Medical games for students: types and how to choose

In the basic cycle, the challenge is to remember the name and the mechanism; in the internship, it is to build the differential with the preceptor waiting. The same game does not solve both things. At the beginning of the course, the common complaint is retaining content and organizing study. Years later, the difficulty changes shape: you know the subject, but the hypothesis does not appear when the case arrives out of order.

NEXO is a daily medical diagnosis game: one clinical case a day, six progressive clues, and ICD-10 proximity feedback across five levels.

This text organizes games for medical students by type, shows what studies say each type trains and proposes a way to choose according to the stage of the course. The idea is simple: before downloading another app, know which skill it exercises and whether that is the skill you need now.

Main points

• Study games in Medicine fit into five types: diagnosis by clues, virtual patient, term game, image game and flashcard with game elements.
• Each type trains a different thing: remembering facts, recognizing a visual or sound pattern, collecting data from a patient or arriving at the name of a condition.
• Virtual patients have the most extensive evidence and improved skills, among them clinical reasoning; for knowledge, they tied with traditional teaching.
• The stage of the course changes the choice: terms and flashcards in the basic cycle, image and diagnosis by clues in the clinical cycle, virtual patient and timed cases in the internship.
• A reliable game says what it trains, requires active response, explains the error and shows who reviews the content.

Summary

• Why the stage of the course changes the choice
• The types of game
• What each type trains
• Which type for each stage
• Signs of a reliable game
• How to build your combination
• Frequently asked questions
• Checklist for choosing a game

Why the stage of the course changes the choice

Medicine asks for different skills throughout the course, and a game only helps if it exercises the right skill at the right time.

In the basic cycle: name, mechanism and relationship

In the first years, much of the work is to remember terms, pathways, structures and mechanisms, and to be able to recall them weeks later. This is where the effort of remembering makes the most difference. In a randomized trial with medical students using electronic nephrology flashcards, retesting the cards already learned yielded more than restudying them on the one-week test, and the students themselves did not perceive this advantage (Schmidmaier et al., 2011). Six months later, recall was low in both groups, which shows that a good method needs to be repeated over time (Schmidmaier et al., 2011).

In the clinical cycle: from sign to name

When cases enter the curriculum, the task is reversed. The book goes from the name of the disease to the signs; the patient arrives by the signs and asks for the name. It is the phase of reading exams, recognizing patterns and building the first list of hypotheses. Image games and diagnosis by clues work precisely on this reversal.

In the internship: priority with little time

In the internship, knowing is not enough: you need to decide what to investigate first, with little time and someone asking why. Games that simulate care, such as virtual patients, and timed cases come closer to this routine. Management, priority and communication continue to be trained with people, in preceptorship and case sessions.

The types of game

The names vary from one app to another, but almost all study games in Medicine fall into one of these five types.

Diagnosis by clues

You receive a case little by little, in clues, and you need to arrive at the diagnosis. The information arrives in a fixed order, which imitates the sequence of investigation: complaint, history, physical exam, exams. This is the format of NEXO: you read up to six clues, write the diagnosis by ICD-10 and see the distance from your guess to the answer, from different chapter to exact ICD. The post What NEXO is and how the diagnosis game works shows a match step by step.

Virtual patient

A virtual patient is a digital and interactive simulation of a clinical scenario, made to teach health professionals (Kononowicz et al., 2019). The term covers quite different things: in an analysis of 330 educational articles, the most common form was the interactive patient scenario (37%), followed by high-fidelity software simulations (19%) and virtual standardized patients (16%), with virtual patient games among the least frequent forms (Kononowicz et al., 2015). In general, you choose what to ask, which tests to order and what to do, and the case responds to your choices.

Term game

These are crosswords, association games and medical vocabulary challenges. A systematic review found 29 studies on crosswords in the health professions and concluded that they are an enjoyable activity, with a positive educational impact and increased knowledge on objective measures (Arnold et al., 2024). They are useful for fixing vocabulary, drug names and definitions, and they often appear in class, as a review activity.

