Childrens National Medical Center

Michael Falk

Dr A, B, C and D are scheduled to run a simulated trauma. Because of schedule conflicts and other constraints, they will get to do this three to four times a year. They need to block an hour to do this and the sim educator has to be there with a tech along with a confederate. It requires physical space, equipment, expensive hardware/software, and significant time and energy. Or all four, three, two or one could log in to a medical game and run the teaching scenario whenever they wish. It could be done from any place with WiFi (coffeeshop, home, airport, in transit etc) and access to a computer or personal computing device. They can play with any number of participants and scenarios they wish and get immediate feedback that they could use to access online resources to correct. Their results are immediately shared with their residency who can track their performance and suggest readings or skills sessions to help improve their clinical practice.

Rapid advances in technology have led to major shifts not only in how medicine is taught but also changed how it’s practiced and how attending physicians stay informed on advances in medical care. Blogging, podcasts, e-learning, online resources and low and high fidelity simulation have quickly diversified how medical students, residents and attending physicians are educated. Medical learners are ‘adult learners’ who respond not only to a wide variety of educational tools but prefer having the ability to choose method they use to acquire the knowledge base needed for the practice of medicine. One of these trends, serious gaming, has recently become an area of interest and remains significantly underutilized as a medical education tool.

"Unlike conventional video games, serious games are not designed to entertain the gamer but to teach skills and give knowledge"

Serious games are defined as an interactive computer application, with or without significant hardware component that has a challenging goal. It is fun to play and engaging, incorporates some scoring mechanism, and supplies the user with skills, knowledge or attitudes useful in reality. Unlike conventional video games, serious games are not designed to entertain the gamer but to teach skills and give knowledge that is useful to them in the real world. While this maybe a new concept to the medical education community, it has been utilized by the military and the aviation industry with superior effect for decades. Medicine is host to a wide variety of tasks that involve either complex decision-making skills, manual dexterity or are physically complicated to learn. All of these skills would be amendable to learning through serious gaming. Also, these games could be available to the learner at any time, from any location and require a computer or personal device, removing major barriers to learning.

A number of research studies have explored either commercially available games that can be used to teach medical skills or developed their own games that teach complex medical-decision making to the learner. Till today, there are five commercially available video games that have been shown to have a clear association between the learner’s performance in the game. It improves the skills associated with increased laparoscopic handling speed and reduced errors when the learner transitions to traditional laparoscopic trainers or on endoscopic task trainers. But these small and focused studies show that more research is needed for the benefit of commercially available games in medical education. It also shows how these games can be best utilized to improve and augment more traditional tools.

More exciting is the development of serious games from ‘scratch’ that are designed specifically to train medical professionals, though with mixed results to date. Within the medical research literature, there are examples of 17 such games and 8 of them have undergone validity testing. In one study, novice learners completed trauma scenarios in a virtual ER, using avatars and all the usual medication and equipment that would be needed. While the other teams were trained using the traditional simulation model. Both groups were assessed using a scale for leadership and there was no difference between the groups. The other study looked at triage in a disaster or mass casualty scenario has been taught using cards that describe each patient. Participants sort the cards from the highest to lowest priority for medical care. When this ‘card sorting’ was tested against a virtual triage trainer, developed in the U.K., there was a marked increase in triage accuracy among those who used the virtual trainer. Sadly, none of the other games studied to date have been validated or shown to have the same impact as these examples.

While the data is conflicting, serious games have the potential to be a major tool in the education of both the medical trainee and the established physician. But what’s holding them back? Commercial games are hard to adapt to a medical objective. Also building a game from scratch involves hours of expensive programming time and technology skills not usually seen in those who went to medical school. The following suggestions could help address these issues and serve as a path forward-

• Further research into conventionally available games that can teach medical skills. This would show that games do serve a role and help convince both learners and educators of their utility and the need for further investment.

• Partnerships are needed between the technology industry and medical educators to develop serious games that are specific to medical education. Most academic medical institutions couldn’t afford or do not have the skills to develop these games on their own. This collaboration would provide the capital development and help open the medical market to these games/products when available.

• Novel funding sources must be explored because some of these games may not be able to generate funding from commercial sales. Malpractice insurers could benefit from the development of serious medical games or trainers, if these games are shown to be educational and to correlate with improved medical-decision making and clinical skills. It would lead to reduced errors and improved patient outcomes. They could then be adapted to the practicing physician community for ongoing demonstration of competency ensuring a standard level of competency across varied locations and practice environments. This not only expands the potential sales market but also serves as another community that could fund the development of serious games in the future.

Gaming has the potential to play a serious role in the future of medical education. Learners at all levels could have the ability to log in from any location at any time and practice individually or as a team. Development of these serious games is beneficial to medical professionals and patients. Moreover, it has the potential to generate revenue for the technology sector in a new market and save money for both medical institutions and malpractice insurers.