This study is designed to evaluate the effect of gamification-based teaching strategies on learning outcomes and student engagement in undergraduate oral pathology education. Traditional didactic teaching methods in dental education are often associated with passive learning and variable student engagement. In response, educational gamification has emerged as an innovative pedagogical approach that integrates game elements into learning activities to enhance motivation, participation, and knowledge retention.

This study employs a crossover interventional design involving undergraduate dental students enrolled in an Oral Pathology course. Participants will be exposed to both traditional teaching methods and gamified learning interventions in a structured sequence, allowing each participant to serve as their own control. The gamified intervention includes the use of an online game designed on Genially to reinforce key concepts in Oral Pathology. The traditional control arm consists of standard lecture-based instruction without gamification elements.

The primary objective of this study is to compare knowledge acquisition between gamified and traditional teaching approaches, measured through standardized assessments administered after each intervention phase. Secondary objectives include evaluating student engagement, satisfaction, and perception of learning effectiveness using validated structured questionnaires.

The study aims to determine whether gamification enhances academic performance and improves student engagement compared to conventional teaching methods. It also seeks to explore student perceptions of innovative teaching strategies and their potential integration into the dental curriculum.

Data will be collected at multiple time points corresponding to each phase of the crossover design. Statistical analysis will compare outcomes between intervention periods, accounting for within-subject variability. The findings are expected to provide evidence-based insights into the effectiveness of gamification in dental education and support curriculum development strategies aimed at improving active learning and student-centered teaching approaches.

This study addresses an important gap in dental education research by systematically evaluating gamification using a controlled crossover design, providing robust comparative data between traditional and innovative teaching methods in oral pathology education.

This study evaluates the effect of gamification-based teaching strategies on learning outcomes and student engagement in undergraduate Oral Pathology education. Traditional lecture-based teaching in dental curricula is widely used; however, it is often associated with passive learning, limited interaction, and variable student engagement. In contrast, gamification integrates game design elements into educational activities to enhance motivation, participation, and active learning.

Study Design Randomized controlled crossover experimental design to compare a gamified learning intervention with a traditional revision approach. This design allows each participant to act as their own control, thereby minimizing inter-individual variability and strengthening internal validity.

Study Setting and Participants The study is conducted among third-year dental students enrolled in the Oral Pathology course, Faculty of Dentistry, Pharos University in Alexandria during spring semester of the academic year 2026. Participants are informed about the study objectives, and a written informed consent is obtained prior to their inclusion.

Data Collection Data collection was carried out during the period from February to April 2026. The data is collected via Google Forms, through face-to-face sessions, or during scheduled tutorials under standardized conditions to ensure consistency and reliability of responses.

Data Collection Tools

1. Demographic Questionnaire: The demographic questionnaire is developed to collect age, gender, cumulative GPA, secondary school education and parental educational level.
2. Learning Style Inventory: The validated VARK questionnaire (Version 9.0) is used to categorize students' learning preferences
3. Gamified Learning Tool: Two custom-designed digital games are designed on Genially(reference). To reduce content related confounding and to enhance the reliability of comparisons across the two intervention phases, a single Oral Pathology topic "White Lesions of the Oral Cavity" is selected for the study. The topic is deliberately divided into two equivalent parts: White Lesions-Part I (WL1) and White Lesions- Part II (WL2), each covering distinct but comparable subtopics with similar learning objectives and cognitive demands.
4. Traditional Revision Session: Standardized PowerPoint slides and instructor-led case discussions covering the same content and learning objectives as the interventional session.
5. Knowledge Assessment Tests: Four parallel, pre-validated versions of a test consisting of 10 Multiple-Choice Questions; including 2 pre-tests (WL1 and WL2) and 2 post-tests (WL1 and WL2).
6. Satisfaction and Engagement Survey: A mixed-methods survey incorporating a 5-point Likert scale to quantify enjoyment, perceived learning, and engagement, adapted from the DREEM framework is used.
7. Focus Groups: Focus groups with a selected number of students (e.g. 20 students) to collect detailed qualitative feedback and further ideas for improvement.

Data Collection Procedures Week 0 (Baseline): Informed consent, demographic questionnaire, and VARK inventory. Cluster Randomization: Participants are randomly assigned to Group A or Group B.

• Week 1 (Phase I) Group A (Intervention): Pre-test → Game → Immediate Post-test on WL1. Group B (Control): Pre-test → Traditional Revision → Immediate Post-test on topic WL1.
• Week 3 (Phase II) - Groups cross over and repeat the process with WL2. Group B (Intervention): Pre-test → Game → Immediate Post-test on WL2.

Group A (Control): Pre-test → Traditional Revision → Immediate Post-test on topic WL2.

• Week 5 All participants complete a comprehensive delayed post-test on WL1 to assess long-term retention.
• Week 7 All participants complete a comprehensive delayed post-test on WL2 to assess long-term retention.

All participants complete the Satisfaction and Engagement Survey. A selected number of students are included in focus groups to collect qualitative feedback.

Data Analysis Data is analyzed using SPSS (Version 28). A p-value < 0.05 is considered significant.

1. Descriptive statistics for demographics.
2. A mixed-model repeated measures ANOVA will be used to analyze knowledge scores, accounting for the crossover design(21).
3. Satisfaction/Engagement: Mann-Whitney U tests will compare satisfaction scores. Qualitative feedback will be analyzed using thematic analysis.
4. Moderating Role of Learning Styles: An interaction term (Learning Style * Intervention Type) will be added to the ANOVA model to test for moderation.
5. Gender, cumulative GPA, socio-cultural status, parental educational level, and school education will be included as covariates in the primary analysis (ANCOVA).

Inclusion Criteria:

All third-year students enrolled in the Oral Pathology course during the Spring semester, 2026.

Exclusion Criteria:

1. Students with previous exposure to the course will be excluded from the study; those who have previously taken the course and failed the exam, or those who are retaking the course to improve their grade.
2. Students who haven't completed General Pathology, General Histology or Oral Biology courses will be excluded from the study.
3. Students with learning difficulties- as determined by Special Cases Coordinator in the faculty- such as dyslexic or bipolar students will be excluded from the current study.
4. Students who were absent during one or more of the intervention sessions.
5. Students who did not consent to participate in the study.

Outcomes assessor was blinded to the intervention (game) when creating the assessment. Also the investigator was blinded to the assessments while creating the games to avoid bias.