Twelve tips for incorporating gamification into medical education

Motivation Theories and Constructs in Experimental Studies of Online Instruction: Systematic Review and Directed Content Analysis

BACKGROUND

The motivational design of online instruction is critical in influencing learners' motivation. Given the multifaceted and situated nature of motivation, educators need access to a range of evidence-based motivational design strategies that target different motivational constructs (eg, interest or confidence).

OBJECTIVE

This systematic review and directed content analysis aimed to catalog the motivational constructs targeted in experimental studies of online motivational design strategies in health professions education. Identifying which motivational constructs have been most frequently targeted by design strategies-and which remain under-studied-can offer valuable insights into potential areas for future research.

METHODS

Medline, Embase, Emcare, PsycINFO, ERIC, and Web of Science were searched from 1990 to August 2022. Studies were included if they compared online instructional design strategies intending to support a motivational construct (eg, interest) or motivation in general among learners in licensed health professions. Two team members independently screened and coded the studies, focusing on the motivational theories that researchers used and the motivational constructs targeted by their design strategies. Motivational constructs were coded into the following categories: intrinsic value beliefs, extrinsic value beliefs, competence and control beliefs, social connectedness, autonomy, and goals.

RESULTS

From 10,584 records, 46 studies were included. Half of the studies (n=23) tested strategies aimed at making instruction more interesting, enjoyable, and fun (n=23), while fewer studies tested strategies aimed at influencing extrinsic value beliefs (n=9), competence and control beliefs (n=6), social connectedness (n=4), or autonomy (n=2). A focus on intrinsic value beliefs was particularly evident in studies not informed by a theory of motivation.

CONCLUSIONS

Most research in health professions education has focused on motivating learners by making online instruction more interesting, enjoyable, and fun. We recommend that future research expand this focus to include other motivational constructs, such as relevance, confidence, and autonomy. Investigating design strategies that influence these constructs would help generate a broader toolkit of strategies for educators to support learners' motivation in online settings.

TRIAL REGISTRATION

PROSPERO CRD42022359521; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022359521.

Game-based educational experience in clinical simulation and academic achievement in medical students: a retrospective study

BACKGROUND

In recent years, medical education has increasingly embraced gamification as a method for teaching clinical skills. In Peru, social isolation resulting from the COVID-19 pandemic forced universities and academic institutions to restructure their teaching methods, while there are no reports about the impact of this strategies in Peruvian students. In this study we evaluated the feasibility and patterns of use of a novel video game based didactic activity in undergraduate students from a School of Medicine in Peru.

METHOD

We conducted a retrospective pilot study in medical students who used the Full Code Medical Simulation platform. We retrieved scoring data obtained from this platform for selected cases of clinical courses with an appropriate number of users [clinical medicine (CM) I (7 cases), CM II (17 cases), surgery I (6 cases) and surgery II (6 cases)]. cases)]. We also evaluated patterns of use and the association between academic performance and the Full Code scores.

RESULTS

A total of 590 students were included in the study. We found a direct correlation between the student's course grade and Full Code score in all courses (CM I: p < 0.001, CM II: p < 0.05, Surgery I: p < 0.05 and Surgery II: p < 0.05). CM II course students who dedicated more time to completing cases received better grades (p < 0.05). The pattern of use of Full code were similar in students regardless their academic performance. In addition, students with higher academic performance were more likely to have higher scores in the platform (p < 0.001).

CONCLUSION

The use of gamification in clinical simulation was highly feasible in students of medicine regardless their academic performance. Prospective and interventional studies are needed to assess if the Full Code platform directly affect the learning outcomes.

Effect of gamification applications on success of dentistry students

BACKGROUND

Gamification, the use of game materials in education, has been used in several scientific fields, and studies have demonstrated its effectiveness in student comprehension.

AIM

To evaluate whether the success of 4th- and 5th-grade dentistry students increases when using the gamification applications Kahoot! and Mentimeter.

