Medical education needs to incorporate evidence-based active learning strategies to enhance student engagement and problem-solving skills [12]. Active learning encompasses different learning methods such as gamification, e-learning, and collaborative learning, where technology and multimedia resources can be used [9]. Gamification and social media have positively impacted student motivation in higher education, and more specially in medical students [3, 7, 10, 13]. However, the impact of these innovative tools on the academic performance has been under-researched. Our study showed that the use of Kahoot and TikTok, compared to traditional methods, significantly improved academic outcomes.

In our study, students who participated in Kahoot increased their average final exam score by 5.4%. This result is consistent with other research that used Kahoot in histopathology classrooms [13], as well as in neuroanatomy or histology [14], showing an improvement in the average final exam score of between 2.1 and 9.1% in the groups that used Kahoot compared to a control group. This improvement may be due to the use of this application as a formative assessment tool that helps students regulate their own performance [10].

On the other hand, there are some studies where the use of educational games did not show improvement in academic performance [15]. For example, a study conducted in a single traumatology session compared exam results based on whether or not Kahoot was used at the end of the session [16]. Based on our results and comparison with the published literature, the authors recommend continuous use in the classroom, rather than occasional use, to provide feedback on learning.

The use of social media is increasingly widespread, with 83% of the population participating in at least one platform [17]. TikTok has been used as a pedagogical tool in other areas of higher education, such as sports science or economics, where it has also been used in the context of collaborative learning and has shown good results in terms of student motivation and creativity [11]. However, there is a lack of evidence on the influence of the use of TikTok on academic results in university education, perhaps because this social network dates back only from August 2018.

In undergraduate medical education, half of students use social media for educational purposes daily [18], which should be used to provide specific training for medical education [6]. In a recent systematic review, the use of social media in this context was associated with improved communication between students and educators, as well as short-term knowledge retention. However, there is little literature evaluating their use as an innovative teaching/learning tool to improve long-term academic outcomes [19].

Our study evaluated the effect of students’ participation in a collaborative basis using the social network TikTok, obtaining in the experimental group an improvement in final scores of 1.57 points compared to students who did not participate. Although we cannot compare our findings with similar studies using TikTok, we found studies in medical education where the use of other social networks as a teaching/learning tool has also shown positive results in student academic performance. A good example was an observational, prospective, and controlled cohort study of geriatrics students using weekly questions on Twitter, with improvements in scores compared to students who did not participate in the social network [20]. Other work with successful evaluation results has used Facebook in anatomy [21], WhatsApp for teaching histology [22], or educational podcasts for learning electroencephalography compared to traditional lectures [23], among others.

On the other hand, educational experiences for medical students using social networks have also been documented without finding benefits in the academic performance of students, such as a randomized controlled trial in which WhatsApp was used in the experimental group of students as a support for teaching pathology, but it was only developed in one subject of the subject. However, they found an increase in student satisfaction with the teaching of the subject [24].

Consequently, although there are few studies that have explored the TikTok social network as a learning tool, our findings are consistent with other studies that have used other social networks as a teaching support tool with increased learning gains.

Academic results improved significantly, with an increase in mean score of 12.9% when comparing the control group to the experimental group, where Kahoot and TikTok were used as active digital teaching/learning tools.

They also found an improvement in academic performance with the use of gamification and social networks in a “digital literacy” course for medical students [25], as well as in research on pharmacology teaching [9]. In this last study, various active learning strategies were used, such as Kahoot, flipped classroom, and educational videos, compared to a traditional teaching group. However, they did not use combined use of social media.

Our study demonstrates how the combination of Kahoot and the TikTok social network, used as innovation tools for active learning in medical students, was very positive in improving academic results in the subject of radiotherapy. Given these results, the teaching team has continued to use these tools in the following academic years, explaining to students the good results obtained by the classmates who decided to participate in them and motivating them to use it as a tool to improve their academic performance.

Therefore, it seems reasonable to recommend the use of gamification and the use of social networks in the classroom for teaching/learning the subject of radiotherapy in medical schools, as well as to continue exploring the use of these tools in medical education to adapt to the preferences of the new generations with innovative tools that are at the same time facilitators of their learning.

This study has several limitations that are presented below. Student participation in both Kahoot and collaborative work with TikTok was voluntary, and it is unknown if the student’s lack of participation could be related to lower interest in the study. We do not know if there were differences in overall academic results, including other subjects, between the experimental and control groups, although the high qualifications required to access medical studies mean that the population is quite uniform in terms of academic performance. This research was only carried out in one subject and in one institution, so more studies are needed to extrapolate and generalize. In this study, students’ perception of the use of gamification and social networks has not been measured, which may be a good complement for future studies.

Finally, we cannot know which of the two teaching/learning tools improved academic performance, whether it was Kahoot or the social network TikTok, or both, so the authors are considering conducting a second study in which we can compare 3 groups with each other.