{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T11:56:10Z","timestamp":1791460570037,"version":"4.3.4"},"reference-count":39,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Copenhagen Capital Region Postdoctorate Research Fund"},{"name":"Herlev and Gentofte Hospital Research Fund","id":[{"id":"https:\/\/ror.org\/051dzw862","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Skin cancer incidence is rising, as is the focus on efficient, evidence-based diagnostic training. However, proficiency in skin cancer diagnosis requires years of practice, and methods to accelerate learning are therefore necessary. Gamification \u2013 integration of game-like mechanics \u2013 is a promising method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the effects of gamification \u2013 in the form of leaderboards showing participants\u2019 ranking \u2013 on the amount of training and skill acquisition in medical students through directed, self-regulated, virtual training.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a nationwide randomized controlled trial, participants were randomized to either the gamification or control group, both of which had access to a quiz-based dermatology diagnosis training platform. The gamification group received a daily leaderboard showing rank, based on points earned through training. Diagnostic skills were assessed via validated 12-case pretests and post-tests. Data were analysed using linear mixed models and t-tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy-one participants were included; 34 556 assessments were completed. The gamification group trained 3.3 times as many cases as the control group: 785 [95% confidence interval (CI) 437\u20131134] vs. 240 (95% CI 154\u2013325); P &amp;lt; 0.01. There was no significant difference in diagnostic skill improvement: 0.12 points out of 12 (95% CI \u22120.7 to 1.3) vs. 0.65 points out of 12 (95% CI \u22120.2 to 1.5), respectively; P = 0.40. The changes were 2.2% and 14.3%, respectively, relative to baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Gamification led to substantially increased training volume, without improving skill acquisition. This may be explained by a shift in focus towards leaderboard placement, diminishing motivation to internalize learning content. Improved understanding of evidence-based dermatology training \u2013 namely the most efficient methods for reaching proficiency \u2013 is needed and requires further large, randomized trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ced\/llag384","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:23:07Z","timestamp":1788780187000},"source":"Crossref","is-referenced-by-count":0,"title":["Gamification of dermatology diagnostics training: a nationwide, randomized controlled trial of 34 556 cases"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0059-3590","authenticated-orcid":false,"given":"Sigrid I P","family":"Kristensen","sequence":"first","affiliation":[{"name":"CAMES \u2013 Copenhagen Academy for Medical Education and Simulation, Rigshospitalet , Copenhagen ,","place":["Denmark"]},{"name":"Department of Plastic and Reconstructive Surgery, Herlev and Gentofte Hospital, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels K","family":"Ternov","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Herlev and Gentofte Hospital, University of Copenhagen , Copenhagen ,","place":["Denmark"]},{"name":"Department of Otorhinolaryngology, Rigshospitalet , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustav G","family":"Nervil","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Herlev and Gentofte Hospital, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven A W","family":"Andersen","sequence":"additional","affiliation":[{"name":"CAMES \u2013 Copenhagen Academy for Medical Education and Simulation, Rigshospitalet , Copenhagen ,","place":["Denmark"]},{"name":"Department of Otorhinolaryngology, Rigshospitalet , Copenhagen ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascale","family":"Guitera","sequence":"additional","affiliation":[{"name":"EADV Task Force for Artificial Intelligence in Dermatology , Mendrisio ,","place":["Switzerland"]},{"name":"Melanoma Institute Australia and the Faculty of Medicine and Health, The University of Sydney, and the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital , Camperdown, NSW ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph P","family":"Braun","sequence":"additional","affiliation":[{"name":"EADV Task Force for Artificial Intelligence in Dermatology , Mendrisio ,","place":["Switzerland"]},{"name":"University of Z\u00fcrich and Derma Utoquai , Z\u00fcrich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Konge","sequence":"additional","affiliation":[{"name":"CAMES \u2013 Copenhagen Academy for Medical Education and Simulation, Rigshospitalet , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Navarrete-Dechent","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile , Santiago ,","place":["Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisbet R","family":"H\u00f6lmich","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Herlev and Gentofte Hospital, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Frend\u00f8","sequence":"additional","affiliation":[{"name":"CAMES \u2013 Copenhagen Academy for Medical Education and Simulation, Rigshospitalet , Copenhagen ,","place":["Denmark"]},{"name":"Department of Plastic and Breast Surgery, Zealand University Hospital , Roskilde ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"2026100807220182700_llag384-B1","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1080\/15384047.2019.1640032","article-title":"Current state of melanoma diagnosis and treatment","volume":"20","author":"Davis","year":"2019","journal-title":"Cancer Biol