METHODS

An experimental design was used to measure the effect of gamification applications on students who were taught using the traditional method. For this purpose, Mentimeter and Kahoot! applications were used in this experimental study. Three groups of 4th- and 5th-grade students were formed: Mentimeter, Kahoot!, and control groups. The effect of gamification applications on achievement was evaluated by administering a post-test to these groups after the instructional process. One-way analysis of variance and t-tests were used for statistical analyses.

RESULTS

A total of 35.5% of the students were in the Mentimeter group, 29.8% in the Kahoot! group, and 34.6% in the control group. Of the total number of students, 54.8% were female and 45.2% were male, while 52.2% were 5th-grade students and 47.8% were 4th-grade students. The overall grade point average was found to be 66.65 (range, 24-100). There was a statistically significant difference in average success scores between students of different groups (P = 0.003 < 0.05) and grades (P = 0.036 < 0.05). The average success score was the highest in the Mentimeter group (71.64) and the lowest in the Kahoot! group (62.15). In the control group, this score was 65.41. The average success score was higher for students in the 5th-grade (68.16) and for female students (68.84).

CONCLUSION

Gamification has a great potential in the education of dentomaxillofacial radiology students. Mentimeter outperformed both the Kahoot! and the traditional method in terms of average student success rates.

Chaotic fun! Promoting active recall of anatomical structures and relationships using the Catch-Phrase game

Active recall, the act of recalling knowledge from memory, and games-based learning, the use of games and game elements for learning, are well-established as effective strategies for learning gross anatomy. An activity that applies both principles is Catch-Phrase, a fast-paced word guessing game. In Anatomy Catch-Phrase, players must get their teammates to identify an anatomical term by describing its features, functions, or relationships without saying the term itself. Once a teammate guesses the term, players switch roles and continue play with the next term(s) until time runs out. Meanwhile, the instructor notes common errors and reviews knowledge gaps with the team at the end of the round. Prior to the first exam, a seven-question evaluation was distributed to the health professional students. A total of 18 dissection lab groups (86%) played one round of Anatomy Catch-Phrase, with many groups playing multiple times. After the first exam, 73 students (61%) completed the evaluation. On a five-point scale, most students indicated they enjoyed Anatomy Catch-Phrase (4.3 ± 0.9), highly recommended it (4.2 ± 0.9), and wanted to play it in the future (4.3 ± 1.0). Most students also found the game relevant to the course material (4.5 ± 0.8), useful for reviewing (3.9 ± 0.9), and helped reinforce their knowledge (3.9 ± 0.9). Anatomy Catch-Phrase was highly rated, with a score of 4.3 ± 0.9. Multiple students also provided enthusiastic unsolicited comments, such as 'LOVED IT! A fun way to study anatomy!:)'. Overall, Anatomy Catch-Phrase was well-received as a fun activity for reviewing the anatomy relevant to the course.

The Effects of Implementing Gamification in the Hepatology Curriculum for Medical Students

Background Gamification, the incorporation of game theory into the curriculum, has been correlated with improved knowledge retention compared to standard didactics. Objective To determine the impact of gamified hepatology modules on medical student knowledge retention and exam performance. Methods We created three web-based, gamified hepatology modules with 15-question pre- and post-tests. Differences in each module's pre- and post-test scores were compared using paired t-tests. Medical school exam scores (total score and hepatology-specific score) in module users versus non-users were compared using independent two-sample t-tests. Results Module completion yielded significant increases in pre- to post-test scores for the jaundice (p=0.002) and anatomy modules (p<0.001). Module users scored 1.2 points higher on the total exam score (p=0.4) and 2 points higher on the hepatology exam score (p=0.31). Post-module survey results revealed higher knowledge retention in hepatology topics, expanded interest in hepatology, and an increased inclination to use web-based learning platforms for future learning experiences. Conclusion Module use led to improved post-test scores in the modules. Module users also had higher hepatology exam and total exam scores, yet, this difference was not statistically significant. Overall, this study suggests that gamification may be beneficial in aiding hepatology knowledge recall.

