Playing an adventure video game featuring a fictitious, young emergency physician treating severe trauma patients was better than text-based learning at priming real doctors to quickly recognise the patients who needed higher levels of care, according to a new trial led by the University of Pittsburgh School of Medicine.

The results, published by The BMJ, held even though doctors assigned to the game enjoyed it less than those assigned to traditional, text-based education. This indicates that if game enjoyment can be improved, the already favourable results might be enhanced.

‘Physicians must make decisions quickly and with incomplete information. Each year, 30,000 preventable deaths occur after injury, in part because patients with severe injuries who initially present to non-trauma centres are not promptly transferred to a hospital that can provide appropriate care,’ explained lead author Deepika Mohan, MD, MPH, Assistant Professor in Pitt’s Departments of Critical Care Medicine and Surgery.

‘An hour of playing the video game recalibrated physicians’ brains to such a degree that, six months later, they were still out-performing their peers in recognising severe trauma.’

Mohan created the game Night Shift with Schell Games, a Pittsburgh-based educational and entertainment game development company. The game is designed to tap into the part of the brain that uses pattern recognition and previous experience to make snap decisions using subconscious mental shortcuts – a process called heuristics.

Physicians in non-trauma centres typically see only about one severe trauma per 1,000 patients. As a result, their heuristic abilities can become skewed toward obvious injuries such as gunshot wounds, and miss equally severe traumas, such as internal injuries from falls. On average, 70 per cent of severely injured patients who present to non-trauma centers are under-triaged and not transferred to trauma centres as recommended by clinical practice.

Both the game and the text-based learning are intended to help physicians improve their decision making regarding severe traumas. The game, however, sought to do this through narrative engagement, or the use of stories to promote behaviour change, which has shown promise in recalibrating heuristics.

Mohan’s team recruited 368 emergency medicine physicians from across the country who did not work at hospitals with trauma specialisation. Half were assigned to play the game and half were asked to spend at least an hour reading the educational materials.

Participants then responded to questionnaires and completed a simulation that tested how often they ‘under-triaged,’ or failed to send severe trauma patients to hospitals with the resources necessary to handle them. Physicians who played the game under-triaged 53 per cent of the time, compared with 64 per cent for those who read the educational materials.

Six months later, Mohan reassessed the physicians and found that the effect of the game persisted, with those who played the game under-triaging 57 per cent of the time, compared to 74 per cent for those who had read the educational materials.

‘There are many reasons beyond the doctor’s heuristics as to why a severe trauma patient wouldn’t be transferred to a trauma centre, ranging from not having an ambulance available to a lack of proper diagnostic tools,’ said Mohan.

‘So, it is important to emphasise that recalibrating heuristics won’t completely solve the under-triage problem and that the problem isn’t entirely due to physicians’ diagnostic skills. But it’s heartening to know we’re on track to develop a game that shows promise at improving on current educational training.’

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