Image game

You see an ECG, an X-ray, a histology slide or hear an auscultation and you need to recognize the finding or the diagnosis. It is pattern training: the more examples, the faster the eye and the ear separate the normal from the altered. In NEXO, the Multimedia mode brings cases with image, audio and other tests, such as X-ray, CT, ultrasound, ECG, histopathology and cardiac and respiratory auscultation, in the same format of up to six clues.

Flashcard with game elements

These are question and answer cards, often with spaced repetition, points, daily goals or competition. Anki is the best-known example of a flashcard with spaced repetition, without being a game as such. Another example is spaced question games: in a trial with urologists from 63 countries, questions sent by email, with a relative scoreboard among participants, were well accepted, and 76% of those enrolled asked to take part in future games (Kerfoot and Baker, 2012).

What each type trains

Studies on each type measure different things, in different populations. Reading what each one measured helps you not to expect from a game what it was not made to give.

Virtual patient: skills and reasoning

In the meta-analysis of randomized trials on virtual patients, they tied with traditional teaching in knowledge (standardized difference of 0.11) and were better in skills (0.90), among them clinical reasoning, with low to moderate quality evidence (Kononowicz et al., 2019). A systematic review focused on medical students found a positive effect on clinical reasoning in 11 of 19 studies; data gathering and ideas about the diagnosis improved more consistently than general measures of problem solving (Plackett et al., 2022). An earlier meta-analysis shows the importance of the comparison: against not studying, the effects were large; against teaching without a computer, they were close to zero (Cook et al., 2010).

Image and sound: recognizing the pattern

In ECG teaching, a meta-analysis with students and residents compared computer-assisted teaching with in-person teaching and found no overall difference in the competence acquired; combined teaching, in-person plus computer, was better than in-person alone, especially with free access to the material and deliberate practice with feedback (Viljoen et al., 2019). In cardiac auscultation, simulation had large effects when compared with no intervention: 1.10 in knowledge and 0.87 in skill, and hands-on practice with the simulator seemed important (McKinney et al., 2013). In histology, virtual microscopy had a small and positive effect on performance compared with light microscopy (standardized difference of 0.28), with wide variation between studies, and it was preferred by students (Wilson et al., 2016).

Terms and flashcards: remembering with effort

For facts and vocabulary, the central mechanism is testing memory. Tested flashcards again yielded more than restudying in one week, in medical students (Schmidmaier et al., 2011). In a study with 72 students from a school in the United States, the number of unique Anki cards seen and the number of questions done were associated with the licensing exam score: every 1,700 cards or 445 questions were associated with one more point (Deng et al., 2015). Another study, by questionnaire, also associated Anki use with higher scores on the same exam (Lu et al., 2021). These are associations, not causal effects measured in a trial. Crossword puzzles increased knowledge on objective measures in the systematic review on the topic (Arnold et al., 2024).

Diagnosis by clues: the most used format in teaching reasoning

Presenting the case little by little, in serial clues, is the most used format in teaching clinical reasoning, and its effectiveness compared with the case presented in full is an open research question (Schmidt and Mamede, 2015). To study this format, NEXO maintains the NEXO Researcher program, open to researchers and institutions.

The types side by side

Type	What it trains	What the studies show
Diagnosis by clues	Reaching the name of the condition from the findings, in the order of investigation	Most used format in teaching reasoning; effectiveness compared in study (Schmidt and Mamede, 2015)
Virtual patient	Collect data, order tests, decide	Better in skills (0.90), equal in knowledge (0.11) compared with traditional teaching (Kononowicz, 2019)
Term game	Vocabulary, definitions, drug names	Greater knowledge on objective measures, in 29 studies (Arnold, 2024)
Image game	Recognizing patterns in ECG, image, slide and auscultation	Simulated auscultation with large effects against no intervention (McKinney, 2013); combined ECG better than in-person only (Viljoen, 2019)
Flashcard with game elements	Remembering facts with effort and spacing	Retesting better than restudying in one week (Schmidmaier, 2011); use associated with exam score (Deng, 2015)

A systematic review of randomized trials on serious games and gamification in the health professions did not find enough evidence to say that one type of game is more effective than another, and rated the quality of the evidence as low or very low (Gentry et al., 2019). The choice, therefore, depends more on the skill you want to train than on a ranking of types. To understand what the studies say about gamification in general, the post Gamificação no ensino médico: o que a evidência mostra gathers the reviews.

