By: Oriaku Kas-Osoka, MD, MEd, FAAP
Some of the best ideas for medical education do not start in a simulation lab—they start in the toy box.
When I think about developing a new educational game, I rarely begin by asking, “What game should I build?” Instead, I ask, “What type of clinical thinking do I want my learners to practice?” Once I know the educational objective, I begin looking backward—not forward—for inspiration. I often then find myself asking a simple question: What childhood game already teaches the type of thinking I want learners to practice? Rather than inventing a game from scratch, I borrow the mechanics from games that learners already understand and redesign them to center on clinical reasoning, especially around high-yield board review concepts.
Many of the games we played as children already teach the cognitive skills we rely on in medicine. We simply did not recognize them as educational tools at the time. Jigsaw puzzles require learners to identify patterns and synthesize information from individual pieces into a complete picture. Taboo encourages rapid knowledge retrieval while communicating complex concepts without relying on obvious cues. Pictionary emphasizes visual recognition and interpretation, while games like Cranium combine creativity, teamwork, communication, and problem-solving through multiple learning modalities.
These games have endured for decades because they are intuitive. Most learners already understand the mechanics, allowing them to spend very little cognitive effort figuring out how to play. Instead, that mental energy can be redirected toward clinical reasoning. Familiarity also creates a level of comfort that encourages participation. Learners who may hesitate to answer questions in a traditional lecture often become enthusiastic contributors once the activity resembles a game they remember from childhood.
Rather than inventing entirely new games, I adapt familiar mechanics to create authentic clinical experiences. The objective is not to recreate the original game, but to preserve the type of thinking it encourages while replacing the content with meaningful medical decision-making.
Over time, I have found myself returning to the same design process regardless of whether I am creating a board review activity, a puzzle challenge, or an escape room. While every game looks different, they are all built using the same framework.
To demonstrate how this framework translates into practice, I applied each step to Inherited Illustrations: A Medical Pictionary Game, a collaborative activity in which learners draw clinical findings and combine those clues to identify genetic syndromes.
Step 1: Begin with the educational objective
Every game starts with a single question: What should learners be able to do at the end of the activity that they could not do before?
This may be recognizing a dermatologic condition, constructing a broad differential diagnosis, selecting the most appropriate diagnostic test, interpreting laboratory results, or developing an evidence-based treatment plan. Defining this objective first prevents the game from becoming entertainment with medicine added afterward. Instead, the educational outcome becomes the foundation upon which every game mechanic is built.
Whenever I find myself spending more time thinking about the game than the learning objective, I know I need to take a step back.
Application to Inherited Illustrations:
For Inherited Illustrations, my objective was for learners to recognize the characteristic clinical findings associated with genetic syndromes and synthesize multiple findings into a unifying diagnosis. Rather than testing isolated facts, I wanted teams to practice connecting physical features, such as short stature, macroorchidism, or syndactyly, to recognizable diagnostic patterns. Successful pattern recognition begins with the ability to identify and describe individual clinical features. Asking learners to draw those features reinforces foundational skills needed to recognize syndromes in clinical practice.
Step 2: Match the educational objective with the right game mechanic
Once the objective is clear, I think about which type of game naturally promotes that style of thinking. If I want learners to rapidly retrieve information under time pressure, a game like Taboo may be the perfect fit. If I want them to recognize visual findings, Pictionary or image-based puzzles often work well. If collaboration, communication, and multiple ways of demonstrating knowledge are important, I often draw on ideas from Cranium. For sequential reasoning, where one clinical decision influences the next, escape rooms provide an ideal structure because each solution unlocks another challenge.
The goal is not to force content into a favorite game. Instead, the game mechanic should amplify the educational objective. When the mechanic and objective complement one another, the learning feels natural rather than forced.
Application to Inherited Illustrations:
Because genetic syndromes are frequently identified through visual pattern recognition, I adapted the mechanics of Pictionary. One learner illustrates each clinical clue while teammates interpret the drawing, retrieve relevant knowledge, and determine which syndrome best represents the complete set of findings.
