*3.1.3 Gamification*

The meaning of gamification varies widely and is often confused with GBL. Gamification is an umbrella term, that involves the application of game elements such as points, levels, time constraints and awards, and use them as non-game settings to other areas of interest [42, 53, 54]. Gamification has been characterized as well adapted to the learning style of Z generation [21, 42, 53–55]. Applied to an educational context, a gamified learning experience can positively influence student engagement by using gamification principles to affect the cognitive, emotional, and social aspects of the learning experience [54]. The cognitive aspect is stimulated through goal-oriented and learning objectives-based activities that challenge students within the gamified environment. The emotional aspect plays an important part in a gamified learning platform: curiosity, frustration, joy, pride and optimism are present during the experience [42]. Most importantly, the gamified learning experiences give feedback and allow repetition, encouraging resilience and reframing of failure, reinforcing the idea that repeated failures will eventually lead students to level completion and achieving learning goals [56]. The social aspect involves the participation of students within an environment where they interact with their peers and are part of a group. In this learning environment, students can have new identities and roles (using avatars and role play), and through branching mechanisms, they are asked to make choices and decisions. Also, gamification allows students to publicly identify themselves as "masters," once they reach a higher level of mastery, and gain social credibility - for example, via a leaderboard [57] - as well as academic recognition by accumulating points [58].

## *3.1.4 Simulations/virtual laboratories*

A virtual laboratory is any online environment that is based on interactive learning either individually or in groups, allowing students to explore topics in an asynchronous manner that has no immediate physical reality [59].

In the last decade, there has been a gradual shift of conventional physical, in-person laboratories towards virtual alternatives, motivated by several reasons. Physical laboratories are expensive. They need advanced instruments and equipment, space, professional personnel, and maintenance. Moreover, the student population is increasing, conducting to higher experimental costs. Virtual laboratories and tools provide significant long-term cost savings. Whilst the initial development or purchase costs may be large, once developed, the majority do not require the ongoing purchase of consumables, the provision of physical space, laboratory equipment or support staff time [60].

Animal-based laboratories, very useful in the past for physiology teaching and learning, can be associated with ethical concerns, while virtual animal model simulations reduce the ethical dilemmas and broadens the types of experiments that can be conducted. Moreover, virtual laboratories exhibit higher levels of efficiency and safety, enabling students to learn in their own time and pace [61–63]. This is also another great advantage when we think of all the students undertaking part-time employment to support their studies. For them, the possibility to study at their own time and pace, at home or elsewhere, and to access virtual laboratories and experiments that always work, and with consistent data, is unvaluable. With these simulations, experiments are far shorter; students can undertake more experiments in the time available increasing their learning. Several studies have already proven that virtual laboratory tools were equally effective as traditional laboratories in increasing student knowledge and understanding, when evaluated by student performance in examinations [62, 64–66].

Nevertheless, virtual laboratories have intrinsic constraints and limitations. They do not provide students with the opportunity to develop key practical or technical skills (hands-on experience), or how to use specific items of equipment or to promote awareness of ethical, health and safety issues. They will always give the characteristic and correct data, like a perfect scenario, and we all know that in real life it's not always like that [60, 63].

Although virtual laboratories have become increasingly common as a form of teaching aid in different learning situations, creating a virtual laboratory for teaching and learning is, however, overly complex, incorporating skills in diverse areas such as interaction design, visualization, and pedagogy. It involves design and production of texts, images, 3D environments and interactivity, and the production requires programming and animation [63, 67]. There are some virtual labs already deposited in open educational resource (OER) repositories (https://libguides.mines. edu/oer/simulationslabs) that can be easily used and are invaluable strategies for this demanding learning/teaching process [63]. When asked whether virtual or traditional laboratories should be discontinued, students saw a place for both within the curriculum, recommending that they should be used in parallel [68].

#### **3.2 How we teach?**

In this enthusiastic process of teaching and learning physiology, our option is for a blended/mixed approach, meaning a process that brings together what we consider the best from different approaches: experiments hands-on, virtual experiments, digital games/simulations, board games, crosswords and word search games.

This way we intend to avoid boredom, to promote curiosity, motivation, and engagement, and to create learning opportunities for all students (visual, auditory and kinesthetic students) to go beyond rote memorization of terms and processes, and towards developing mental models of physiological phenomena.

Reflecting the importance of technology in the Z Generation, all students own at least one Internet-ready device (e.g., iPad, laptop, tablet, smartphone), enabling the use of online resources in this approach.

### *3.2.1 Crosswords*

Crosswords are an easy and fun way to engage students**.** Crossword puzzles have the purpose of encourage students to form words or phrases which lead to the answers. It can be used as a means of enhancing general and scientific information, assuming a facilitative role for problem-solving skills.

This is an in-house crossword (**Figure 5**). Starting from physiologic concepts or definitions, and using online free tools (https://worksheets.theteacherscorner.net/ make-your-own/crossword/), the puzzle shown in the image is created.

#### *3.2.2 In-house created learning board games*

In a combined work of teachers and students, through a Pedagogical project financed by Polytechnique Institute of Viseu (IPV), The MacVet Project (Create, Simulate and Learn), three in-house learning games were created from classic games: Vetpoly, Physiohedbanz and Pictionaryvet (**Figure 6**).

The traditional Monopoly board game has been converted to VetPoly. The original game has been adapted by creating a new board, community box cards and lucky cards, so that the game would reflect the veterinary field environment. The community box cards have been turned into Quizz timecards. Whenever the player lands on a Quizz time house they will have to answer a physiology question. If the player gets it right, he will receive a monetary reward; if he makes a mistake, he will be penalized and will have to return the amount indicated on the card to the bank. This game adapts to various curriculum units, just by replacing the Quizz time cards.

**Figure 5.**

*Physio crosswords. (in English, for example n° 1: Across1: TSH target organ. Answer: Thyroid).*

#### **Figure 6.**

*Vetpoly board and game; Physiohedbanz game and rules' card; Pictionaryvet rules' card.*

The Hedbanz was converted to Physiohedbanz. Using cards with figures/concepts related to physiology, that students must identify without seeing it. The game is based in old game of "What am I?" Player has to ask "yes" or "no" questions before time runs out (e.g., ADH. The student with the ADH card, must ask if it is a hormone, if it acts in the renal tubules, if it inhibits diuresis). In the end wins the player with more scoring badges.

The Pictionaryvet, similar to the classic Pictionary game, requires some drawing skills. Students are invited to draw the concepts/terms/processes, all related to physiology. Like Physioheadbanz, there are time restrictions for each team.
