We're going to talk about gamification. So how many people play video games? Yeah, OK, this is for you. So I'm going to talk to you, and so will Cheryl Chang. We have this divided in a couple of different ways, and you'll see exactly why that happens to be. These are my disclosures, none of which are financial in nature. And you will be convinced by the end of this talk that we have not at all used any augmented intelligence. Cheryl has more disclosures that are more impressive than mine. But even though she's a neurologist, she also avoided the use of generative AI. She is your current treasurer. These are our objectives. We'll talk about gamification. What is it? How does it compare to how we typically educate people? What are the key principles that are leveraged? Because I'm going to suggest that our organization, in particular, gamifies a number of things. Cheryl's going to take you through all the neurocognitive underpinnings for this, and we'll talk about why these things will work in medical education in general, and critical care in particular. So if you ask the question, what is gamification? It has a clear definition, and it's a simple one. You introduce gameplay in a non-game setting, and we call that gamification. Yes, there's another paper. It's out in Critical Care Explorations. It's very lovely. Download it. I'm sure you'll all read it twice. But it'll help you understand this. What is the world of games? When you look at this map here, this Venn diagram, it says educational content. We do that. That's e-learning. All of us have done that. Then there's this thing called serious games. Serious games have a deliberate purpose. It uses game techniques. And in this space, where you have the desire to embrace learning, but also behavioral change, that's where gamification fits. All the other stuff, when you raised your hands, that's in the fun and storytelling part. That's gameplay. You probably have Xbox or some other platform. Maybe you're using your iPhone. Getting from games to game-based learning can be categorized in this way. And you can see, across the top, from games to game-based learning, and you have four domains. What is it? What's the goal? What format? And what is the use case? When you look at gamification, there's game elements in a non-game context. We covered that with the definition. The goal is behavior and attitude modification. But if you look just to the right, you're also going to modify skills, knowledge, and attitude. It's digital. But you can make it standalone so that it's portable. One of the key tenants is that you are engaged. And when you do that, it provides a creative solution to an existing problem. We have a number of those. When you think about traditional instructional design, and this gave me flashbacks to when I was in college, you can see these things in the past in gray, in the future in blue. Just by example, from passive to active learning. If you look in the center, restricted access to open access, free open access medical education. And far to the right, learners examined, learners evaluated. It's not just passing the test. The principles that are enacted in gamification deserve some scrutiny. And they are listed here for you. You have something that motivates people, because it's fun. The users engage their rewards, their achievements. You are used to these things. But it also presents a challenge. And in the process of navigating those challenges, learn something that is of use. Everyone will recognize Mario Kart. And when you look at Mario Kart, it did all of those things. Because here you are. You have some challenges. You got five races. You are unfortunately being negatively influenced. You're in third place when you always wanted to be in first place. And you can see all the people ahead of you. You are not doing as well as you should. But you have four more times going around to get it right. If you do it right, you get rewarded. And so now, here you are. You're up in first. You've got a big first. You can see where you are on the map. You're going to get to these rewards before everyone else. And it reinforces itself in a way that is driven by challenge, but also requires you to do something different to be better. The elements that drive that interaction are listed here. And it's everything from rewards to, in gamification, a real world context, something that you would apply on a daily basis. There is a subculture to this where it can be adapted to you. How do you wish to have things presented? What can you anticipate? What are my achievements like? When will I get them? And as you get them more rapidly, your engagement goes up because you are being rewarded in a way that has utility. In order to understand why you would like this, Cheryl's going to talk about the neurocognitive foundations. And then I'll have a few more comments. This is not what you want to do. This would be a bad thing. We do not want to be affiliated with internet gaming disorder. We do, on the other hand, wish to be affiliated with something that's adaptive. But why do people develop that? What is the characteristic? In this game, World of Warcraft, which is the multiplayer online role-playing game that had no ending, was the source. It was an open platform. You never had an endpoint. So that what we design to meet particular needs must have a finish line. We have to make sure that we don't create this particular disorder. The way that World of Warcraft did this in particular was that you could be anyone today. You could be a different person tomorrow. The permutations were limitless. You will be confined to being the clinician that you are. But we will leverage this real-time feedback. And you can see this person has feedback. You're too close. You're too far away. You have your scoreboard. You have information that's flowing to you. You have a resource panel. Think of this as your pharmacopeia. You have other people that can help you, the rest of your team. And you have a particular objective. And as you pursue that successfully, you get rewarded. These are things that we should leverage. It raises the question, how can we use this in medical education and then practice? It has already been used in these four categories. These are not critical care pieces. We have something else that we need. This is SimWars, team-based simulation. It drives the need for assessment, a differential diagnosis, a final diagnosis. There are participants. There are observers. You can see them behind the glass. It has been used by emergency medicine, OBGYN, neurocritical care, and simulation interest groups. And this piece of it has competition because it's team-based. It's relevant to what you do. And therefore, this