Discussion

A gamified intervention was associated with a short-term increase in engagement with local antimicrobial stewardship resources. Directing clinicians to specific, locally endorsed materials through simple, interactive tasks appears to improve resource visibility during a defined campaign.

Gamified educational strategies have shown gains in engagement and motivation in healthcare education. A meta-analysis found that gamification improved retention of antimicrobial resistance content compared with conventional lectures. ^{Reference Nowbuth, Asombang and Alaboud5} A recent prospective study of clinicians and students demonstrated that a lecture followed by interactive group games resulted in an improvement in pre-post assessment scores in distinguishing bacterial and viral infections (48% vs 94%), selecting appropriate empiric therapy (34% to 84%), and knowledge of resistant gram-negative bacteria (32% vs 78%). ^{Reference Sumana, Shettar and Maheshwarappa6}

While these results are promising, most evaluations of game-based learning have focused on students rather than practicing clinicians. Undergraduate and postgraduate learners often participate in structured curriculum where games can be integrated into classroom or simulation settings, allowing for easier implementation and assessment. In contrast, clinicians in active practice face competing priorities, variable schedules, and limited protected time for education, which may influence both uptake and effectiveness of gamified interventions. A review of 53 gamification studies revealed that less than 20% of studies occurred in clinical or hospital-based environments involving practicing professionals. ^{Reference Lee, Lee, Lai, Chen, Chen and Yau7} There is a paucity of data on whether similar strategies translate to sustained behavior change or improved clinical decision-making among experienced providers.

Limitations of the 7 Days, 7 Quests intervention include a single‑center setting limiting generalizability. Participation was voluntary, and a prize raffle may have introduced selection bias. Engagement was measured by page traffic and quest completion, not by knowledge retention, prescribing behavior, or clinical outcomes. Rankings of usefulness and enjoyment were self‑reported and may be influenced by response bias. Responders were all hospital employees. Physician and advanced-practice provider participation was limited by difficult consultant access to the hospital SharePoint site and restricted email outreach. Future interventions will assess if consistent integration of gamified tasks or quests results in sustained resource use, change in attitudes toward stewardship teams, and/or downstream prescribing behaviors.