In this extra post, Dr Muz Ahmad and Dr Mary Mina explore gamifying clinical communication, such as handover and referral skills, to undergraduate medical students. They based their teaching activity on the television show, Dragon’s Den, combined with peer learning and experiential practice. Muz and Mary are Clinical Skills Facilitators at Edinburgh Medical School.
There is a growing demand to better prepare medical students for clinical practice, particularly in the context of reduced placement opportunities caused by increasing medical school intake across the UK. Despite completing undergraduate training, many graduates report feeling under-prepared for practice—especially when faced with challenging communication tasks such as handovers and referrals. These skills are critical not only for individual performance, but for patient safety.
The General Medical Council (GMC) explicitly highlights delegation and referral as core competencies for graduating doctors, requiring both clinical understanding and the ability to communicate clearly with colleagues (1). Poor communication between healthcare professionals is widely recognised as a contributor to adverse patient outcomes, yet teaching these skills effectively and sustainably remains a challenge within modern medical curricula.
Traditionally, handover teaching has relied on faculty-led sessions and live simulation. While effective, these approaches are often resource-intensive and difficult to scale. For example, previous referral simulation sessions delivered to final-year students at Edinburgh Medical School successfully improved confidence and competence, but required substantial faculty involvement. In an era of increasing student numbers and constrained teaching capacity, alternative teaching environments are needed.
Rethinking the teaching environment
In response to these challenges, we developed a renewed workshop grounded in small-group learning, peer engagement, and gamification. Our aim was to create a teaching environment that was engaging, educationally robust, and feasible to deliver at scale.
Gamification, defined as ‘the use of game design elements in non-game contexts’, is an ’emerging method of teaching that is gaining traction in medical education’ (2). This form of teaching is a powerful tool that has been shown to increase student enjoyment, motivation, and engagement in learning tasks, and is shown to encourage collaboration by offering opportunities to work as a team; a core skill necessary for success in a career in healthcare (3). To our knowledge, there are no published articles describing this method to teach handover and referral skills to undergraduate medical students.
Our workshop was delivered as a 90-minute, face-to-face session within the final-year ‘Assistantship’ programme. Rather than positioning students as passive recipients of expert knowledge, the session was intentionally designed to support active participation, peer learning, and experiential practice.
Learning through observation, discussion, and practice
The session began with a brief Think–Pair–Share activity, encouraging students to reflect on prior experiences of handovers and referrals. This also introduced an adapted SBAR-D framework (Situation, Background, Assessment, Recommendation, Decision), providing a shared structure for the activities that followed.
The core activity drew inspiration from the television programme ‘Dragon’s Den’. Students worked in small groups and assumed the role of ‘Dragons’, using structured checklists to evaluate pre-recorded video handovers of varying quality. Groups discussed the strengths and weaknesses of each handover and decided whether to ‘invest’ using prop money provided as part of the game. This low-pressure format allowed students to critique clinical communication critically, without the anxiety of performing in front of a large group.
Learning was then consolidated through a peer-practice activity. Students worked in pairs to conduct fictional referral scenarios using detailed patient information, including observations, blood results, and drug charts. Peer feedback was provided using the same structured checklist, reinforcing consistency between observation and practice.
This alignment between watching, analysing, practising, and reflecting was informed by constructivist, social, and experiential learning theories. Students learned not only by doing, but by observing others, articulating reasoning, and receiving feedback from peers.
What did students gain?
Evaluation of the workshop demonstrated statistically significant improvements in students’ self-reported confidence and preparedness in delivering handovers and structuring referrals. Qualitative feedback further highlighted the value of the teaching environment itself.
Students consistently described the session as interactive, engaging, and relevant. Many valued the opportunity to practise communication skills in a safe space and appreciated not being required to perform in front of the entire group. The realism of the scenarios and the practical insights shared by facilitators were also highlighted as strengths.
Interestingly, students expressed a strong preference for peer-led learning. While faculty were present to support and guide discussions, learners preferred independent engagement with materials, mirroring the self-directed nature of clinical placements. This finding perhaps suggests that peer feedback can be as meaningful, and sometimes more acceptable, than tutor-led feedback.
Suggestions for improvement focused on timing and depth: students wanted more time for peer practice, additional scenarios, and earlier delivery within the curriculum to allow opportunities to apply learning during placements.
Sustainability and transferability
A key strength of this approach is its sustainability. The use of pre-recorded videos, reusable materials, and structured peer feedback significantly reduces the need for intensive faculty involvement. While initial development was time-consuming, the longevity and adaptability of the resources support efficient delivery to large cohorts.
This teaching model also has clear potential beyond undergraduate education. With appropriate adaptation, it could be applied to postgraduate training, interprofessional education, or more complex referral scenarios, including managing conflict or incivility.
Reflections on innovative teaching
This project demonstrates that effective teaching environments do not necessarily require high-fidelity simulation or extensive staffing. Innovative use of gamification techniques, combined with peer learning and experiential practice, can offer a scalable and educationally sound approach to teaching complex communication skills.
As medical education continues to evolve under increasing pressure, innovative, student-centred teaching environments such as this may play an important role in preparing learners for the realities of clinical practice, while remaining sustainable within modern curricula.
Curious to read about all the details? Check out our article, ‘Dragon’s Den’: Gamifying Handover Skills Teaching’ at: https://doi.org/10.1111/tct.70338
References
1. General Medical Council. Delegation and referral [Internet]. 2024 [cited 2026 Jan 23]. Available from: https://www.gmc-uk.org/professional-standards/the-professional-standards/delegation-and-referral
2. Deterding S, Dixon D, Khaled R, Nacke L. From game design elements to gamefulness: defining “gamification.” Association for Computing Machinery [Internet]. 2011 Sep 28 [cited 2025 Jul 11]; 11: 9–15. Available from: https://dl.acm.org/doi/10.1145/2181037.2181040
3. Krishnamurthy K, Selvaraj N, Gupta P, Cyriac B, Dhurairaj P, Abdullah A, et al. Benefits of gamification in medical education. Clinical Anatomy [Internet]. 2022 May 30 [cited 2025 Jul 11]; 35(6): 795-807. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ca.23916
Muz Ahmad
Muz is a Clinical Skills Facilitator at Edinburgh Medical School where she supports medical students to develop skills in practical procedures and acute care/resuscitation, both in simulation but also in clinical areas. Muz completed a fellowship in Simulation and is a doctor by background.
Mary Mina
Mary is a Clinical Skills Facilitator at Edinburgh Medical School where she supports medical students to develop skills in practical procedures and acute care/resuscitation, both in simulation but also in clinical areas. Mary completed a fellowship in Clinical Communication and is a doctor by background.
