The following steps should be taken into consideration when planning a game experience or the use of Gamified Learning Platforms on AMR/AMS:

1. Define Clear AMR/AMS Learning Objectives: Precisely determine what knowledge, skills, or attitudes the game or gamified experience aims to develop (e.g., understanding stewardship principles, improving diagnostic accuracy for infections, promoting prudent antibiotic use in specific scenarios). Learning objectives must drive the game design. (Gentry et al., 2019).
2. Identify Target Audience and Context: Tailor the game/gamification to the specific needs, prior knowledge, and professional context of the target learners (e.g., medical students, veterinarians, pharmacists, nurses, farmers, general public). (Trehan et al., 2024, list various AMR games targeting different audiences).
3. Select Appropriate Game Type and Mechanics: Choose a suitable format (e.g., digital serious game, mobile app game, board game, card game, gamified e-learning course) and relevant game mechanics. Common mechanics include points, badges, leaderboards (PBLs), challenges, levels, storytelling/narrative, immediate feedback, virtual patients or scenarios, competition, and collaboration. (Trehan et al., 2024; Nowbuth et al., 2023 note board/card games and scoring are common; Sørensen et al., 2018, used virtual patients and scoring).
4. Integrate Accurate AMR/AMS Content: Embed scientifically accurate and up-to-date AMR/AMS information, guidelines, and principles seamlessly within the gameplay or gamified activities. Ensure content reflects relevant aspects like the One Health approach where applicable. (Nowbuth et al., 2023, point to a current gap in games comprehensively addressing One Health).
5. Design and Development (Consider Co-design): Develop the game or gamified platform. Involving target users (e.g., healthcare professionals, students) and subject matter experts in a co-design process can significantly enhance relevance, engagement, and usability. (Ashiru-Oredope et al., 2022, detail a co-design process for an AMR board game).
6. Pilot Testing and Iterative Refinement: Thoroughly pilot test the game/gamified experience with a representative sample of the target audience to identify any usability issues, gameplay problems, or areas where learning objectives are not being met. Use feedback to refine the design. (Trehan et al., 2024, mention usability testing for AMR games).
7. Integration into Educational Strategy and Clear Instructions: Determine how the game/gamification will be used (e.g., standalone tool, part of a formal course, supplementary activity). Provide clear instructions on how to play, access the platform, and understand the learning goals.
8. Facilitated Debriefing (Especially for Serious Games): Crucially, incorporate structured debriefing sessions after gameplay. This helps learners reflect on their in-game experiences, decisions, and outcomes, and explicitly connect these to real-world AMR/AMS practices and principles, thus consolidating learning. (Gentry et al., 2019, note the importance of debriefing).

Facilitator’s role: Introduce the game/gamified platform and its AMR/AMS learning objectives, explain rules and mechanics, guide gameplay if necessary (particularly for physical games like board games (Ashiru-Oredope et al., 2022), monitor engagement, manage any technical or logistical aspects, and, most importantly, lead effective and reflective debriefing sessions to ensure learning transfer.

Participant’s role: Actively engage with the game or gamified elements, make decisions and experience their consequences within a safe, simulated environment, potentially collaborate or compete with peers (depending on design), critically reflect on their gameplay experiences, and participate fully in debriefing sessions to connect game-based learning to their professional roles and responsibilities in AMR/AMS.

Methods

• In-game performance metrics: Tracking scores, levels achieved, specific decisions made, time taken to complete tasks, resources managed, or adherence to simulated AMR/AMS protocols. (Sørensen et al., 2018).
• Pre- and post-game assessments of knowledge, attitudes, confidence, or clinical reasoning skills related to AMR/AMS using validated questionnaires or custom-designed tests. (Sørensen et al., 2018, showed knowledge increase; Nowbuth et al., 2023, highlight assessment of knowledge and prescribing behaviors).
• Direct observation of problem-solving skills or teamwork during gameplay (especially for multiplayer or board games).
• User experience and usability evaluations using standardized tools (e.g., System Usability Scale – SUS) or tailored feedback forms. (Trehan et al., 2024 discuss SUS scores for AMR games).
• Participant feedback on engagement, enjoyment, perceived learning value, and realism. (Ashiru-Oredope et al., 2022 collected user feedback on their AMR games).
• Analysis of discussions during debriefing sessions for evidence of reflection and learning.

Tools

Built-in game analytics dashboards, pre-post knowledge/attitude questionnaires, System Usability Scale (SUS), observation rubrics for skills demonstrated during gameplay, structured debriefing guides, focus group discussions or interviews for qualitative feedback.