The State of Play in Physiology Education: Igniting Active Learning through Game-Based Learning and Gamification Research and Practices

Game-based learning (GBL) and gamification have emerged as promising pedagogical strategies in physiology education, leveraging play to enhance student engagement and conceptual understanding. This review examines the current studies (2020-2025) implementing games across diverse physiological domains, with multi-system integration and cardiovascular topics predominating. While GBL emphasizes experiential learning through complete game experiences, gamification applies discrete game elements to motivate task completion. Physical formats dominate, though digital adoption increased post-pandemic. Despite widespread enthusiasm, methodological rigor remains limited: most studies employed quasi-experimental designs with self-reported outcomes and minimal psychometric validation. Critical gaps include insufficient transparency in game materials, limited assessment of higher-order thinking, and narrow participant diversity. Future advances require theory-driven design, rigorous evaluation frameworks, and open sharing of educational resources to establish evidence-based best practices. • Game-based learning and gamification in physiology education appear effective in fostering student engagement; however, evidence supporting their impact on long-term learning outcomes remains inconclusive. • Empirical evidence is critically synthesized to evaluate not only learning gains but also methodological rigor, theoretical grounding, and alignment between game mechanics and physiological content. • The review advances a research agenda that emphasizes theory-driven design, stronger experimental controls, multimodal assessment (including cognitive and behavioral measures), and replication across diverse educational contexts. • Practical implications are articulated for physiology educators, instructional designers, and researchers, translating design principles into actionable strategies while identifying common pitfalls in implementation and evaluation.