# Are Serious Games an Effective Teaching Tool in Anatomy Education? A Systematic Review
## 5 Future Directions  
Future work should focus on well-crafted randomized clinical trials to effectively evaluate the impact of using serious games in anatomy teaching with combined qualitative and quantitative evaluation tools. We recommend building upon the existing games and applying them on a larger scale across different populations with long-term follow-up for a comprehensive analysis. This is crucial in understanding the lasting impact of serious games on anatomy learning. It is also encouraged to compare these developed games to the different anatomy teaching aids, such as cadavers, plastinated specimens, 3D models, virtual dissection apps, and artificial intelligence techniques. Additionally, serious games development should be planned based on educational theory and integrated into existing pedagogies. A well-designed future study exploring the effectiveness of serious games for learning new knowledge or the rehearsal/revision of skills and/or knowledge is warranted. Several studies in this review addressed components of the MDA (Mechanics, Dynamics, Aesthetics) framework, which provides a useful tool for analyzing the design elements of serious games [30,31]. Mechanics focus on the game components, whether related to data presentation or design algorithms (including maps, avatars, models, and timers). Dynamics are run-time behaviors based on inputs from the mechanics (for example, feedback, rewards, notifications, and personalizations). Aesthetics are the emotions and responses evoked in the players, such as competitiveness, challenges, or fantasy [31]. For instance, scoreboards and leaderboard elements represent competitive challenges [15,20], while personalization features and animated models have also been integrated [10,16,23]. However, the overall application of this framework remains inconsistent. Future research could benefit from more systematic adherence to tools like MDA, thereby supporting comparability and rigor in anatomy education. Serious game development in anatomy has also begun incorporating artificial intelligence (AI). [PERSON] et al. proposed an online platform that delivers a gamified learning tool, enhanced by AI-based recommendation systems and a virtual assistant by evaluating usability and user satisfaction; they demonstrated the potential of AI-driven strategies to personalize learning experiences for medical students [9]. Beyond technical innovation, new online platforms offer means for the broader dissemination and iterative improvement of such games. [PERSON] et al., for example, deployed their serious game publicly and collected feedback from thousands of users, which allowed them to refine game design and increase generalizability [12]. University learning platforms such as Moodle represent another avenue for the larger-scale dissemination of serious games, enabling more controlled evaluations during initial implementation. Future research should concentrate on common definitions and frameworks--like MDA--to improve comparability across studies and address the issues raised in this review. To ensure the reliability and generalizability of results, methodological rigor must be strengthened by designing robust studies with larger sample sizes, incorporating control groups, and using standardized outcome measures. Furthermore, along with conventional assessments of knowledge acquisition, the scope of evaluation should be expanded to include broader outcome indicators, such as student engagement, motivation, and long-term retention. A systematic approach to integrating serious games into existing institutional e-learning platforms would allow for wider dissemination and controlled evaluation. In addition, investigating AI-driven innovations could help customize learning experiences while addressing concerns related to cost, accessibility, and ethics. Future studies that prioritize these areas can facilitate the effective design and implementation of serious games in anatomy education.