{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T23:52:04Z","timestamp":1790034724790,"version":"4.0.1"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Gamification has rapidly proliferated across medical education, promising enhanced engagement, improved knowledge retention, and more motivated learners. Yet the uncritical embrace of game mechanics in contexts defined by human suffering raises profound questions that the field has largely failed to confront. This critical essay first proposes a typology distinguishing gamification, serious games, and game-based learning to identify which specific design elements pose the greatest ethical risks in which learning contexts. It then examines the philosophical and empirical tensions inherent in translating patient pain, vulnerability, and existential distress into point systems, leaderboards, and competitive challenges. Drawing on Nussbaum\u2019s objectification framework, Buber\u2019s I-Thou philosophy, evidence from systematic reviews, and the well-documented phenomenon of empathy decline during medical training, this essay argues that competitive, rewards-driven gamification, when applied to clinical scenarios without structured reflection, risks accelerating the very dehumanization it sometimes claims to counteract. The essay acknowledges that cooperative, narrative-driven, and perspective-taking game designs can support empathy development, and proposes concrete ethical guidelines for educators seeking to balance innovation with humanistic values.<\/jats:p>","DOI":"10.3389\/fmed.2026.1810141","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T04:46:16Z","timestamp":1775018776000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["When suffering becomes a game: a critical examination of gamification in medical education and its implications for compassion and empathy"],"prefix":"10.3389","volume":"13","author":[{"given":"Changiz","family":"Mohiyeddini","sequence":"first","affiliation":[{"name":"Oakland University William Beaumont School of Medicine","place":["Rochester, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"103993","DOI":"10.1016\/j.nepr.2024.103993","article-title":"Rising gamification in health education: a bibliometric study.","volume":"78","author":"Y\u0131ld\u0131","year":"2024","journal-title":"Nurse Educ Pract."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e10794","DOI":"10.1002\/aet2.10794","article-title":"Much ado about gaming: an educator\u2019s guide to serious games and gamification in medical education.","volume":"6","author":"Watsjold","year":"2022","journal-title":"AEM Educ Train."},{"key":"B3","doi-asserted-by":"publisher","first-page":"96","DOI":"10.6224\/JN.201802_65(1).13","article-title":"Applying game-based learning in nursing education: empathy board game learning.","volume":"65","author":"Lu","year":"2018","journal-title":"J Nurs."},{"key":"B4","doi-asserted-by":"publisher","first-page":"106409","DOI":"10.1016\/j.nedt.2024.106409","article-title":"Empathy development through game-based learning: an investigative study on nursing professionals.","volume":"144","author":"Mohan","year":"2025","journal-title":"Nurse Educ Today."},{"key":"B5","doi-asserted-by":"publisher","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":"B6","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s12909-023-04955-1","article-title":"Reflecting on gamified learning in medical education: a systematic literature review grounded in the Structure of Observed Learning Outcomes (SOLO) taxonomy 2012\u20132022","volume":"24","author":"Huang","year":"2024","journal-title":"BMC Med Educ."},{"key":"B7","doi-asserted-by":"publisher","first-page":"168","DOI":"10.3390\/info17020168","article-title":"Gamification in digital mental health interventions: a systematic review of the engagement\u2013efficacy\u2013ethics trilemma.","volume":"17","author":"Ngabo-Woods","year":"2025","journal-title":"Information."},{"key":"B8","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1186\/s12909-025-07044-7","article-title":"Emerging trends in gamification for clinical reasoning education: a scoping review.","volume":"25","author":"Lee","year":"2025","journal-title":"BMC Med Educ."},{"key":"B9","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1111\/j.1088-4963.1995.tb00032.x","article-title":"Objectification.","volume":"24","author":"Nussbaum","year":"1995","journal-title":"Philos Public Affairs."},{"key":"B10","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1093\/jmp\/jhad007","article-title":"The phenomenology of objectification in and through medical practice and technology development.","volume":"48","author":"Svenaeus","year":"2023","journal-title":"J Med Philos."},{"key":"B11","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1097\/ACM.0b013e318221e615","article-title":"Empathy decline and its reasons: a systematic review of studies with medical students and residents.","volume":"86","author":"Neumann","year":"2011","journal-title":"Acad Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1097\/ACM.0000000000003175","article-title":"Does empathy decline in the clinical phase of medical education? 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