The House Cup: Using Longitudinal Gamification to Improve Didactic Attendance

OBJECTIVE

Determine if a point-based attendance system combined with longitudinal gamification is feasible and improves didactic session attendance and learner perceptions at our internal medicine residency.

METHODS

A prospective before-after cohort study. Weekly attendance was tracked from June 2022 through April 2023 at our university-affiliated internal medicine residency program. We implemented a point-based longitudinal game incentivizing residents to attend didactics with positive reinforcement in July 2022 (C: carrot). We added tiered positive reinforcement and positive punishment to the game in January 2023 (CS: carrot and stick). Attendance during these periods was compared to pre (P) and postintervention (S). Perceptions were assessed during the P, C, and CS periods with Likert scale ratings.

RESULTS

CS was associated with higher attendance than other study periods (P = .002). Median attendance was P-51% (IQR 37.5-64.5), C-65% (IQR 50-74), CS-81% (IQR 78-94), and S-66% (IQR 63-71). Perceptions were similar during pre and intervention study periods, including perceptions of camaraderie (P-4.4, C-4.4, CS-4.5; P = .56), interest in attending didactic sessions (P-3.7, C-3.4, CS-3.2; P = .21), and mandate as the primary reason for attending didactics (P-3.1, C-3.1, CS-3.2; P = .96).

CONCLUSIONS

A point-based attendance system combined with a longitudinal game that included tiered positive reinforcement and positive punishment was feasible and associated with higher didactic attendance but not associated with changes in resident perceptions.

Gamified versus non-gamified online educational modules for teaching clinical laboratory medicine to first-year medical students at a large allopathic medical school in the United States

BACKGROUND

Medical educators seek innovative ways to engage learners efficiently and effectively. Gamification has been explored as one way to accomplish this feat; however, questions remain about which contexts gamification would be most useful. Time constraints and student interest present major barriers for teaching laboratory medicine to students. This study aims to compare two versions of an interactive online module, one gamified and one not, for teaching laboratory medicine concepts to pre-clinical medical students.

METHODS

First-year medical students reviewed either a gamified or non-gamified version of an interactive online module in preparation for an in-person flipped classroom session on Laboratory Medicine. Learning theory guided the design of the modules and both contained identical content, objectives, and structure. The "gamified" module included the additional elements of personalization, progress meters, points, badges, and story/role play. After reviewing the module, students completed an anonymous knowledge check and optional survey.

RESULTS

One hundred seventy-one students completed the post module knowledge check as assigned (82 gamified, 89 non-gamified). Knowledge check scores were higher for the students who reviewed the gamified module (p < 0.02), corresponding to an effect size of 0.4 for the gamified module. Eighty-one students completed optional post-module surveys (46 gamified, 35 non-gamified). Instructional efficiency was calculated using task difficulty questions and knowledge check scores, and the resulting instructional efficiency was higher for the gamified module. There was no significant difference in the student-reported time required to complete the modules. Additionally, both versions of the module were well received and led to positive ratings related to motivation and confidence. Finally, examination of open-ended survey results suggested that the addition of game elements added value to the gamified module and enhanced engagement and enjoyment.

CONCLUSIONS

In this setting, the addition of gamification to an interactive online module enhanced learning outcome, instructional efficiency, student engagement and enjoyment. These results should inspire further exploration of gamification for teaching Laboratory Medicine concepts to pre-clinical medical students.

Performance in Kahoot! activities as predictive of exam performance

BACKGROUND

Game-based learning (GBL) is effective for increasing participation, creativity, and student motivation. However, the discriminative value of GBL for knowledge acquisition has not yet been proven. The aim of this study is to assess the value of Kahoot! as a discriminative tool for formative assessment in medical education in two different subjects.

METHODS

A prospective experimental study was conducted on a sample of 173 students enrolled in neuroanatomy (2021-2022). One hundred twenty-five students individually completed the Kahoot! prior to the final exam. In addition, students enrolled in human histology during two academic courses were included in the study. The control group course (2018-2019) received a traditional teaching methodology (N = 211), while Kahoot! was implemented during 2020-2021 (N = 200). All students completed similar final exams for neuroanatomy and human histology based on theory tests and image exams.

