Gamification is the use of elements of game design to increase user engagement. Gamification has been successfully incorporated into medical and scientific endeavors in recent years, from health/fitness and patient education applications, to genome comparisons (Phylo), protein structure prediction (Foldit) and malaria parasite quantification. Gamification as a tool has proven ability to improve motivation, participation and time investment across multiple settings, we incorporated elements of gamification into the design of software that allowed our residents to participate in a medical knowledge competition with their peers in order to encourage extracurricular learning. We used the conceptual frameworks of user-centered design and situational relevance to achieve meaningful gamification, including connecting with users in multiple ways and aligning our ‘game’ with our residents’ backgrounds and interests in furthering their education. The purpose of this study was to assess acceptance and use of a novel gamification-based medical knowledge software designed to supplement traditional graduate medical education among internal medicine (IM) residents and to determine retention of information on subsequent retest.
Gamification as a tool is not about creating games to pass the time away. It is about driving positive behavior changes in people by engaging them and offering rewards in the form of points, badges or bonuses. At its heart, gamification is about influencing behavior and improving outcomes, both of which are key goals for the pharmaceutical industry.
Gamification as a tool can include simulation training, patient adherence, clinical information, medical education and research that influence patient behavior in positive ways.
Benefits from Gamification
Increased Engagement
Studies on games and virtual patient simulations for medical education measure domains of engagement, such as learner satisfaction, flow (fun, enjoyment, and concentration), and variety. Games and gamification elements introduce fun and excitement in stressful environments. Well-designed games are cognitively challenging, but not overwhelmingly so. They keep students engaged and facilitate progression through difficult tasks. Games support the need for adult learners to inventory and master short-term and long-term aims by breaking activities into a series of networked activities that are varied and interesting. These tasks engage learners in different aspects of serious play, such as strategizing, collaborating, decision making, competing, evidence gathering, reviewing feedback, and reflecting.
Cognitive engagement makes sense from a neurologic perspective. As noted by Chatfield, games activate pleasure centers in the brain. Research suggests video game play results in increased dopamine levels. Cognitive scientists conclude that games should be fast and should include an element of unpredictability. An absence of predictability activates distributed attention, leading to errors that indicate that adjustments in students’ behaviors are needed.
Enhanced Collaboration
Games and simulations offer opportunities to practice working as part of a team. These skills are necessary for health care delivery in the future. Education experts assert students scaffold more knowledge through discussions and activities with instructors and other classmates. Games for social and cooperative play are based on interaction with other players in a social setting, requiring teamwork or competition. Examples of games and simulations supporting cooperative teamwork are Bravo (C-3 Softworks), TurningPoint (Turning Technologies, LLC), and DecisionSim (Kynectiv, Inc).
The process of game play has the potential to connect people to learning communities. For example, video game players often join collaborative communities, blog about experiences, and analyze statistics associated with game play. Thus, including opportunities for game participants to reflect and strategize through debriefings aligns with health care education using case-based instruction, a method that uses patient cases to simulate critical thinking and decision making in the classroom.
Real-World Application
Games and virtual patient simulations may be designed to allow students to solve real-world problems. Contextualizing patient case practice allows students to safely apply medical theory to a specific instance, sometimes mediated by a mentor. For example, video games set in virtual worlds present realistic challenges, which align with the notion of “authentic learning” that is deemed useful for practicing real-life decision making. This approach is intended to enhance the realism and relevance of a lesson.
Clinical Decision Making
Medical students require ample deliberate practice in clinical reasoning. Learning exercises that engender intrinsic motivation and make deliberate practice engaging are valuable. Games offer platforms for deliberate practice and provide multiple opportunities for demonstrating competence and receiving feedback. Clinical reasoning, information retrieval, and diagnostic acumen are skills practiced in games and virtual simulations for medical education. Video game play also allows for deliberate, risk-free practice of reasoning and technical skills while enhancing spatial and temporal visual systems. For these reasons and others, games are being developed to augment skill training related to surgical training.
Distance Training
Modern health care curricula incorporate blended learning, field-based experiences, and distance learning. In these environments, electronic games, mobile applications, virtual patient simulations, and other technology-enhanced learning tools are useful for tracking competency-based learning and supporting a variety of interactive experiences. Furthermore, a key advantage of gamified training platforms in distance training is that some, such as Turning Technologies, LLC, can integrate with a learning management system.
Learning Analytics
While students benefit from deliberate practice in risk-free environments, educators benefit from the analytics (scoring systems, statistical reports) offered by many electronic games and virtual patient simulation platforms. For example, decision-based games may be designed to automatically track every decision a student makes47 and allow educators to focus on the review of observed deficits after instruction. Instructors can review end-of-game reports to evaluate key learning takeaways and provide feedback to individuals or groups.
Swift Feedback
Games leverage the motivational power of reward schedules, instant feedback, dashboards, and meters to guide a learner along a self-training pathway. Mobile case-based games such as Prognosis: Your Diagnosis (Medical Joyworks) and virtual patient simulations such as DecisionSim (Kynectiv, Inc) offer opportunities to review concepts, retry, and finally attain a better score. For example, when a student selects the wrong answer or makes a clinical error, he or she is stimulated to seek more medical information.
Widespread use of mobile technology is key to the adoption and spread of Gamification as a tool. Games must be available at the point of need. Multi-channel availability, including social media and direct response, is essential to ensure high levels of usage and measurable feedback. Recent surveys show medical professionals already use mobile technology in their practices.
Physicians seem to be on board with the idea of engaging with patients through Gamification as a tool, both to improve the quality of care they provide and for the health of their patients. Manhattan Research’s Taking the Pulse U.S. 2014 survey, 40 percent of doctors said that they thought utilizing technology to communicate with and keep track of patients would lead to better health outcomes. More than one in three said they had undergone evaluation or received an award based on metrics measuring cost of treatment, patient outcomes or referrals within the previous year. Two in five said they have increased the use of digital tools to communicate with patients in the previous year.
