Motivating Students: Incentives that Build Clinical Reasoning

To build clinical reasoning, students need to develop habits of processing that originate with deeper learning. Habits are formed when one is motivated to continue to pursue new discoveries and reinforce previous learning.

Keeping students motivated towards deeper learning can be quite a challenge. Because of the stressful learning environment of nursing education and a lack of preparation for this type of learning, many students do not possess the knowledge, skills, and attitudes required to push toward the goal of clinical reasoning. Motivation is often found in punitive or threatening experiences such as “prepare for class or else…” or “this will be on the exam…”

What if motivation were an internal force in the student that motivated them to not only take the next step in developing positive habits, but also in exceeding the requirements for the course?

This is where gamification comes into the academic arena. With gamification, students are allowed to create their own lesson plan based on personal strengths, weaknesses, and interests, as well as a desire to compete with others. When a course uses gamification tools (e.g., individualized learning modules, adaptive quizzing, achievement levels, and badges) students are then motivated by an internal force that pushes them to best themselves and others.

Individualized Learning, Assessment, and Quizzing

With gamification, the instructor provides students with access to individualized learning and assessment tools. Some learning and quizzing activities must be completed in subsequent order. Others are available at any time, allowing students to access them whenever they choose. Regardless, the activities are completed in a time frame that best fits their own personal needs. While some due dates are necessary, giving students a choice, when possible, can serve as an effective motivational tool.

These tools are often digital and are adaptive in nature. This means that the learning activities, assessments, and quizzes are based on each student’s prior activities and achievement levels. For instance, if a student indicates confusion with a particular concept, that concept will be repeated more often than for a student who does not indicate confusion with the concept or does well with a related assessment.

Frequent individualized quizzing is also a significant motivational strategy and learning tool for students. These tools provide each student with a customized quiz based on their progression through the course, their previous learning activities, and other benchmarks set by the instructor.

Achievement Levels

When gamification is used, the students “level up” (also known as progressing to the next level) by completing certain activities (e.g., creating an SBAR on the patient scenario in a video) and meeting goals (e.g., attaining a certain mastery level in the adaptive quiz for a concept). For instance, in one gaming platform, if they complete a module on loop diuretics, they receive 200 experience points. If they complete 3 modules in a week, they get another 50 points. With adaptive quizzing, when a student attains a mastery level of 1 they attain 25 points, a mastery level of 2 earns 100 points, and for level 3 they earn 200 points. Once students get to 1,000 points, they move from a rank of “private” to “corporal.” Once they reach the rank of “general,” they are finished with the course.


Another motivational tool in the gamification instructional design is the badge. A badge indicates an accomplishment related to a certain domain. For instance, when they have finished all four modules on diuretics, they get a badge with a urinal on it. If they complete the three oxygenation modules, they get a badge with a non-rebreather mask as the emblem. Maybe there is a badge for biological terrorism, and to attain it, all they have to do is watch three videos on the CDC website.

Social Engagement and Competition

From the beginning of time, people have been interested in the success of others compared to themselves. Competition serves to inspire people to do better. Gamification utilizes this interest to motivate students to pursue learning. In gamification, the instructor may allow learners to see their level, rank, or achievement compared to others. Students may also see their success compared to a national sample if a tool is widely used. This sense of rank provides students with yet another reason to continue in their quest for additional growth.

Next Steps

When considering gamification tools, be sure to inquire about the ability for faculty to create individualized learning and assessment plans for students. Identify if levels, achievement, and badges are a part of the mix. If a faculty member is trying to create some of these activities without the assistance of technology, partnering with other faculty and students in the development phase is invaluable. Develop ideas for administering badges and create opportunities for students to choose what they would like to learn, and when.

Gamification has the ability to motivate learners in such a way that their outcomes improve as much, if not more than, their satisfaction with the learning experience.

Tim Bristol,


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