RESULTS

The correlation between the Kahoot score and the final grade was analyzed for all students enrolled in neuroanatomy who completed both exercises. The correlation between the Kahoot exercise and the theory test, image exam and final grade was significantly positive in all cases (r = 0.334 p < 0.001, r = 0.278 p = 0.002 and r = 0.355 p < 0.001, respectively). Moreover, students who completed the Kahoot! exercise obtained significantly higher grades in all parts of the exam. Regarding human histology, the theory tests, image exams and final grades were significantly higher when using Kahoot! versus the "traditional" methodology (p < 0.001, p < 0.001 and p = 0.014, respectively).

CONCLUSIONS

Our study demonstrates for the first time that Kahoot! can be used to improve and predict the final grade in medical education subjects.

Billing Bonanza: Improving Resident Knowledge of the 2021 Revised American Medical Association Outpatient Billing Guidelines Through Gamification

Introduction

Residents often feel unprepared for independent practice, citing an unfamiliarity with billing as a common cause. Gamification has been well studied as a means to engage learners but not as a way to improve resident knowledge of outpatient billing guidelines.

Methods

We delivered a session to incoming PGY 1 residents with a goal of improving billing proficiency. The session included a pretest and posttest questionnaire, a prerecorded PowerPoint lecture, and Billing Bonanza, a game with instructions and rules that used gamification to reinforce billing concepts.

Results

Residents demonstrated improvement in percentage of correctly answered questions from 42% on the pretest to 67% on the posttest, which resulted in a statistically significant increase of 0.24 questions correct.

Discussion

This session led to improvement in baseline billing knowledge.

Study Based on Gamification of Tests through Kahoot!™ and Reward Game Cards as an Innovative Tool in Physiotherapy Students: A Preliminary Study

BACKGROUND

Kahoot! is an educational tool allowing teachers to create a series of gamified tests with the aim of reinforcing educational content, thus improving the teaching-learning process. The objective of this project is to evaluate the acquisition of content through gamified tests with Kahoot! and reward cards compared to the traditional teaching methodology (contents not reinforced).

METHODS

This Physiotherapy Teaching Innovation Project (PTIP) was carried out in four subjects of the Degree in Physiotherapy at the University of Jaén (Spain). The teachers responsible for each subject were instructed in the use of Kahoot! and reward cards. These teachers randomly selected the contents that were going to be reinforced with Kahoot! while the other 50% of the contents would not be reinforced. In the final exam of each subject, the results related to the reinforced contents were compared with those non-reinforced and the degree of satisfaction of the students with the experience was evaluated.

RESULTS

A total of 313 students participated in this PTIP. In all subjects, we determined a significant increase in the number of correct answers in an improvement range from 7% (95% CI 3.85 to 9.38) to more than 20% (95% CI 17.61 to 26.86) in favor of the questions that alluded to reinforced content using Kahoot! compared to the non-reinforced contents. More than 90% of the participants considered the use of Kahoot! useful and motivating. Our findings showed that Kahoot! motivated more than 65% of students to study daily.

CONCLUSIONS

The students obtained better academic results in the questions related to contents reinforced with tests through Kahoot! and reward cards compared to those non-reinforced, showing that this methodology can be an effective tool to promote retention and content assimilation.

Benefits of gamification in medical education

Medical education is changing at a fast pace. Students attend medical school with a high degree of technological literacy and a desire for a diverse educational experience. As a result, a growing number of medical schools are incorporating technology-enhanced active learning and multimedia education tools into their curriculum. Gamified training platforms include educational games, mobile medical apps, and virtual patient scenarios. We provide a systematic review of what is meant by gamification in this era. Specific educational games, mobile apps, and virtual simulations that may be used for preclinical and clinical training have been discovered and classified. The available data were presented in terms of the recognized platforms for medical education's possible benefits. Virtual patient simulations have been shown to enhance learning results in general. Gamification could improve learning, engagement, and cooperation by allowing for real-world application. They may also help with promoting risk-free healthcare decision-making, remote learning, learning analytics, and quick feedback. We account for Preclinical training which included 5 electronic games and 4 mobile apps, while clinical training included 5 electronic games, 10 mobile applications, and 12 virtual patient simulation tools. There were additionally nine more gamified virtual environment training products that were not commercially accessible. Many of these studies have shown that utilizing gamified media in medical education may confer advantages. This collection of hyperlinked resources may be utilized by medical students, practitioners, and instructors at all levels.

