Researchers at the University of Pittsburgh Medical Center (UPMC) observed significant improvement in the triaging abilities of physicians who played an educational video game compared to those who practiced with a traditional educational app.
Deepika Mohan, MD, released her group’s study on Wednesday, finding that physicians who participated in the video game were 17% less likely to under-triage patients. Those who were exposed to the educational app were 11% more likely to severely injure a patient compared to those who played the video game.
“Night Shift” is an iOS game created in a collaboration between UPMC and Pittsburgh-based Schell Gaming Company. Mohan told HealthLeaders Media the collaborative process lasted nine months, as she supplied the medical and technical aspects while Schell crafted the game.
The trial was funded by a $2.3 million grant from the National Institutes of Health (NIH), which covered the cost of developing the game and providing iPads to the 366 participating physicians.
According to Mohan, video games have previously been used for simulation testing, but “Night Shift” is the first to incorporate a narrative element which evaluates physicians in a trauma setting. In the game, doctors are presented with patients whose cases are derived from abstracts published in the New England Journal of Medicine, which gave Mohan permission to use them for the clinical trial.
The virtual patients’ experiences range from not feeling well internally to one who is dealing with rapid blood loss as the result of a gunshot wound. Mohan said earlier trauma prototypes bored the participating physicians, so the group introduced diagnostically challenging cases to engage them on an emotional and intellectual level.
The game also provided physicians with a sense of agency to make decisions (and potentially mistakes) in a time-sensitive situation. Trauma, which is Mohan’s primary area of study, afforded her research team an opportunity to examine the effects of heuristics in emergency medical situations.
Mohan described heuristics as the mental shortcuts humans use to answer complex questions in a matter of seconds. While heuristics have been criticized for leading humans away from strictly rational thought, Mohan said the unconscious action can be a powerful strategy when improved to align with rules.
Mohan mentioned stroke, heart attack, or sepsis as other medical situations that rely on quick decisions by physicians. Though physicians see more patients see more patients for trauma than other cases, Mohan says it is still important to practice handling rare conditions with an outsized impact on public health. The results of the trial surprised Mohan and her team, who hypothesized a negative result due to the difficulty of changing behavior. Mohan has since indicated a willingness to develop more games focusing on other medical situations, should she once again receive NIH grant funding. She said health systems could potentially implement these educational video games as a low-cost measure to benefit patients.
“In trauma, being triaged appropriately can make it more likely that you get to go home, go back to work, less likely to have pain in one year, and if you’re over [65 years old] you can live independently again,” Mohan said. “All of these things matter to the patient, but the problem is that it’s a hidden benefit, which is hard to monetize.”
Such a move would require a health system of insurance company deciding to implement the video game as a training method to cut costs and provide better quality care to our patients, according to Mohan.
Despite participants showing improvement in avoiding diagnostic errors, most of the physicians did not enjoy playing the game. Several told Mohan they found the exercise to be “distracting” and “frivolous.”
Mohan suggested this might have been due to the reluctance of physicians to participate in clinical trials because of busy schedules or the mean age of participants, which was 40 years old.
Meanwhile, the educational apps focused on continuing education for physicians, including one which was developed by the American College of Surgeons. The first app included a textbook summary, videos of key procedures, and educational checklists. The second app featured a multiple-choice pretest and a post-test which required a certain score to certify that a physician passed the course.
Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.