A gamified formative question bank to enhance student learning and engagement in a foundational medical science course.

While gamified learning platforms show promise for engaging digital learners and promoting active learning, evidence of their effectiveness in predicting academic outcomes remains limited. This study examined how engagement patterns and incentives impact academic outcomes in a gamified environment to determine whether a formative question bank enhances engagement, supports self-regulated learning, and provides data to guide academic support. First-year medical students (N = 201) participated in an optional gamified question bank delivering weekly questions across a five-block foundational sciences course. Student engagement was quantified using a Player Efficiency Rating (PER) incorporating accuracy, consistency, and response timelines. Statistical analyses examined correlations between engagement metrics and academic performance, comparing response patterns across student performance tertiles. Ninety-seven percent of students participated, achieving a mean accuracy of 79.8%. PER showed strong positive correlations with final course grades (R = 0.30, p < 0.001). High-performing students responded to questions significantly earlier than low-performing students (p < 0.01). Students in the highest engagement tertile achieved significantly higher final grades than middle and low-engagement groups (p < 0.001). Question accuracy consistently correlated with summative knowledge scores across all course blocks. An externally incentivized block demonstrated the highest participation (85.6%) and accuracy (86.5%). A gamified question bank effectively promotes beneficial study behaviors and reliably predicts academic performance. Early engagement was linked to higher achievement, while low engagement correlated with lower exam performance, highlighting the opportunity to identify academically at-risk students. These findings support gamified platforms as valuable tools for enhancing learning outcomes and enabling early intervention strategies.