Ethics in educational game design: what to avoid
Table of contents
Imagine any study app, in a generic example, that sends a notification at 11 pm: "Your streak will end in one hour!". The student, exhausted after a shift, opens the app, answers three questions without thinking and goes to sleep relieved. They learned nothing that night, but the app logged one more day of use. Who benefited from that?
NEXO is a daily medical diagnosis game: one clinical case a day, six progressive clues, and ICD-10 proximity feedback across five levels.
Games and game elements can make studying lighter and more frequent. The same features, used another way, can hold the user's attention without teaching, create anxiety or push decisions the user would not make calmly. This guide explains what so-called dark patterns are, what research shows about unpredictable rewards and manipulative design, which warning signs to look for in an educational game and what a design that respects learners would look like.
Key points
- Dark patterns are design choices that lead the user to act in favor of whoever created the product, not in their own favor.
- Unpredictable and frequent rewards play a central role in digital products associated with compulsive behavior.
- Manipulative design was found often in apps used by young children.
- Spending on random reward boxes in games is associated with gambling problems.
- An ethical educational game measures success by learning, not only by time spent using it.
What dark patterns are
A definition
Dark patterns are interface features that influence user behavior to the benefit of whoever designed the product (McGarrigle et al., 2026). They exploit shortcuts in thinking: haste, fear of missing out, laziness about changing a setting, the desire for approval.
Also in health apps
A review of digital health apps shows that developers use these features, intentionally or not, to lead users to specific decisions, especially in apps without official approval (Mildner et al., 2024). The authors call for more transparency for users and more attention from regulators, so that people gain autonomy and have their data better protected (Mildner et al., 2024).
Common examples
- Artificial urgency: countdowns and "last chance" warnings with no real reason.
- Selective friction: signing up is easy, leaving or turning off notifications is hard.
- Abusive default settings: everything on from the start, in favor of maximum use.
- Guilt and social pressure: messages that make the user feel bad for stopping.
- Unpredictable rewards: random prizes that encourage coming back just to see what comes next.
Rewards that hold you
The logic of variability
A review of behavioral addictions describes how the intermittent nature of rewards in gambling, which arrive at unpredictable intervals, can activate learning processes similar to those of chemical addictions (Clark and Zack, 2023). The authors show that similar sources of variability appear in other digital products, including games, shopping and social media, and that online access adds new forms, such as infinite scrolling and personalized recommendations (Clark and Zack, 2023).
Frequency and uncertainty
The same review points to two factors that increase the effect: the time until the uncertainty is resolved and the frequency of exposure (Clark and Zack, 2023). The faster and more frequent the cycle of expectation and reward, the greater the potential to hold the user (Clark and Zack, 2023).
What this means in an educational game
Game elements are not the problem in themselves. Points, levels and achievements can give structure and a sense of progress. The problem starts when the prize is no longer tied to learning and becomes just a reason to come back. A chest of random rewards for opening the app teaches you to open the app, and nothing more.
What research found
Reward boxes and gambling
Random reward boxes, common in video games, are items bought with real money whose contents are randomized. In a survey of 1,172 players who did not know the aim of the study, the researchers confirmed the association between the amount spent on these boxes and the severity of gambling problems (Zendle and Cairns, 2019). The authors consider two explanations: the boxes could act as a gateway to gambling, or people with gambling problems could be drawn to spend more on them (Zendle and Cairns, 2019).
Another study, with 2,728 players, found very strong evidence of a correlation between spending on these boxes and gambling problems, with no relation to mental well-being or psychological distress (Etchells et al., 2022). Those who spent on reward boxes also tended to spend more on other digital purchases (Etchells et al., 2022).
Apps for children
In a study with 160 children aged 3 to 5, the researchers played and analyzed the apps each child used most (Radesky et al., 2022). Features to prolong play appeared often: navigation restrictions in 45.9% of the apps and attractive lures in 45.1% (Radesky et al., 2022). Children from families with less parental education were more exposed to this type of design (Radesky et al., 2022).
Online betting
A scoping review on online betting gathered 16 articles and listed patterns such as hidden spending control tools, bonuses with complicated conditions, a minimum balance to withdraw, difficulty closing the account and urgency messages (McGarrigle et al., 2026). The authors warn that the potential for harm is clear, but that data on the effect on behavior is lacking, partly because companies do not open their data (McGarrigle et al., 2026).
Health tools with other interests
An analysis of digital tools about alcohol consumption funded by the beverage industry found misinformation and dark patterns throughout these tools (Roy-Highley et al., 2024). Only 33% of them gave accurate feedback to the user, against 100% of independent tools (Roy-Highley et al., 2024). The lesson for education: who funds a tool and who benefits from it matters.
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Warning signs in an educational game
The game punishes those who stop
Guilt messages, losing everything earned through a day away and insistent late-night reminders turn studying into an anxious obligation. A break from studying should be something normal, not a defeat.
The reward has no relation to the content
If you earn more points for opening the app than for answering a difficult question correctly, the game is rewarding use, not learning.
Too much luck
Random prizes, roulette wheels and surprise boxes bring the logic of betting into studying. In board games, which have their own guide in this series, the balance between luck and knowledge also matters.