Ther"},{"key":"2026100807220182700_llag384-B2","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1111\/jdv.18050","article-title":"Prevalence of most common skin diseases in Europe: a population-based study","volume":"36","author":"Richard","year":"2022","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2026100807220182700_llag384-B3"},{"key":"2026100807220182700_llag384-B4","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s00403-020-02097-8","article-title":"Reliable test of clinicians\u2019 mastery in skin cancer diagnostics","volume":"313","author":"Ternov","year":"2021","journal-title":"Arch Dermatol Res"},{"key":"2026100807220182700_llag384-B5","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1001\/jama.2011.1234","article-title":"Technology-enhanced simulation for health professions education: a systematic review and meta-analysis","volume":"306","author":"Cook","year":"2011","journal-title":"JAMA"},{"issue":"10 Suppl.","key":"2026100807220182700_llag384-B6","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1097\/ACM.0b013e3181ed4c96","article-title":"A new concept of unsupervised learning: directed self-guided learning in the health professions","volume":"85","author":"Brydges","year":"2010","journal-title":"Acad Med"},{"key":"2026100807220182700_llag384-B7","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1111\/j.1365-2923.2012.04268.x","article-title":"Directed self-regulated learning versus instructor-regulated learning in simulation training","volume":"46","author":"Brydges","year":"2012","journal-title":"Med Educ"},{"key":"2026100807220182700_llag384-B8","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1080\/01421590500046924","article-title":"Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review","volume":"27","author":"Issenberg","year":"2005","journal-title":"Med Teach"},{"key":"2026100807220182700_llag384-B9","doi-asserted-by":"crossref","DOI":"10.2196\/48357","article-title":"Improving skin cancer diagnostics through a mobile app with a large interactive image repository: randomized controlled trial","volume":"6","author":"Nervil","year":"2023","journal-title":"JMIR Dermatol"},{"key":"2026100807220182700_llag384-B10","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.joto.2019.12.003","article-title":"Understanding the effects of structured self-assessment in directed, self-regulated simulation-based training of mastoidectomy: a mixed methods study","volume":"15","author":"Andersen","year":"2020","journal-title":"J Otol"},{"key":"2026100807220182700_llag384-B11","doi-asserted-by":"crossref","first-page":"e867","DOI":"10.3109\/0142159X.2012.714886","article-title":"Comparative effectiveness of instructional design features in simulation-based education: systematic review and meta-analysis","volume":"35","author":"Cook","year":"2013","journal-title":"Med Teach"},{"key":"2026100807220182700_llag384-B12","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1097\/MAO.0000000000002541","article-title":"Decentralized virtual reality training of mastoidectomy improves cadaver dissection performance: a prospective, controlled cohort study","volume":"41","author":"Frend\u00f8","year":"2020","journal-title":"Otol Neurotol"},{"key":"2026100807220182700_llag384-B13","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1007\/s10459-020-10000-3","article-title":"Gamification of health professions education: a systematic review","volume":"26","author":"van Gaalen","year":"2021","journal-title":"Adv Health Sci Educ Theory Pract"},{"key":"2026100807220182700_llag384-B14","author":"Deterding"},{"key":"2026100807220182700_llag384-B15","doi-asserted-by":"crossref","DOI":"10.2196\/14746","article-title":"Leaderboard design principles to enhance learning and motivation in a gamified educational environment: development study","volume":"9","author":"Park","year":"2021","journal-title":"JMIR Serious Games"},{"key":"2026100807220182700_llag384-B16","first-page":"e562","article-title":"Gamification and serious games in dermatology education: a systematic review and quality assessment","volume":"38","author":"Kristensen","year":"2023","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2026100807220182700_llag384-B17","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1093\/ced\/llae375","article-title":"Use of game-based learning strategies for dermatology and dermoscopy education: a cross-sectional survey of members of the International Dermoscopy Society","volume":"50","author":"Donoso","year":"2025","journal-title":"Clin Exp Dermatol"},{"key":"2026100807220182700_llag384-B18","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s41077-016-0025-y","article-title":"Reporting guidelines for health care simulation research: extensions to the CONSORT and STROBE statements","volume":"1","author":"Cheng","year":"2016","journal-title":"Adv Simul"},{"key":"2026100807220182700_llag384-B19","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ijnurstu.2014.09.006","article-title":"Basic statistical reporting for articles published in biomedical journals: the \u2018Statistical Analyses and Methods in the Published Literature\u2019 or the SAMPL Guidelines","volume":"52","author":"Lang","year":"2015","journal-title":"Int J Nurs Stud"},{"key":"2026100807220182700_llag384-B20"},{"key":"2026100807220182700_llag384-B21","article-title":"Effect of histopathological explanations for dermoscopic criteria on learning curves in skin cancer training: a randomized controlled trial","volume":"13","author":"Ternov","year":"2023","journal-title":"Dermatol Pract Concept"},{"key":"2026100807220182700_llag384-B22","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/S40037-015-0160-5","article-title":"Data analysis in medical education research: a multilevel perspective","volume":"4","author":"Leppink","year":"2015","journal-title":"Perspect Med