Let's Play Games: A Comparison of Case-Based Learning Approach With Gamification Technique

Case-based learning (CBL) has been in practice throughout the world for several decades now. Our institute adopted it some four years back when we shifted toward a modular system of teaching. It is the main technique being used for conducting small group discussions. We decided to introduce a new technique called the gamification technique for conducting small group discussions. There was a need to determine the effectiveness of this new method, as well as to assess factors for its preference so that it could be modified to increase its efficacy. The aim of this research was to quantitatively and qualitatively assess the effectiveness of said gamification teaching technique by comparison with the traditional CBL technique. This was a mixed-method, randomized controlled trial. It was conducted at Khyber Medical College on first-year medical students from June to October 2021. Group-based teaching involving both CBL and the gamification approach was used in this study in a crossover manner. Addressing the ethical concerns, and after informed consent pre-testing and post-testing were done to quantify the performance, an open-ended survey was disseminated after the sessions to check the perceptions of the students. The study recorded (quantitatively) that the post-testing mean score of the gamification teaching technique was 3.41 ± 0.982. For CBL, the mean was 3.55 ± 1.055. This showed a recording of an insignificant difference with a p-value of 0.608. In qualitative analysis, about 12 (80%) students preferred the gamification technique. Their perception was that it instilled competitiveness and increased the involvement of students in class. Gamification also raised their motivation level. This research further revealed that the CBL approach had the advantage of quick learning via the facilitator presentation. Due to the handouts, it was easy to follow. One of the negative points of CBL was that the participants found it a boring and monotonous way of learning. The chief drawback of gamification was that the students were unsure about the accuracy of the information they initially prepared, as it was not being directed by the facilitator. The study concluded an insignificant quantitative difference between the two techniques. On the qualitative end, however, the students preferred gamification.

Effective online large-group teaching in health professions education

Online large-group teaching (OLGT), employed to reach a large group of learners in separate physical locations, allows asynchronous learning and facilitates social distancing. While online large-groups can be a powerful and resource-lean means of health professions education, it has challenges and potential pitfalls that may affect the learning process and outcomes. Through a sociomateriality framework, this article describes strategies for effective online large-group teaching in health professions education in three key strands. Firstly, to optimize learning, OLGT sessions should match learning needs with appropriate OLGT platforms, incorporate strategies to sustain learner attention, and accommodate learners of different abilities. Secondly, to develop a learning culture, OLGT must not only focus on cognitive aspects of learning but also build a community of practice, nurture digital professionalism and professional identity. Thirdly, we discuss the avoidance of pitfalls such as cognitive overload of both tutors and learners, technical issues and security risks, mitigating inequities in access to online learning, and the use of program evaluation to plan for sustained improvements. We conclude with a case vignette that discusses the challenges of OLGT and the application of the above strategies in a teaching scenario.

Pre-class online video learning and class style expectation: patterns, association, and precision medical education

BACKGROUND

Online video learning has been gaining substantial attention in medical education. The purpose of the study was to evaluate medical students' online video-viewing patterns as well as to identify features associated with their class style preferences in precision medicine courses.