is gamifying simulation-based education. It can be extended to procedural skill sets as well. This comes from the Society of Academic Emergency Medicine. They run something called Sono Games. I will call your attention to the theme-based outfits. These are different teams. Some of them are a little bit more amusing than others. But look at all those teams. They all want to be there. This is their autonomy and user engagement. It's four hours, multiple rounds. Can you imagine doing anything for four hours? They love this. This is great. It's hands-on learning. You pick your own team. This is fabulous. It drives transactive memory generation. But you are always successful. It's been crafted to be successful. No risk. There's no patients you can harm. Routine evaluations. They love learning more about ultrasound, and then they use it afterwards. It is an implementation piece. And so you can see, there's all the competition. Not only are the participants dressed particularly, but you get to have people that are engaged in some outfits. These are the shepherds, if you will. This is a different use. Chaos. This is what we all assume happens in the emergency department. It's always chaos there. Only one person left. It's fine. What this does is now very relevant for rapid response teams, code teams. You have random partners, people you don't know. It's also team-based, and it tests different things. Cognition, strategy, procedural skills. There are only three rounds, eight different teams, much more limited. But you can see that this has been pre-planned. People are being splinted. Some people are wearing headbands. These are the domains that they test, including critical care. And for their space, it's been uniquely adapted for the emergency department. It mimics the flow through the ED. There's apparently also the need to have an emcee with a mic, but that's okay. But it's engaging, and everyone is engaged. So how do we use this in critical care? The first, and CHESS did this before we did, they made an escape room. It was very popular, and they used this to drive continuing medical education about PFTs, point-of-care ultrasound, interstitial lung disease, and then a path for management. It was also contained within a space for a debrief so that participants got to interact with trainers, and you could figure out what went well and what did not. But that was a physical escape room at their Congress. American Association of OR Nurses, well, they've done this in a virtual escape room as well. Therefore, it's on your time in an on-demand fashion. For us, guideline distribution, uptake, and then the de-implementation of things that we don't want you to use, all of the choosing wisely pieces. We know that we teach people how to learn about the guideline. We tell them what they should do, but then there's the implementation piece, and it doesn't get implemented as much as it gets taught. That's the knowledge-to-practice gap, and then it can be used for team training. Let's talk a little bit more about that. At this Congress, you will be exposed to multiple new guidelines. It's been a banner year for that. You'll know about it. You may even embrace all the things that are contained within it. Of course, it makes sense to you, but then you must apply it. How do you make that happen for people who haven't been here at the Congress, and maybe who don't see the need for that because things are just fine? You can close that knowledge-to-practice gap by understanding what the modifiers are, including resources, barriers, and enablers for that particular patient care setting, and say, I have a toolkit. Our toolkits now are on a piece of paper. Please do this. Not effective. What if you integrated that with your electronic health record? That's something different because our current behavioral influences in healthcare are either penalties, these are all compliance and laws and policies, or they're incentives, and the incentives, if they come to you in your wallet, they can be very powerful. If it comes to the hospital, it doesn't impact you very much at all, but these incentives would be right in front of your face. So you take a condition of interest, sepsis, reinforce the desired action. You hit the sepsis button that says, this patient, I think, has sepsis, or they had a score that said they're at risk of sepsis, and you click on obtain blood cultures. There's a reward for you with something that pops out. Do you need to pass to the next step in the guideline? Yes or no. If you click no and you get the next step right, it's a different reward, and if you reward each and every step, you can then collect this in many different ways. The team that's on that day, the team that's always on on day shift, this particular unit, not limited to sepsis, but it also helps you figure out who should not be in the guideline. You think about the hour one bundle and how much fluid? We've debated that before. Are there excluding conditions? This can be your prompt, and if you find that there are and you list them, this supports your documentation, it also gets you to do something different that is guideline consistent. But there is uncharted territory, if you are a Star Trek fan, places where it could be used, but it has not yet been applied. One of these is right down here in the bottom corner, personal development. How do we use this to help you? Right now we have the LEAD program for your professional development, but we don't have much for your personal development. This is an application waiting to be used in your downtime, but this piece is key. We spend a lot of time talking about post-intensive care syndrome. How do we help people to help themselves, to reinforce appropriate behaviors, such as physical therapy, and collect that data to figure out using machine learning and augmented intelligence approaches, none of which you are sure are in this talk, to be adaptive and can design what that person is seeing to fit their unique needs in their specific setting. So we'll leave you with these conclusions. Education is changing. This will not be the way you will be educated, what we're doing right now, in five years. Gamification has foundations that would make it successful, it can be effective, and it's fun. So critical care medicine in general, but this organization in particular, we unroll guidelines, we should have a way to install that in a way that your hospital will find acceptable, that helps you be successful at closing the knowledge to practice gap and reinforcing learning along the way. So thank you for your attention. I think we have questions. Thank you.

gamification

medical education

critical care

team-based simulations

virtual escape rooms