Problem-based learning (PBL) emphasizes learning behavior that leads to critical thinking, problem-solving, communication, and collaborative skills in preparing students for a professional medical career. However, learning behavior that develops these skills has not been systematically described. This review aimed to unearth the elements of effective learning behavior in a PBL context, using the protocol by Arksey and O’Malley. The protocol identified the research question, selected relevant studies, charted and collected data, and collated, summarized, and reported results. We discovered three categories of elements—intrinsic empowerment, entrustment, and functional skills—proven effective in the achievement of learning outcomes in PBL.

The application of gamified elements to PBL to promote student engagement has not been systematically described. Hence, we conducted a review based on Arksey and O’Malley’s five-stage scoping review framework, involving research question identification, relevant study identification, study selection, data charting, and result collating and reporting. We searched three databases using five search terms combined with a Boolean operator: “problem-based learning” AND “persuasive OR gamify OR gamification OR game”. The initial pool of 5532 sources was evaluated according to the eligibility criteria, and 14 original articles were selected for the final data extraction. A content analysis was performed, and several persuasive gamification elements for PBL were identified. The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. The analysis unearthed six main categories of persuasive gamification elements, which have been proven to be effective in the achievement of learning outcomes: high-fidelity simulation, inquisitive exploration, collaborative learning, interactive instruction, guidance and feedback, and rewards. These findings highlight the persuasive gamify elements that can be incorporated to support the active learning and engagement of students in PBL, thus preparing them to be lifelong, self-directed learners.

Introduction: Non-alcoholic Steatohepatitis (NASH) is an emerging chronic liver disease with limited therapy available. Studies utilizing animal models induced with cholesterol diet ranging from 1-2% are hampered by inconsistent yield of NASH features. Therefore, we aimed to establish a NASH animal model utilizing 12% cholesterol diet (CD) and to investigate the effects of Tualang honey (TH) known for its anti-inflammatory and antioxidative properties in this model. Methods: Twenty-four Sprague-Dawley rats were divided into 2 groups (12% CD and standard diet) and were fed for 6 weeks. Following the establishment of NASH, the rats in the 12% CD group were subsequently divided into 3 groups. The first group was continued with only 12% CD. In the other 2 groups in addition to the 12% CD they were given TH treatment at different concentrations (1.2 and 2.4 g/kg/day) for 4 weeks. Blood biochemical analysis and histological assessment of liver were subsequently performed. Results: The liver histological sections of the rats fed with 12% CD showed macrovesicular steatosis, ballooning degeneration with lobular and portal inflammation. They also had increased serum alanine aminotransferase (ALT), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), fasting insulin, HOMA-IR and reduced high density lipoprotein cholesterol (HDL-C). Meanwhile, the TH treatment groups exhibited significant improvement in both the NASH grading and activity scores. The ALT, LDL-C, TC, triglyceride (TG), fasting insulin and HOMA-IR levels were reduced significantly. Conclusions: The 12% CD was able to induce NASH in the animal model. Tualang honey improved insulin sensitivity, dyslipidaemia, steatohepatitis.