METHODS

A mixed methods research design was used. Part of the cognitive load of the class content of "acute liver failure" was shifted to a 10-minute pre-class online video learning which was further reduced using threshold concept strategy. In the 2019 academic year, all fifth-year medical students who had viewed the pre-class video were invited to take a survey on their learning process and four class style expectations for the upcoming in-person class. For each round of medical students, teaching assistants helped collect anonymous survey data before the class. The teacher then adjusted the in-person class as part of precision medical education. Furthermore, the researchers coded the video-viewing patterns through an action log transformation, along with the questionnaire results, for analysis. Mann-Whitney U and Kruskal-Wallis tests were employed to compare group differences. Qualitative data were content-coded through a descriptive approach using thematic analysis.

RESULTS

Of the 130 medical students, 114 (87.7%) joined the pre-class video learning, 113 (86.9%) responded to the questionnaires, and 87 (66.9%) provided their comments. Most medical students preferred the class styles of a thorough introduction (42.5%) and concept orientation (44.2%). High-engagement viewing patterns were associated with difficult concepts and the provision of comments. Class style expectation and video-viewing patterns did not demonstrate significant linkages. A majority of the substantial comments initiated thought-provoking questions after the online video learning.

CONCLUSION

Association between medical students' preferred class styles and online video-viewing patterns was not necessarily linked. However, medical teachers are recommended to modify class styles based on medical students' expectations after pre-class learning, thereby providing precision medical education.KEY MESSAGEImplementing precision medical education in the blended class is feasible.Online video learning is an ideal platform for balancing the dilemma between increasing the cognitive load of class content and the practice of precision medical education.The association between medical students' preferred class styles and online video-viewing patterns was not clearly seen.

FUN AND GAMES: DESIGNING A GAMIFIED CENTRAL VENOUS CATHETERIZATION TRAINING SIMULATOR

Gamification, or adding elements of games to training systems, has the potential to increase learner engagement and information retention. However, the use of gamification has yet to be explored in Central Venous Catheterization (CVC) trainers which teach a commonly performed medical procedure with high incidence rates. In order to combat these errors, a Dynamic Haptic Robotic Trainer (DHRT) was developed, which focuses on vessel identification and access. A DHRT+ system is currently under development that focuses on whole procedure training (e.g. sterilization and catheter insertion), including a gamified Graphical User Interface. The goal of this paper was to (1) develop a game-like, patient-centered interface to foster personalized learning and (2) understand the perceived utility of gamification for CVC skill development with expert doctors. This paper outlines some of the potential benefits and deficits of the use of gamification in medical trainers that can be used to drive simulation design.

Student Perception and the Effectiveness of Kahoot!: A Scoping Review in Histology, Anatomy, and Medical Education

The impact of the Covid-19 pandemic has presented challenges in medical education particularly, with development of online learning in a short time period. Notably there has been a significant increase in the use of digital technology applications to meet this challenge. For instance, in the first quarter of 2020 the game-based software Kahoot! reported a threefold increase in players and a fivefold increase in asynchronous learning globally. However, there is limited research into the use of game-based digital technology applications such as Kahoot! and the associated learning theories, particularly in histology, anatomy, and medical education. This scoping review explored the utilization, outcome scores, and student perceptions of learning with the application of Kahoot! in histology, anatomy, and medical education. Online databases were used to identify articles published between 2013 and 2021 from which 12 articles were included in the review. The majority of articles supported positive student outcomes including improved collaborative learning, improved knowledge of content, attendance, and participation. Minor negative aspects included increased time on task, overwhelming learning content, and distractions due to gadgets. None of the articles included a control group. The main educational theories identified were active learning followed by social and constructivism learning theory. In light of the Covid-19 pandemic a rapid and fundamental shift in how digital applications are being used in educational institutions has evolved. Further research on learning frameworks and studies with control groups is required to evaluate Kahoot! as a potentially valuable online application in histology, anatomy, and medical education.

Applying the Plan-Do-Study-Act cycle in medical education to refine an antibiotics therapy active learning session

BACKGROUND

Active learning improves learner engagement and knowledge retention. The application of continuous quality improvement methodologies, such as the Plan-Do-Study-Act (PDSA) framework, may be useful for optimizing medical education, including active learning sessions. We aimed to enhance student satisfaction and achievement of learning outcomes by applying the PDSA framework to an antibiotic utilization curriculum for medical students.