Which type for each phase

The table below is an editorial guideline, built from what each type trains. Studies rarely separate the basic cycle, clinical cycle and internship, and a scoping review on serious games pointed out the need for games and studies aimed at postgraduate education (Haoran et al., 2019).

Phase	The main challenge	Types that help most	How to use
Basic cycle	Retaining names, pathways and mechanisms	Flashcard, term game, histology image	Daily cards with spacing; terms as class review; slides to train the eye
Clinical cycle	Going from the sign to the name and reading tests	Diagnosis by clues, image game, virtual patient	One case per day; ECG and image with explanation; virtual patient to collect data
Internship	Prioritizing hypotheses with little time	Virtual patient, diagnosis by clues with time	Short cases during breaks in the shift; discussing management with the preceptor
Review for exams	Keeping everything alive at the same time	Flashcard, question bank, diagnosis by clues	Mixing areas; taking the case error to the cards

Basic cycle in practice

Start with the cards and the term games, which exercise recall of facts. When a mechanism is solid, look for a case in which it appears as a sign: it is the first contact with the logic of diagnosis. In NEXO, the daily case serves this purpose from the first year, because each case ends with a clinical explanation that links the condition to the mechanism.

Clinical cycle and internship in practice

In the clinical cycle, replace some of the cards with cases: one case per day with the list of hypotheses written before each clue. On internship shifts, NEXO's Adrenaline mode, with a case against the clock, and Multimedia, with an exam to interpret, bring training closer to the routine. The Archive gathers the previous daily cases to train in volume a specialty in which you made more mistakes.

Review for exams in practice

In the final stretch, the goal changes from learning to maintaining. The cards hold the facts, the question bank trains the exam format and the cases mix areas, which forces you to recognize the picture without knowing in advance which chapter it comes from. Use the mistakes from the cases as a map: the specialty in which you make the most mistakes in the Archive is the first candidate for the next block of questions.

Signs of a reliable game

Before putting a game into your routine, it is worth looking at some signs. They apply to any type.

The objective and the pedagogical strategy are clear

A systematic review on serious games in medical education evaluated the pedagogical strategy of the games and the quality of the evidence about them; the evidence of effectiveness was considered moderate by the MERSQI score, and the games appear as a complement, without replacing traditional teaching tools (Gorbanev et al., 2018). A good game says what it trains and how.

The game requires an active answer and explains the mistake

The types with clearer evidence are those that make you produce an answer and receive correction: retesting the cards (Schmidmaier et al., 2011) and practicing ECG with feedback (Viljoen et al., 2019). Look for games that show why the answer was right or wrong.

The content has review and the game has validation

In a review on serious games in medical and surgical education, six of the 30 games had gone through some validation process, and none had completed it for the intended use (Graafland et al., 2012). Ask who writes and who reviews the cases. At NEXO, doctors from each specialty review the cases in their area through the NEXO Curator program.

The game shows what you still do not know

A good game returns a picture of your performance: which topics you make the most mistakes in, how long you take, what type of mistake you make. In deliberate practice with feedback, this picture is what guides the next study block, and combined ECG teaching yielded more precisely when there was practice with feedback (Viljoen et al., 2019). Be wary of games that only show points and never show the mistake.

The comparison of the studies makes sense

A game that "works" against studying nothing can tie with a good class. In virtual patients, the effects were large against no intervention and close to zero against teaching without a computer (Cook et al., 2010). When a game cites studies, see what it was compared with.

How to put together your combination

No single type covers everything, and the right combination changes with the phase. A balanced week usually has a little of each thing.

