Game-based interventions for development of medical competencies and entrustable professional activities: an integrative review

Abstract

ABSTRACT Introduction: Contemporary medical education is undergoing a paradigmatic transition from the traditional time-based model to competency-based curricula and Entrustable Professional Activities (EPA). Given the non-linear and multidimensional nature of medical acts, there is a need for instruments that develop synthesis capacity and clinical judgment in inherently uncertain practice environments, ensuring patient safety and the resident’s psychological safety to promote a sustainable teaching-learning process. Objective: The objective of this study is to examine the available scientific literature on the application of Game-Based Interventions (GBI) for competency development and the assessment of Entrustable Professional Activities in medical residency programs. Methods: This is an integrative literature review based on 32 articles selected from 173 studies published between 2020 and 2025, and filtered from the PubMed, SciELO, Lilacs, Web of Science, and Scopus databases. Results: A predominant procedural bias was observed in the current literature, with a focus on surgical specialties. The findings demonstrate that the studied interventions possess the inherent possibility of allowing freedom to err in protected environments, as well as real-time feedback and gamification mechanics, such as instant progress visualization or rankings, which can promote recursive and frequent feedback loops, accelerating competency acquisition for the resident as a complex adaptive system. Conclusion: Game-Based Interventions are consolidated as strategic tools for the operationalization of EPAs, with highlighted potential for Family and Community Medicine, as they foster efficient learning spirals and ground the training for the ethical and technical management of uncertainties inherent to Primary Health Care.