# Are Serious Games an Effective Teaching Tool in Anatomy Education? A Systematic Review
## 4 Discussion  
With the rise of innovative learning tools, the use of games has gained significant popularity in recent years, particularly in medical education. Over the past few years, there has been growing research evidence investigating the effect of games as a pedagogical method. Several studies incorporated gamification or serious games in health science education, aiming to enhance the learning process and outcomes [25; 26; 27; 28]. However, despite growing interest in gamification and serious games, their application in anatomy education remains limited and fragmented. This systematic review aimed to investigate the role of serious games in teaching anatomy to undergraduates across different health specialties. A key observation in this review was the exclusive use of serious games across the included studies, despite the broader literature often conflating serious games and gamification. This overlap may arise from inconsistent definitions, where serious games involve fully functional games designed for educational purposes, while gamification integrates game elements into non-game contexts. The lack of clarity in some studies, where gamified approaches may have been mislabeled as serious games, highlights the importance of precise terminology. Future research must adopt standardized definitions to ensure accurate evaluation and reporting, thereby fostering consistency in this emerging field. The selection of anatomical branches and game designs varied significantly among studies, likely reflecting differences in students' levels, specialties, and the complexity of the game. For example, games focusing on neuroanatomy [10; 24] incorporated unique interactive features such as brain assembly tasks and functional exercises. [PERSON] et al. [24] developed a virtual reality-based game, while [PERSON] et al. [10] had a storyline with a main character. The player is requested to help the main character '[PERSON]' assemble his brain parts through an interactive scenario, with impeded clues to the answers. Similarly, histology-focused games demonstrated innovative approaches to engagement, such as customizable backgrounds, music, and avatars [21; 23]. However, the underrepresentation of certain branches, such as gross anatomy, highlights the need for targeted development to address challenging concepts like anatomical nomenclature and spatial relationships. Furthermore, these examples reveal a lack of consistent design principles or a focus on addressing the specific challenges of anatomy education, such as the complexity of spatial relationships and anatomical nomenclature [11]. Without a unified approach, the effectiveness of these \begin{table}
\begin{tabular}{l l} \hline
**Positive Outcomes Reported** & **Study** \\ \hline \multirow{4}{*}{Enhance knowledge acquisition} & [PERSON] et al., 2023 [23] \\  & [PERSON] et al., 2020 [24] \\  & [PERSON] et al., 2017 [10] \\  & [PERSON], 2016 [13] \\ \hline \multirow{4}{*}{Engagement} & [PERSON] et al., 2023 [1] \\  & [PERSON] et al., 2022 [3] \\  & [PERSON] et al., 2020 [16] \\  & [PERSON], 2018 [21] \\  & [PERSON] \& [PERSON], 2013 [20] \\ \hline \multirow{2}{*}{Positive feedback and impression} & [PERSON] et al., 2022 [12] \\  & [PERSON] et al., 2017 [10] \\ \hline Complementary learning tool & [PERSON] et al., 2022 [22] \\ \hline Team collaboration & [PERSON], 2018 [21] \\ \hline Modify study habits & [PERSON] et al., 2015 [15] \\ \hline Increase task completion rate & [PERSON] \& [PERSON], 2013 [20] \\ \hline \end{tabular}
\end{table} 
Table 3: Positive learning outcomes of serious games. tools remains difficult to compare or generalize. A systematic approach to designing games based on learner needs and curriculum demands could bridge these gaps. While most studies assessed the impact of serious games on knowledge acquisition, few explored broader outcomes such as engagement, motivation, or long-term retention. These dimensions are critical for understanding the full potential of serious games as educational tools [29].