{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:55:03Z","timestamp":1790747703597,"version":"4.1.0"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"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>\n                    Large-group lectures (150 students and upwards) remain a central component of healthcare professions education despite longstanding concerns about passivity, limited interaction, and difficulties in providing formative feedback at scale. These concerns have acquired renewed relevance as educators face digitally connected student cohorts, ubiquitous smartphones, and growing concerns about digital distraction. Student response systems (SRS), initially introduced through dedicated \u201cclickers\u201d and now commonly accessed through students\u2019 own digital devices, offer one approach to transforming the large lecture from a predominantly transmission-oriented format into an interactive learning environment. Meta-analytic evidence indicates positive effects of SRS on cognitive and non-cognitive learning outcomes, while research across psychology, nursing, medicine, dentistry, and other higher education settings suggests that their educational value depends less on the technology itself than on the pedagogical processes it enables. In this\n                    <jats:italic>Perspective<\/jats:italic>\n                    , we argue for a shift from viewing SRS primarily as engagement technology towards understanding it as pedagogical infrastructure for retrieval, formative assessment, peer discussion, feedback, self-monitoring, and metacognitive calibration in large lectures. Drawing on nearly two decades of research and educational experience with response technology, we propose an evolution from\n                    <jats:italic>SRS 1.0<\/jats:italic>\n                    , centred on response and participation, through\n                    <jats:italic>SRS 2.0<\/jats:italic>\n                    , centred on formative feedback and dialogue, towards\n                    <jats:italic>SRS 3.0<\/jats:italic>\n                    , where artificial intelligence may enable adaptive questioning, misconception detection, personalised feedback, and instructor decision support. This development creates new opportunities for healthcare professions education, but also requires renewed attention to pedagogy, digital competence, privacy, cognitive offloading, and the role of the educator.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2026.1967058","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:56:39Z","timestamp":1790744199000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the clicker: rethinking student response systems as pedagogical infrastructure for healthcare professions education"],"prefix":"10.3389","volume":"13","author":[{"given":"Rune Johan","family":"Krumsvik","sequence":"first","affiliation":[{"name":"University of Bergen, Faculty of Psychology","place":["Bergen, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vegard","family":"Slettvoll","sequence":"additional","affiliation":[{"name":"University of Bergen, Faculty of Medicine","place":["Bergen, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"36","DOI":"10.18261\/ISSN1891-943X-2012-01-04","article-title":"Formative e-assessment in plenary lectures","volume":"7","author":"Krumsvik","year":"2012","journal-title":"Nordic J Digit Lit"},{"key":"B2","doi-asserted-by":"publisher","first-page":"78","DOI":"10.5172\/ijpl.2013.8.2.78","article-title":"Theoretical and methodological issues of formative e-assessment in plenary lectures","volume":"8","author":"Krumsvik","year":"2013","journal-title":"Int J Pedagogies Learn"},{"key":"B3","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.compedu.2015.04.002","article-title":"Creating formative feedback spaces in large lectures","volume":"88","author":"Ludvigsen","year":"2015","journal-title":"Comput Educ"},{"key":"B4","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s10639-015-9437-x","article-title":"Clickers and formative feedback at university lectures","volume":"22","author":"Egelandsdal","year":"2017","journal-title":"Educ Inf Technol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"19","DOI":"10.18261\/issn.1891-943x-2017-01-02-03","article-title":"Peer discussions and response technology: short interventions, considerable gains","volume":"12","author":"Egelandsdal","year":"2017","journal-title":"Nordic J Digit Lit"},{"key":"B6","doi-asserted-by":"publisher","first-page":"69","DOI":"10.18261\/issn.1891-943x-2019-01-02-06","article-title":"Clicker interventions at university lectures and the feedback gap","volume":"14","author":"Egelandsdal","year":"2019","journal-title":"Nordic J Digit Lit"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2478","DOI":"10.1111\/bjet.12922","article-title":"Behind the scenes: unpacking student discussion and critical reflection in lectures","volume":"51","author":"Ludvigsen","year":"2020","journal-title":"Br J Educ Technol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"37","DOI":"10.18261\/issn.1891-943x-2019-01-02-04","article-title":"Nursing students\u2019 experiences with the use of a student response system when learning physiology","volume":"14","author":"Bingen","year":"2019","journal-title":"Nordic J Digit Lit"},{"key":"B9","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.compedu.2015.11.013","article-title":"A meta-analysis of the effects of audience response systems (clicker-based technologies) on cognition and affect","volume":"94","author":"Hunsu","year":"2016","journal-title":"Comput Educ"},{"key":"B10","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.compedu.2016.02.007","article-title":"Measuring the effect of ARS on academic performance: a global meta-analysis","volume":"96","author":"Castillo-Manzano","year":"2016","journal-title":"Comput Educ"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.edurev.2015.10.003","article-title":"Do we click in the right way? A meta-analytic review of clicker-integrated instruction","volume":"17","author":"Chien","year":"2016","journal-title":"Educ Res Rev"},{"key":"B12","doi-asserted-by":"publisher","first-page":"4550","DOI":"10.1080\/10447318.2023.2228526","article-title":"Re-examining the effect of audience response systems on learning outcomes: evidence from the last decade","volume":"40","author":"Akbay","year":"2024","journal-title":"Int J Hum Comput Interact"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e386","DOI":"10.3109\/0142159X.2012.680938","article-title":"The effects of audience response systems on learning outcomes in health professions education. A BEME systematic review: bEME guide no. 21","volume":"34","author":"Nelson","year":"2012","journal-title":"Med Teach"},{"key":"B14","doi-asserted-by":"publisher","first-page":"103896","DOI":"10.1016\/j.compedu.2020.103896","article-title":"A systematic review of audience response systems for teaching and learning in higher education: the student experience","volume":"153","author":"Wood","year":"2020","journal-title":"Comput Educ"},{"key":"B15","doi-asserted-by":"publisher","first-page":"164","DOI":"10.56373\/2021-2-8","article-title":"Bruk av responsteknologi i forelesninger: erfaringer fra \u00abpraksisstudiet\u00bb ved UiBs tannlegeutdanning","volume":"132","author":"Krumsvik","year":"2021","journal-title":"Nor Tannlegeforen Tid"},{"key":"B16","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1080\/03069400.2024.2335033","article-title":"Student-active lectures in legal education","volume":"58","author":"Egelandsdal","year":"2024","journal-title":"Law Teach"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/s10758-026-09955-w","article-title":"Student response systems (SRS): a game changer in college classrooms?\u2014an explorative study of technology-enhanced learning","author":"Jacobsen","year":"2026","journal-title":"Technol Knowl Learn"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1967058\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:56:39Z","timestamp":1790744199000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1967058\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":17,"alternative-id":["10.3389\/fmed.2026.1967058"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1967058","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"1967058"}}