Step 3: Build layers of clinical reasoning
One of the biggest differences between educational games and simple trivia is that medical practice rarely ends after making a diagnosis. Instead of asking learners for a single correct answer, I try to reconstruct the sequence of decisions they make during patient care.
For example, a dermatology puzzle may begin by asking teams to assemble a clinical image. Once completed, they identify the lesion, develop a differential diagnosis, determine which historical or physical examination findings would support their leading diagnosis, select the most appropriate diagnostic test if indicated, and finally recommend initial treatment.
Each successful step unlocks another challenge, allowing the game to mimic the progression of real clinical reasoning rather than isolated fact recall. As complexity increases, learners begin to connect concepts rather than memorize individual answers.
Application to Inherited Illustrations:
Each syndrome is represented by three separate clue cards, requiring learners to gather and integrate information rather than make a diagnosis from a single feature. Teams first identify each illustrated finding and then combine all three clues to determine the syndrome, moving from observation to interpretation and finally to diagnostic synthesis.
Step 4: Design progression rather than competition
Competition can certainly increase excitement, but it should never become the primary purpose of the activity. Instead, I try to design games around progression. Every correct answer reveals another clue, unlocks another puzzle, advances the patient case, or opens the next stage of the challenge. Progress creates momentum.
Rather than asking, “How many points do we have?” learners begin asking, “What happens next?” That subtle shift changes the focus from winning to solving problems together. Teams naturally begin discussing diagnoses, debating treatment options, and explaining their reasoning to one another because collaboration becomes the fastest path forward.
Interestingly, some of the richest educational moments occur when learners disagree. Those conversations often generate more learning than arriving at the correct answer immediately.
Application to Inherited Illustrations:
Although teams can earn points for correctly identifying syndromes, the game’s momentum comes from progressing through the clues. Learners must successfully interpret three illustrations before attempting the final diagnosis, and teams that become stuck may pass and continue playing without receiving points for that round, keeping the activity moving without allowing competition to overshadow learning.
Step 5: Refine through observation
No game is perfect the first time it is played. Some of my greatest improvements have come from simply watching learners interact with the game. I pay close attention to where discussions naturally develop, where instructions create confusion, and whether teams spend more time talking about the medicine than about the rules.
One of the questions I ask myself after every implementation is: “Were learners discussing clinical reasoning or were they discussing game mechanics?”
If the mechanics become the focus, I simplify them. If learners are enthusiastically debating diagnoses, defending treatment plans, and teaching one another without prompting, then the design is accomplishing its purpose.
Each implementation becomes another opportunity to refine the experience so that future learners spend less time learning the game and more time practicing medicine.
Application to Inherited Illustrations:
As I refined the game, I focused on making the process easy to follow by organizing each syndrome into a consistent three-clue set and providing clear instructions, a structured score sheet, and an answer key. During gameplay, I can also observe whether teams are discussing the medical significance of the illustrations or getting distracted by drawing rules, allowing me to simplify instructions or revise unclear clues.
Perhaps the most important lesson I have learned is that educational games are not really about games at all. They are about creating experiences that make clinical thinking visible.
Whether learners are assembling a puzzle, drawing on a whiteboard, escaping a locked room, or rotating through game pieces inspired by Cranium, the activity itself is simply the vehicle. The real educational value lies in the conversations that emerge as learners explain their reasoning, challenge one another’s assumptions, justify their decisions, and collaboratively solve clinical problems.
While formal outcomes are still evolving, learner feedback has been consistently positive. Participants report high engagement, increased confidence with board-style content, and appreciation for practicing clinical reasoning in a psychologically safe environment.
For me, the greatest measure of success is not whether a team finishes first or earns the highest score. It is hearing learners continue discussing the cases after the game has ended, connecting the experience to patients they have cared for, or applying those same reasoning strategies on rounds the following day.
If a childhood game can inspire those conversations, it has become far more than a game; it is a catalyst for meaningful learning. Sometimes the next great innovation in medical education is simply a familiar game viewed through a clinical lens.
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