By: Nicole Damari, MD, MS, Christine Zhou, DO
“Okay, I’ll chop the vegetables, you take care of the rice,” one of us says from the couch, controller in hand. Our characters scramble through a chaotic kitchen as meal orders roll across the screen and the timer ticks down. We speak succinctly as we aim to complete as many meal orders as possible. When the timer hits zero, ending our round of the cooperative cooking simulation videogame Overcooked[i], one of us muses, “If we got really good at this, I wonder if we’d be a better team in a code.”
We laughed initially, but kept wondering: could playing games really make you better at taking care of a dying patient? In playing Overcooked, we practiced closed looped communication, situational awareness, adaptability, time management, and even emotional intelligence. Are these not also skills we need every day we practice medicine?
According to a Pew Research Center survey[ii], 60% of Americans ages 18-29 and 53% of Americans ages 30-49 reported playing videos games sometime or often. Both analog and video gaming are multi-billion-dollar global industries, and it is not uncommon for players to invest several hundred hours into a single game. It’s hard not to wonder what motivates people to invest so much in games – and whether these features can be harnessed for other means.
The question of whether games can serve a purpose beyond entertainment is not a new one. Decades of education literature has explored different facets of game-based learning, from theoretical frameworks to practical applications across varied subject matter. The Handbook of Game-Based Learning[iii] provides a rich overview for those who want to explore further. While there is some representation in health professions education[iv] [v] [vi], uptake is scattered and piecemeal. How can health professions education explore this untapped potential?
What is game-based learning?
There are multiple approaches to using games in education, with key approaches including serious games, gamification, and game-based learning.
- Serious games refer to games that have a secondary goal beyond entertainment. In the educational setting, a game designed to help players meet defined learning objectives would be considered a serious game.
- Gamification refers to the application of game elements to a non-game task. For example, you could gamify aspects of patient care by awarding learners points, badges, or prizes for meeting specific metrics.
- Game-based learning refers to the use of games to meet an educational objective. This might be achieved through gamification, through the design of a serious game with that educational objective in mind, or through repurposing an existing game to reach the educational objective (as we mused about doing with Overcooked).
Games for learning can be further categorized based on the type of learning objectives they target. In the opening chapter of The Handbook for Game-Based Learning, Plass et al delineate four potential functions of educational games:
- practicing existing knowledge and skills
- acquiring new knowledge and skills
- preparing for future knowledge
- developing learning and innovation skills
Many learners have had some exposure to the first, often through jeopardy, Kahoot, or other question-based games that encourage them to practice recall of previously learned information. Games that push players to learn new knowledge during gameplay are less common, largely due to the challenge of striking the right balance between knowledge acquisition and entertainment, though there are successful games that take this approach. Games that prepare players for future learning aim to create a shared experience that provides a foundation to build upon in future didactics. For example, one could imagine a game in which learners navigate a series of communication challenges, laying groundwork for a subsequent didactic on effective communication tools. Finally, the fourth category encompasses games that have learning objectives beyond knowledge acquisition.
Why should we use games to learn?
Perhaps even more important than the what of educational games is the why. As with any curricular piece, being deliberate about the educational tools we choose is important. Games offer some unique benefits[vii] that can be leveraged within medical education curriculum.
First, it’s important to acknowledge the obvious benefit of a well-designed game: it’s fun. While this may seem not seem immediately significant, if the enjoyment does not come at the cost of learning, this is a worthwhile outcome in and of itself, and it may motivate learners to engage with the material more than they might have otherwise. The ability of games to motivate players is based in more than just their fun factor – games employ short and long-term incentive systems, game mechanics, and design elements that can engage learners cognitively, behaviorally, emotionally, and interpersonally. Leveraging these features for education has powerful potential.
Beyond engagement and motivation, games also allow space for graceful failure. Within medical education, many learning experiences can also feel high stakes, either due to potential judgement from preceptors and team members or due to the risk of patient harm. Games are often low stakes by nature, providing a space where learners can hold grace for themselves as they learn from their own failures. Not only does this encourage intellectual risk taking and exploration, but it also has the potential to increase player comfort with failure and reframe these moments as growth opportunities. In other words, games inherently promote growth mindset.
Further, video games in particular offer opportunities for education personalized to the learner. Many digital games can adapt to a player’s input and performance to create an experience that meets their unique needs. Similarly, games can generate and collect personalized learner data that may have formative or summative uses. Games have thus already showcased their potential in helping us achieve the lofty goals of precision medical education.
Alright, I’m convinced.
Broadly, the existing literature on game-based learning and serious games is rich with both exciting examples of well-executed game-based curricula as well as further potential in medical education that has not been fully accessed. The unique features of games have potential applications to many facets of medical education at all levels, from medical knowledge acquisition to clinical reasoning to communication skills to professional development, and beyond – the only limit is our creativity as educators.
So, does a team that excels in Overcooked perform better together in a code? We can’t say for sure, but that’s only one of the many game-based learning questions yet to be answered.
Thank you to our new editor, Nicole Damari, for your first article and for recruiting Christine Zhou!
References
- Overcooked. Ghost Town Games / Team17, 2016. Playstation, XBox, Windows game.
- Brown, A. “Younger men play video games, but so do a diverse group of other Americans.” Pew Research Center
- Plass, JL, Ed.; Mayer, RE, Ed.; Homer, BD, Ed. ”The Handbook of Game-Based Learning.” MIT Press. Cambridge, MA, 2020.
- Gentry SV, Gauthier A, L’Estrade Ehrstrom B, Wortley D, Lilienthal A, Tudor Car L, Dauwels-Okutsu S, Nikolaou CK, Zary N, Campbell J, Car J. Serious Gaming and Gamification Education in Health Professions: Systematic Review. J Med Internet Res. 2019 Mar 28;21(3):e12994
- Edwards SL, Zarandi A, Cosimini M, Chan TM, Abudukebier M, Stiver ML. Analog Serious Games for Medical Education: A Scoping Review. Acad Med. 2024 Oct 31.
- van Gaalen AEJ, Brouwer J, Schönrock-Adema J, Bouwkamp-Timmer T, Jaarsma ADC, Georgiadis JR. Gamification of health professions education: a systematic review. Adv Health Sci Educ Theory Pract. 2021 May;26(2):683-711.
- Plass JL, Homer BD, Kinzer CK. ”Foundation of Game-Based Learning.” Educational Psychologist. 50(4), 258–283, 2015.
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