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Abstract Introduction Pathology teaching for medical undergraduate students linking basic and clinical sciences together is a challenging task. Kahoot! is a game-based online digital formative assessment tool that can engage students in its learning. This study analyzed the effect of Kahoot! use on studentś learning of Pathology. Methods The study was carried out on the first-year Pathology students at Helwan University, Faculty of Medicine, after ending a basic Pathology course. The study is a retrospective quasi-experimental quantitative study. Academic performance of students in Pathology was compared between Kahoot! and non-Kahoot! users (55 students each). In addition, an online survey was introduced to the 55 Kahoot! user students to investigate their perceptions on Kahoot!. Survey and test score data were analyzed by appropriate tests using IBM-SPSS (Statistical Package for Social Sciences) Version 21.0. The level of significance was P <0.05. Results Kahoot! enhanced Pathology understanding (83.6%), retaining knowledge (87.3%), made learning fun and motivating (89.1%). Other mentioned advantages of Kahoot! were practicing for the exam (40%), simple and easy to use (36.4%), competitive (18.2%), self-confidence booster (10.9%), forming a comprehensive image of the lecture (9%), quick (9%), and imagining skills booster (5.5%). Mentioned disadvantages included no explanation for the answers to the questions (20%). A quarter of the students stated that the time limit for the questions was short (27.3%). Kahoot! use was significantly associated with better Pathology academic performance (P=0.001), and it was not related to the general academic performance of the students (P=0.06). The majority of users (85.4%) recommended its continuous future use. Conclusions The study offers an endorsement to the use of Kahoot! for gamifying formative assessment of Pathology and can provide a basis for the design of an online Kahoot!-based continuous formative assessment plans implemented outside-classroom in the Pathology curricula.
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