The Paramedicine Board of Australia (PBA) describes a wide variety of professional capabilities required of registered paramedics in order to practice safely and competently (PBA, 2018). These capabilities depict the knowledge, skills and professional attributes that must be learned, maintained, and practiced across a diverse array of clinical settings, generally through various forms of clinical professional development.

However, knowledge and skills decay over time, and this presents a particular challenge when important skills are unable to be practiced or used with sufficient frequency (Woodman et al., 2021). Critical skills that have been found to be deficient in both professional and student paramedics include paediatric airway management (Youngquist et al., 2008) and drug calculation ability (Boyle & Eastwood, 2018; Khasawneh et al., 2020; Whitfield et al., 2020). In one study by Hill et al. (2022) a cohort of paramedics expressed low confidence and high anxiety regarding out of hospital childbirth, due to poor training, low frequency of cases, and skill decay.

At the same time, paramedics report a range of barriers to continuing professional development, including difficulty physically attending CPD events, fatigue from shift-work, financial, personal and time costs, lack of engagement with training materials (‘jumping through hoops’), and fear related to poor prior experiences of employer-facilitated training sessions due to didactic and ‘unprofessional’ teaching style (Hobbs et al., 2021).

In this setting, gamification shows potential as means to increase learner engagement and motivation with educational material, and thereby redress knowledge and skills deficits within the workforce.

For example, in their review of the health literature, van Gaalen et al. (2021) found that it is possible to improve learning outcomes in health professionals education via gamification, especially when game attributes are geared toward improving learning behaviours and attitudes towards learning. More generally, research has shown that gamification can foster intrinsic motivation, make learning more engaging, and increase knowledge retention (Putz et al., 2020).

These findings suggest that deficits in paramedic knowledge and skills, in areas such as drug calculation, out of hospital childbirth management, and paediatric airway management, might benefit from some of the purported attributes of gamification, or gamified design. Considering drug calculation ability in paramedics, for example, Khasawneh et al. (2020) found that, in addition to poor numeracy skills, mathematics anxiety was a specific barrier for paramedic students that lead to avoidance of courses or activities related to mathematics, and impeded their ability to perform drug calculations under pressure. In a study looking at gamification using the quiz game Kahoot! Stoyanova et al. (2018) found that while the gamification intervention did not affect academic performance of year 11 students with low intrinsic motivation for studying mathematics, it did positively affect their emotional state, stimulated interest and promoted learning. While the intervention did not demonstrate overt academic gains, the emotional and engagement outcomes could be considered a prerequisite to further achievement for maths avoidant participants. Similar engagement responses have been found using Kahoot! In other academic settings that involve complex, difficult and potentially mundane topics (e.g. Jones et al., 2019).

Apart from knowledge and numeracy skills, online gamified content might also assist with practical skill acquisition and retention. This may be especially relevant for paramedics who work remotely, or who cannot attend face to face training for other reasons. For example, the use of immersive virtual reality has been demonstrated to improve complex skill acquisition for orthopaedic surgeons (Lohre et al., 2021). Moreover, symbolic rehearsal involving visualisation, note taking, or drawing how to perform a task without actually performing the task has been shown to reduce the rate of skill decay (Kluge et al., 2016). Such studies suggest that immersion, facilitated by technological advancement, and cognitively engaging content – both apparent attributes of various forms of gamified design – may help promote skill development and hinder skill decay.