Within recent years the concept of gamification has acquired increasing popularity (Mckeown, 2016) More recently such educational technology utilizing gamification principles has been explored within medical education (Graafland et al., 2012). The interactive and collaborative nature of many online applications possibly lends well to both clinical and educational gamification principles. Central to the concept of gamification is motivations towards learning and changing behaviour. Evidence is shown that intrinsic motivation is more successful towards long-term behaviour change. Mandated change or extrinsic motivation has been shown to be less successful over long periods of time. The goal of gamification is to provide intrinsic motivation in the learner by connecting with their core values in providing rewards and positive reinforcement towards self-determined change (Ryan, & Deci, 2000). Successful games to continually challenge the player in order to keep the user interested with new tasks and experiences. This fits well with Ericsson’s theory of deliberate practice. A player should not be automatically good at the game however with repetitive training the player should be guided towards becoming an expert (Blohm, & Leimeister, 2013). Such a principle facilitated through carefully designed software holds much potential within medical education. After all, these basic principles are proven extremely motivational within the commercial context. Many of these concepts are used successfully within the video game industry in order to “hook” players into the game environment for long periods of time (Wit-Zuurendonk, & Oei, 2011).
Gamification within education falls under the category of “serious games”. The so-called serious games have non-entertainment purposes behind their design. They may be entertaining, and they should be intrinsically motivating, but their main purpose is towards changing behaviour and learned tasks. Upon review of the medical literature a few recent studies show promise (Graafland et al., 2012).
Digital laparoscopic simulation is shown a statistically significant correlation with handling surgical tasks within a live animal model (Rosenberg et al., 2005). An emergency department simulator game has also been developed and has shown promise in significantly increasing triage accuracy amongst nurses (Knight et al., 2010). Virtual patient simulators have also been developed which apply gamification principles. For instance, a virtual emergency department has been created were medical students manage six cases simultaneously. It has been shown that this technology improved team and leadership performance scores and enhanced medical content knowledge (Youngblood et al., 2008). These principles of gamification have also been applied at the organizational level. An online award based system was implemented for a surviving sepsis campaign which demonstrated a significant reduction in mortality (Mckeown et al., 2016).
With this success, these games could potentially replace certain aspects of clinical teaching. The self-directed nature of many such of many such games lends itself well to discovery learning and learner centred instructional design. One obstacle towards more readily adopting this technology has been proving content and face validity of the particular computer programs, which are often simulators (Graafland et al., 2012). Such evidence-based practice within medical education is required in order to adopt educational technologies which of the potential to directly or indirectly affect patient care. Recent systematic review demonstrated that out of 30 serious games identified within the medical peer-reviewed literature, only six had completed full validation (Graafland et al., 2012).
Within the future, and with the increasing evidence behind such games, this validation will likely accelerate, however this will slow adoption of this innovation. It may be more expedient to apply principles of gamification to junior medical trainees who are not yet immersed in the clinical environment. Massive online open courses (MOOCs), have applied many of these principles of gamification successfully (Harder, 2013). This is achieved through providing online badges, and applying the benefits of social media as a reward. In this way a learner who is successful in tasks is positively reinforced by receiving social capital (Harder, 2013). The development of such MOOCs is still a relatively early stage within medical education. This would be an area ripe for further research.
The need to train medical experts efficiently and to provide intrinsic motivation towards tasks which may not be generally immediately recompensing, demonstrates a potential demand for further gamification within medical education. The underlying educational theory behind gamification makes sense especially with the medical education context. The initial researchers produced over the last 10 years shows promise for profound benefits. Nevertheless, further research of gamification is required, especially in simulation-based learning.
References: Blohm, I., & Leimeister, J. (2013). Design of IT-based enhancing services for motivational support and behavioral change. Business and Information Systems Engineering, 55(4), 275-278.
Graafland, M., Schraagen, J. M., & Schijven, M. P. (2012). Systematic review of serious games for medical education and surgical skills training. British Journal of Surgery, 99(10), 1322-1330. doi:10.1002/bjs.8819
Harder, B. (2013). Are MOOCs the future of medical education? BMJ,346(2). doi:10.1136/bmj.f2666
Mckeown, S., Krause, C., Shergill, M., Siu, A., & Sweet, D. (2016). Gamification as a strategy to engage and motivate clinicians to improve care. Healthcare Management Forum, 29(2), 67-73. doi:10.1177/0840470415626528
Ryan, R. M., & Deci, E. L. (2000). Intrinsic and extrinsic motivations: classic definitions and new directions. Contemporary Educational Psychology,25(1), 54-67. doi:10.1006/ceps.1999.1020
Wit-Zuurendonk, L. D., & Oei, S. (2011). Serious gaming in women’s health care. International Journal of Obstetrics & Gynaecology, 118, 17-21. doi:10.1111/j.1471-0528.2011.03176.x