Competitive Online Fun Strengthens Medical Education

Not so long ago, becoming a doctor was almost as much a test of endurance as it was a learning experience. Surviving marathon shifts was a rite of passage.

"It gave us the continuity to follow a case, but I'd have to say I wasn't the same doctor at hour 40 that I was at hour two," James Willig, MD, MSPH, Associate Professor in Infectious Disease at UAB, said.

For both patient safety and the well being of physicians in training, the Accreditation Council for Graduate Medical Education and the Institute of Medicine recommended reforms that have limited the maximum number of hours today's medical residents are working.

"While this should reduce the risk of medical errors from exhaustion, there is a trade-off. We haven't quite found a way to replace some of the in-depth medical education that the longer shifts allowed. When I was training, if something came up there was time for me to ask questions and find someone to explain until I got it. Today, when we are doing rounds, we try to answer questions, but there are time pressures in trying to get residents where they need to be next. We may have to put a question off till later, and later there may not be time." Willig said.

James Willig, MD, MSPH

"I and my colleagues in the Infectious Disease Department, Dr. Martin Rodriguez and Dr. Mukesk Patel, felt that we had to find a way to give our students the depth and range of knowledge they would need to become good physicians. Our strategy was to meet learners where they hang out--in digital media.

"Millennials are computer native and grew up playing video games. When they have a spare moment, they have a digital device in their hands. They may think I don't know what they are doing, but I do--I was the same when I was a resident.

"So we applied the principles of gamification to medical education to make learning fun. It's an activity they can enjoy in their free time that rewards them with knowledge and motivates them to learn more," Willig said.

"We call our game Kaizen. It's named after the Japanese principle of continuing improvement. The Center for Clinical and Translational Science (CCTS) at UAB helped us with programming support. Instead of just creating a game, we created a tool set so anyone could log on to build a game. So far, our departments of General Surgery, Ob-Gyn, Emergency Medicine and the School of Dentistry, as well as our post grad and undergrad medical school have games going. The Emergency Department is working on using the game for distance learning in Kenya. We're also partnering with the School of Nursing. Nancy Wingo and Cathy Roche have been very active and the nursing students have six games going.

"The response from our students has been so enthusiastic. As they start talking about the game, it really catches fire. Students can play individually or in teams, and you can set prizes as you like. We have leader board updates every week that show who is ahead, and there's a surge of activity as students compete to move up. The games also foster a strong sense of community and you see a lot of humor in user names and in badges marking different game levels. Beginners in one get a petri dish icon, and beginners in one of the nursing games get a bed pan or urinal as in "you're-in the game on level one."

"We can go to the top people in a specialty and ask them for their ten best questions. They tend to put a lot of thought into it and often follow up with very good, detailed answers explaining the topic.

"Students earn points for answering questions, and extra points for a hot streak answering several correctly in a row. There are also bonus points for answering questions on consecutive days. We want to reward both accuracy and consistency. They have fun and they laugh while learning," Willig said.

The game software has been built and expanded primarily by "sweat equity."

"We've struggled with the idea of developing a business model, but we've resisted. There simply aren't enough free, accessible educational tools. This tool set could be used in so many areas of education. To sustain it, we may have to eventually find a way to pay for someone to do the basic housekeeping--perhaps donations or something along that line. As of now, people just call us and we help them get set up online to start uploading their questions, players, badges and whatever prizes they want to offer.

"There isn't a charge. The only requirement is that any questions or badges they create go into the bank of questions and badges everyone can use. When time and resources allow, we'd like to create a phone app version of the game.

"One of the most important things we hope the game will help students do is to develop the habit of life-long learning," Willig said. "I tell them that I can teach them the right answer this year, but it may not be correct next year. Medical knowledge is changing so fast, we have to keep learning to keep up."