The PMJ editors met recently, and it was a pleasure to meet up with a range of engaged, eloquent, educated and motivated individuals who all share a passion for Postgraduate Medical Education. It was therefore a little bit of a surprise when a reference to an article on the gamification of medical education proved to be a little contentious.
My colleagues thought that gamification was not necessarily a ‘thing’ and that for the PMJ to publish a paper with such a term in the title might be a bit wayward. However, fears were allayed by the fact that I had heard of gamification, and in fact it is a technique in learning that has been in recognised use in other fields for really quite some time. There is an excellent “Do Lecture” from the 2009 lecture series on the subject, and within patient education, there is quite an industry dedicated to themed ‘games’ – from nutrition to disease management for example – from Channel 4 and from SurgerySquad.
Other than the lecture above, I also heard about ‘gamification’ of learning at a Society of Acute Medicine conference where a team from the Netherlands presented their simulation game – ABCDESim. This is a serious game that allows players to gain skills and learning around resuscitation of the acutely unwell patient.
So there are real ‘games’ and their use in education has been examined in the educational literature – highlighting the engagement with subject matter that can be achieved through games, even if the longer term benefits of gaming within education are not fully defined.
The paper that raised an eyebrow analyses the effect of not so much a ‘game’ as the application of the principles of gamification – namely 1) voluntary participation
2) explicit rules of competition for each user
3) immediate feedback on performance
4) participation in competing teams
5) the ability improve in terms of rank (eg being awarded a badge or prize for specified achievements)
The game was really a bank of MCQs that addressed core knowledge expected of the residents on an internal medicine residency programme. The ‘play’ element of this was in the competition associated with answering the questions and comparing oneself, or ones team to the performance of others, and the ability to see real-time positions on a leaderboard, and earn badges for good performance and answering certain numbers of questions.
The researchers found that residents did engage well with the game, and were often found to be answering questions in their own time, that some of the techniques they employed to maintain motivation were well founded ( eg regular state of play emails, personalised leaderboards highlighting potential ‘opponents’ that could be overtaken with a few more questions and the earning of badges for good performance) and that there were qualitative and quantitative benefits – particularly with regards to retention of knowledge over time.
So it seems that millenials are open to the gamification of education. And perhaps millenials are going to be the first generation whose minds have been changed by the internet. Research from Columbia university in 2011 indicated that there could be a preference to recall where to find information, rather than actually retain the factual content. This combination presents medical educators with an intriguing challenge – our younger colleagues are happy to engage with technology in novel ways to improve their education, but that very engagement with technology might be eroding what have been seen as key attributes of effective clinicians in the past.
However, how new are these features really? The gamification of medical knowledge is hardly new. Although the rules weren’t exactly software-derived, and universally applied, I can still recall my housemates jousting with medical facts as we approached finals – indeed, the only reason I recall the fluorescence of amyloid being apple green after staining with congo red is down to a housemate trying to ‘psych out the opposition’ on the morning of a medicals final paper. The stimulus to learning such ‘games’ provided probably contributed to my success, and to a certain extent still does. An older example is the teaching ward round when the consultant questions students in turn to tease out facts in ever increasing detail – ultimately reaching the registrar who traditionally answered with aplomb.
And the other feature of millenial learning – the ability to find knowledge, rather than retain or analyse it? As we are now deep into advent, it is perhaps appropriate to turn to the motto of King William’s College Christmas Quiz:
Scire ubi aliquid invenire possis, ea demum maxima pars eruditionis est
“To know where you can find anything is, after all, the greatest part of erudition”
So the features of learning elicited in this study are certainly worth noting, and employing them to maintain interest, and enhance postgraduate education for the emerging generation of clinicians is important, but we shouldn’t be fooled that learning itself, or the competitive nature of learners has changed too much – history teaches us that medics have always been competitive, and that when it comes to knowledge seeking – our forefathers already knew that knowing everything wasn’t always the be all and end all – but knowing where to find out was almost as important.