As a medical intern, Dr. James Willig, CCTS Informatics Co-Director and UAB Assistant Dean of Clinical Education, liked to play games. Like a lot of his peers, he played them on his Palm Pilot, trying to disguise this activity as “research” when on rounds. “We knew what games we could get away with and what games made sounds that would get us busted” he told a packed audience at the CCTS June Forum.
After the Accreditation Council for Graduate Medical Education (ACGME) changed duty hour standards for residents in 2003 and 2011, Willig, now an associate professor of medicine, began to wonder how the limits were affecting medical education and training. He also recognized that, while today’s residents are “more likely posting to Facebook than playing Blackjack,” the instinct to “check out” during a dry lecture on rounds isn’t uncommon and is easier than ever to hide given the ubiquity of smartphones. The lack of engagement, plus lost training time, struck Willig as both a problem and an opportunity.
“Have you ever studied for three hours and felt like it was only 5 minutes? Me neither! But who hasn’t experienced this phenomenon while playing a game? I began to wonder, could we apply elements of gamification to graduate medical education?” Weaving in the final thread, the idea of continual improvement and lifelong learning underlying the Kaizen management philosophy, and the basis for an experimental teaching platform was born.
Key Gaming Elements
Willig built as many “behavioral hooks” into the software as he could to see if students could learn while playing, borrowing from the reward systems commonly used in online games. In combination, he noted the following were effective at increasing both motivation and engagement:
Intrinsic rewards:
Self-efficacy: increased knowledge, acquisition of a new skill
Personal challenge: problem-solving
Socialization: collaboration with colleagues, social interaction
Extrinsic rewards:
Achievements: points, badges, levels
Reputation: status within the community of users
Other key elements included concise questions focused on key teaching points and the use of humor, mnemonics, and visual images to increase attention.
Kaizen Catches Fire
Working with the CCTS Informatics team, Willig rolled out the first Kaizen game for the Dept. of Internal Medicine’s (IM) residency program in 2011-12. Residents could play on teams as themselves or as an alias and could see their rank against other residents on a game board. Willig gave funny names to the levels, and noted, “Nobody wanted to be a ‘petri dish’ or on ‘crutches,’ the two lowest performance levels!” Residents answered a total of 16,427 questions, showing significant retention of knowledge.
Based on such a positive outcome, and with several requests to build new games, the CCTS Informatics team set out to create an interface that would enable educators to use the Kaizen platform tools to build their own games. Partnerships developed among general medical programs, and with the Schools of Nursing, Dentistry, Public Health, and Business. The different groups used the Kaizen platform in novel ways such as to prepare for board review, to demonstrate learned competencies, to practice medical calculations, or to connect with alumni. Kaizen has even been used to train rural health workers in Kenya so they no longer have to travel when practice guidelines change. “I’ve been so impressed with the creative ways partners are using Kaizen,” Willig said.
The newest game, developed by Dr. David Redden and Mr. Brian Wallace of the CCTS, addresses the NIH requirement for training in rigor, reproducibility, and transparency (R2T) for F, K, and T fellows. The course can be used by institutional training programs (e.g., T32, K12) to fulfill this education expectation in a fun and innovative way. [Editor's Note: It's not too late to register for the next CCTS Kaizen R2T game, which opens on June 19! Register here.]
The Evolution of a Platform: Kaizen-ME
With internal funding in hand, Willig was able to acquire servers and rebuild the front end of the platform, creating a team landing and communication page. The Kaizen-ME Game Manager enabled educators to set their game parameters: number of players, number of teams, badges, scoring, questions, timed or not, etc. Willig and his team eventually “took away the walls” to enable a shared library of questions, so it took educators less time to develop a new game. Likewise, a library of badges grew and became a shareable resource. To date, more than 87 educational games across 15 disciplines have taught 5,816 distinct Kaizen registered users. In total, 204,722 question responses have occurred.
The Future of Kaizen
Willig believes there is more to learn from studying Kaizen players, beyond the analyses he had already conducted on player attrition, engagement, and retention of knowledge. He plans to look more closely at play style and has developed a Player Efficiency Rating to help analyze the platform's effectiveness. He also plans to add new tools and features for game managers, including the creation of a game library.
In Case You Missed It
Willig's talk is available for viewing on the CCTS YouTube channel. Mark your calendar for our monthly CCTS Forum, which we host the first Wednesday of every month from 4:45-6pm.