The role of leaderboards for gamification in virtual reality simulation mastoidectomy training: a controlled trial

Purpose: There is a rising interest in providing safe, effective, and sustainable surgical training strategies in otology. Despite the wide landscape of training modalities, a key factor in improving surgical skills is motivation. In this explorative, randomized controlled trial, we aimed to preliminarily assess the effectiveness of a leaderboard as a gamification feature to boost residents’ engagement in training with a virtual reality simulator for mastoidectomy. Methods: University of Padova (Italy) Otolaryngology residents were enrolled and randomly allocated into two groups submitted to a virtual simulation program: a study group, where training was enhanced with gamification (leaderboard), and a control group without gamification. Each group had four weeks to practice on the simulator; the number of residents who actually used the simulator, as well as the number of training sessions per active participant were evaluated. Results: The leaderboards, used as a gamification element in the study, appeared to enhance the use of the simulator: non-use rate was 18% in the intervention group and 31% in the control one, whereas the frequency of participants who completed more than one simulation was significantly higher in the study vs. the control one (Fisher’s exact test: p=0.042). Conclusion: Our findings suggest that leaderboards as a gamification strategy could enhance residents’ engagement in training with a virtual reality temporal bone surgical simulator.