undergraduate students, resulting also in high scores and high levels of satisfaction. Incorporating game-based learning could potentially be a successful learning experience. However, the incorporation of such activities may not work equally well for all instructors. No formal evaluation of the instructors' performance or attitude towards gamification was conducted; however, the instructors who designed the present study also conducted the activity and have strong commitment with active learning methodologies. Victoroff and Hogan (2006) demonstrated that the personal qualities of the instructor such as approachability, enthusiasm and willingness to provide guidance and feedback, contribute to effective learning experiences. Additionally, specific instructor skills like checking in with students and employing an interactive teaching style might be key factors in successful learning. Given the overall satisfaction reported by students in the present and previous studies when using game-based educational strategies, future studies should explore their potential further. Universities should also consider providing additional training for instructors to foster active student engagement through these methods.

5 Conclusions

The high test scores and positive satisfaction ratings observed in both student cohorts suggest that game-based educational strategies offer an innovative and practical complement to traditional methods for memorising endodontic terminology.

Author Contributions

Conceptualization: I.F.-G., A.A.; methodology: I.F.-G., P.R., A.A.; formal analysis: A.A.; investigation: I.F.-G., P.R., A.A.; data curation: I.F.-G., A.A.; writing – original draft preparation: I.F.-G., P.R., A.A.; writing – review and editing: A.A.; supervision: A.A. All authors have read and agreed to the published version of the manuscript. All authors contributed to the present manuscript. This study was selected for presentation in the ESE Education Prize category in 2023.

Conflicts of Interest

The authors declare no conflicts of interest.