Constant comparison
Rankings can motivate, but when they appear all the time and only show who is ahead, they discourage most people and encourage shortcuts. An optional ranking, by groups or compared with your own previous performance, tends to be healthier.
Hard to leave
If turning off notifications, deleting the account or exporting your data is much harder than signing up, be suspicious.
Promises and numbers without context
Games that say "raise your grade" without showing evidence, or that display usage statistics as if they were measures of learning, mix marketing and education.
How to protect yourself as a student
Turn off notifications that arrive outside the hours when you study. Decide in advance how much time you want to spend on the app each day and stop when you get there, even if the streak or the ranking ask for more. From time to time, ask yourself whether what you do in the game shows up in exams, on shifts and in reasoning with patients. If the answer is no, change the tool or change how you use it.
What ethical design would look like
Learning as the main metric
An ethical educational game measures its own success by what the user learns: correct answers on new questions, retention over time, improvement in reasoning. Time of use and number of sessions are secondary data.
Rewards tied to effort
Points and achievements should reflect completed tasks and difficulty overcome. Predictable, explained rewards help the user understand their own progress.
Autonomy
The user decides when to study, which notifications to receive and how much time to devote. Moderate default settings that are easy to change respect this autonomy. Transparency about data, advocated for health apps (Mildner et al., 2024), also applies to study games.
Accepted breaks
Good design recognizes that medical students have shifts, exams and fatigue. Streaks that tolerate absences, reminders at reasonable times and messages that welcome those who return after a few days favor long-term study.
Care for those who are most vulnerable
Studies with children and with gambling show that manipulative design affects most those with fewer resources to defend themselves (Radesky et al., 2022). In medical education, this includes students who are anxious, exhausted or in exam weeks. Ethical design thinks of them first.
Questions for those who create
- Does this feature help the user learn or just come back?
- Would I use this feature if I were tired after a shift?
- Does the user understand why they received this reward?
- Are leaving, pausing and turning off as easy as entering?
Learning at your own pace with NEXO
A study game should fit into the routine of those who study. The NEXO case of the day is fictional, with a real clinical presentation, and the diagnosis arrives in up to six clues, with ICD-10 proximity showing how far each guess was. Each clue is clinical information, and the reward is reaching the diagnosis with fewer clues.
The guide what NEXO is explains the whole match, and the release of modes is on the NEXO Economy page.
If you coordinate a medical school, a student league or a residency and want cases for your class, see NEXO Closer. Researchers in medical education can propose studies through NEXO Researcher. Physicians who review cases take part through NEXO Curator, and those who create health content on social media can take part through NEXO Creators.
Frequently asked questions
What are dark patterns?
Interface features that influence user behavior for the benefit of whoever designed the product (McGarrigle et al., 2026).
Is gamification bad?
Game elements can help when rewards are tied to learning. The problem is using them only to hold the user.
Why are random rewards a concern?
Unpredictable and frequent rewards play a central role in digital products associated with compulsive behavior (Clark and Zack, 2023).
Are reward boxes related to gambling?
Studies with thousands of players found an association between spending on these boxes and gambling problems (Etchells et al., 2022).
How to recognize a manipulative educational game?
Guilt for stopping, prizes unrelated to the content, too much luck, constant comparison and difficulty leaving.
What does ethical design do?
It measures success by learning, ties rewards to effort, respects autonomy and accepts breaks.
Ethical design checklist
- Measure learning, not just usage.
- Tie rewards to tasks and difficulty.
- Avoid prize draws.
- Accept breaks without punishment.
- Send reminders at reasonable times.
- Make leaving as easy as entering.
- Be transparent about data and funding.
- Think first of those who are tired or anxious.
Want to study at your own pace with one clinical case per day? Play the case of the day on NEXO.
References
- McGarrigle J, Smith J, Griffiths J, Torrance J, Quigley M, Dymond S. Dark patterns in online gambling: A scoping review and classification of deceptive design practices. J Behav Addict. 2026. https://pubmed.ncbi.nlm.nih.gov/41493466/
- Mildner T, Savino GL, Schöning J, Malaka R. ["Dark patterns": manipulative design strategies in digital health applications]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2024. https://pubmed.ncbi.nlm.nih.gov/38332141/
- Clark L, Zack M. Engineered highs: Reward variability and frequency as potential prerequisites of behavioural addiction. Addict Behav. 2023. https://pubmed.ncbi.nlm.nih.gov/36701907/
- Zendle D, Cairns P. Loot boxes are again linked to problem gambling: Results of a replication study. PLoS One. 2019. https://pubmed.ncbi.nlm.nih.gov/30845155/
- Etchells PJ, Morgan AL, Quintana DS. Loot box spending is associated with problem gambling but not mental wellbeing. R Soc Open Sci. 2022. https://pubmed.ncbi.nlm.nih.gov/35991334/
- Radesky J, Hiniker A, McLaren C, Akgun E, Schaller A, Weeks HM, et al. Prevalence and Characteristics of Manipulative Design in Mobile Applications Used by Children. JAMA Netw Open. 2022. https://pubmed.ncbi.nlm.nih.gov/35713902/
- Roy-Highley E, Körner K, Mulrenan C, Petticrew M. Dark patterns, dark nudges, sludge and misinformation: alcohol industry apps and digital tools. Health Promot Int. 2024. https://pubmed.ncbi.nlm.nih.gov/39377424/