METHODS

Guided by the Plan-Do-Study-Act framework, between February 2017 and July 2019, we developed, implemented, and revised an active learning session for medical students, focused on appropriate utilization of antibiotics during their Internal Medicine clerkship.

RESULTS

Across twelve sessions, 367 students (83.4%) completed the post-evaluation survey. Although baseline ratings were high (97% of respondents enjoyed the "active learning" format), constructive comments informed iterative improvements to the session, such as modifying session timing, handouts and organization of the gaming component. Intervention 3, the last improvement cycle, resulted in more favorable ratings for the active learning format (p = 0.015) improvement in understanding antibiotics and their clinical application (p = 0.001) compared to Baseline ratings.

CONCLUSIONS

This intervention suggests that active learning, with regular incorporation of student feedback vis-à-vis a PDSA cycle, was effective in achieving high student engagement in an Internal Medicine core clerkship session on antibiotic therapy. Iterative interventions based on student feedback, such as providing an antibiotic reference table and answer choices for each case, further improved student receptivity and perceived educational value. The study findings have potential implications for medical education and suggest that the application of the PDSA cycle can optimize active learning pedagogies and outcomes.

Development and implementation of a novel Web-based gaming application to enhance emergency medical technician knowledge in low- and middle-income countries

BACKGROUND

Increasing access to high-quality emergency and prehospital care is an important priority in low- and middle-income countries (LMICs). However, ensuring that emergency medical technicians (EMTs) maintain their clinical knowledge and proficiency with procedural skills is challenging, as continuing education requirements are still being introduced, and clinical instructional efforts need strengthening. We describe the development and implementation of an innovative asynchronous learning tool for EMTs in the form of a Web-based trivia game.

METHODS

Over 500 case-based multiple-choice questions (covering 10 essential prehospital content areas) were created by experts in prehospital education, piloted with EMT educators from LMICs, and delivered to EMTs through a Web-based quiz game platform over a 12-week period. We enrolled 252 participants from nine countries.

RESULTS

Thirty-two participants (12.7%) completed the entire 12-week game. Participants who completed the game were administered a survey with a 100% response rate. Ninety-three percent of participants used their mobile phone to access the game. Overall, participants reported that the interface was easy to use (93.8% agreed or strongly agreed), the game improved their knowledge (100% agreed or strongly agreed), and they felt better prepared for their jobs (100% agreed or strongly agreed). The primary motivators for participation were improving patient care (37.5%) and being recognized on the game's leaderboard (31.3%). All participants reported that they would engage in the game again (43.8% agreed and 56.3% strongly agreed) and would recommend the game to their colleagues (34.4% agreed and 65.6% strongly agreed).

CONCLUSIONS

In conclusion, a quiz game targeting EMT learners from LMICs was viewed as accessible and effective by participants. Future efforts should focus on increasing retention and trialing languages in addition to English.

Comparing the Effectiveness of a Virtual Toxicology Escape Room at Two Emergency Medicine Residencies

Introduction Physical distancing guidelines during the coronavirus disease 2019 (COVID-19) pandemic forced medical residency programs to move a large portion of required didactics to virtual settings. Toxicology, a core component of emergency medicine (EM) education, was forced to adapt to similar constraints. An in-person escape room style puzzle was modified to a virtual format for educational purposes, and shared with and evaluated by two different residency programs. Materials and methods A virtual escape room, "Escape the Toxin: Online!" was created to test knowledge of toxicologic ingestion and antidote utilizing Google Forms and delivered using Zoom teleconference software to two EM residency programs in the Philadelphia region. After small groups completed the gamified activity, their scores were calculated and they completed an anonymous evaluation. Results Residents at the program where a Medical Toxicology fellowship is located found the virtual escape room to be more effective and enjoyable compared to the second program. Despite some differences in perceived effectiveness, the majority of participants were able to correctly solve the puzzle and get to the antidote. Conclusion The majority of learners who participated from both residencies agreed that they would recommend this virtual program to other EM residents.