A possible week in the clinical cycle

1. Every day: the daily case, with the list of hypotheses written before each clue.
2. Every day: the day's review cards, including the diagnoses you got wrong in the cases.
3. Twice a week: a block of ECG or imaging with explanation, or a few cases from Multimedia.
4. Once a week: a virtual patient or a case session with the class, to train data collection and management.
5. At the end of the week: the Archive, with the cases from the specialty in which you made the most mistakes.

A possible week in the basic cycle

1. Every day: the review cards for the semester's subjects, with increasing intervals.
2. After each class: a terms or association game with the new vocabulary.
3. Twice a week: a block of histology slides or images with explanation.
4. Every day, in a few minutes: the daily case, reading the clinical explanation to link the picture to the mechanism you studied.
5. At the end of the week: review the terms and mechanisms that appeared in the cases and that you still could not explain.

A possible week in the internship

1. Every day: study from the day's patient and record the doubt that remained.
2. During breaks on the shift: a short case, with the hypothesis written before each clue, or Adrenaline, with the case against the clock.
3. Twice a week: ECG, imaging or auscultation, in Multimedia or in the service's material.
4. Once a week: present a case to the preceptor and ask them to point out the reasoning mistake.
5. At the end of the week: take to your cards the diagnoses you got wrong or guessed right.

Where NEXO comes in

In NEXO, you train diagnosis with up to six clues in the daily case, reasoning against the clock in Adrenaline, image and sound patterns in Multimedia, regional epidemiology in Continents and volume in the Archive. The Anki button creates the card straight from NEXO and opens it in the Anki app, searches the cards you already have and, when the case has an image, takes the image to the card, which links the case to your review cards. To learn how the limits of each mode work, see the NEXO economy page. If you want to bring the game to your medical school, league or residency, check out NEXO Closer; if you create Medicine content, NEXO Creators.

Frequently asked questions

What are the types of games for medical students?

Diagnosis from clues, virtual patient, terminology game, image game (ECG, X-ray, slide, auscultation) and flashcard with game elements. The term "virtual patient" alone covers very different formats, from the interactive scenario to high-fidelity simulation (Kononowicz et al., 2015).

Which type of game is best for studying Medicine?

It depends on what you want to train. The review of randomized trials found insufficient evidence to say that one type is superior to another (Gentry et al., 2019). For facts, flashcards tested again (Schmidmaier et al., 2011); for skills and reasoning, virtual patients (Kononowicz et al., 2019); for patterns, image and auscultation practice with feedback (McKinney et al., 2013).

Do games replace the question bank and the books?

Games work as a complement: the review on serious games describes them as tools complementary to traditional ones (Gorbanev et al., 2018). The book provides the basis, the question bank trains the exam format and the game exercises a specific skill.

How can NEXO help at each stage of the course?

In the basic cycle, the daily case links the mechanism studied to the clinical sign, with an explanation at the end of each case. In the clinical cycle, cases with up to six clues train going from the sign to the name, and Multimedia trains exams and auscultation. In the internship, Adrenaline brings the case against the clock. To research the effect of the format, check out NEXO Researcher.

How much time a day is worth dedicating to games?

A little every day usually fits the routine better than a lot at once. Studies on testing memory recommend frequent tests spaced over time (Larsen et al., 2008), and the NEXO daily case fits in the minutes before class. The game should take up a small part of studying, alongside the book, the questions and clinical practice.

How to choose a reliable game?

See if it says what it trains, if it requires an active answer, if it explains the error and who reviews the content. Validation is the weakest point of serious games (Graafland et al., 2012), so prefer games that show who signs and reviews the cases.

Checklist for choosing a game

1. Name the skill you want to train now: remember, recognize, collect data or reach the diagnosis.
2. Choose the type that trains that skill.
3. Prefer an active answer, in which you produce the answer.
4. Check whether the error is explained, and read the explanation even when you get it right.
5. See who reviews the content and whether the game cites the studies on the methods it uses.
6. Combine types throughout the week, instead of betting on just one.
7. Take the error to review, in your cards or in your notebook.
8. Reassess at each stage of the course, because the skill you need changes.

Want to start with diagnosis from clues? Play today's case in NEXO.

References

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