Educ"},{"key":"2026100807220182700_llag384-B23","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1097\/ACM.0000000000000681","article-title":"Learning curves in health professions education","volume":"90","author":"Pusic","year":"2015","journal-title":"Acad Med"},{"key":"2026100807220182700_llag384-B24","first-page":"3025","volume-title":"Proceedings of the Annual Hawaii International Conference on System","author":"Hamari","year":"2014"},{"key":"2026100807220182700_llag384-B25","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1111\/medu.13074","article-title":"Motivation to learn: an overview of contemporary theories","volume":"50","author":"Cook","year":"2016","journal-title":"Med Educ"},{"key":"2026100807220182700_llag384-B26","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1093\/ced\/llad177","article-title":"Gamified learning in dermatology and dermoscopy education: a paradigm shift","volume":"48","author":"Donoso","year":"2023","journal-title":"Clin Exp Dermatol"},{"key":"2026100807220182700_llag384-B27","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1037\/0003-066X.55.1.68","article-title":"Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being","volume":"55","author":"Ryan","year":"2000","journal-title":"Am Psychol"},{"key":"2026100807220182700_llag384-B28","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1177\/0146167296221003","article-title":"Elements of the competitive situation that affect intrinsic motivation","volume":"22","author":"Reeve","year":"1996","journal-title":"Pers Soc Psychol"},{"key":"2026100807220182700_llag384-B29","first-page":"22","article-title":"Gamification and multimedia for medical education: a landscape review","volume":"116","author":"McCoy","year":"2016","journal-title":"J Am Osteopath Assoc"},{"key":"2026100807220182700_llag384-B30","doi-asserted-by":"crossref","DOI":"10.2196\/12994","article-title":"Serious gaming and gamification education in health professions: systematic review","volume":"21","author":"Gentry","year":"2019","journal-title":"J Med Internet Res"},{"key":"2026100807220182700_llag384-B31","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1007\/s00464-016-5152-y","article-title":"A serious game skills competition increases voluntary usage and proficiency of a virtual reality laparoscopic simulator during first-year surgical residents\u2019 simulation curriculum","volume":"31","author":"El-Beheiry","year":"2017","journal-title":"Surg Endosc"},{"key":"2026100807220182700_llag384-B32","doi-asserted-by":"crossref","first-page":"447","DOI":"10.3109\/0142159X.2014.888409","article-title":"Fun, collaboration and formative assessment: skinquizition, a class wide gaming competition in a medical school with a large class","volume":"36","author":"Schlegel","year":"2014","journal-title":"Med Teach"},{"key":"2026100807220182700_llag384-B33","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.jdin.2024.03.008","article-title":"Gamification of dermatoscopy education using a smartphone mobile platform: a pilot study","volume":"16","author":"Aponso","year":"2024","journal-title":"JAAD Int"},{"key":"2026100807220182700_llag384-B34","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s00405-021-06632-9","article-title":"Assessing competence in cochlear implant surgery using the newly developed Cochlear Implant Surgery Assessment Tool","volume":"279","author":"Frend\u00f8","year":"2022","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"2026100807220182700_llag384-B35","first-page":"343","article-title":"Removing gamification: a research agenda","author":"Seaborn","year":"2021","journal-title":"Extended Abstracts of the 2021 CHI Conference on Human Factors in Computing Systems"},{"key":"2026100807220182700_llag384-B36","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1080\/10447318.2020.1870828","article-title":"The more, the merrier? How adding and removing game design elements impact motivation and performance in a gamification environment","volume":"37","author":"Groening","year":"2021","journal-title":"Int J Hum Comput Interact"},{"key":"2026100807220182700_llag384-B37","doi-asserted-by":"crossref","first-page":"219","DOI":"10.5152\/iao.2022.21429","article-title":"Cochlear implant surgery: virtual reality simulation training and transfer of skills to cadaver dissection \u2013 a randomized, controlled trial","volume":"18","author":"Frend\u00f8","year":"2022","journal-title":"J Int Adv Otol"},{"key":"2026100807220182700_llag384-B38","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1111\/j.1553-2712.2008.00227.x","article-title":"Deliberate practice and acquisition of expert performance: a general overview","volume":"15","author":"Anders Ericsson","year":"2008","journal-title":"Acad Emerg Med"},{"key":"2026100807220182700_llag384-B39","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1097\/ACM.0b013e3182308d37","article-title":"Medical education featuring mastery learning with deliberate practice can lead to better health for individuals and populations","volume":"86","author":"McGaghie","year":"2011","journal-title":"Acad Med"}],"container-title":["Clinical and Experimental Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ced\/advance-article-pdf\/doi\/10.1093\/ced\/llag384\/71188239\/llag384.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ced\/advance-article-pdf\/doi\/10.1093\/ced\/llag384\/71188239\/llag384.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T11:22:15Z","timestamp":1791458535000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ced\/advance-article\/doi\/10.1093\/ced\/llag384\/8812161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":39,"URL":"https:\/\/doi.org\/10.1093\/ced\/llag384","relation":{},"ISSN":["0307-6938","1365-2230"],"issn-type":[{"value":"0307-6938","type":"print"},{"value":"1365-2230","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"article-number":"llag384"}}