The Use of Gamification to Boost Residents’ Engagement in Simulation Training

gamification surgical simulation boosts results

Want to increase the utilization of key simulators to improve ROI? Then you need to read this JAMA Surgery article which helped one program reduce cost per hours by over 11 times! ‘The Use of Gamification to Boost Residents’ Engagement in Simulation Training’ by B. Price Kerfoot, MD of Boston Healthcare System and Harvard Medical School and Nicole Kissane, MD, of Boston Medical Center and Boston University.

Abstract: Interval deliberate practice of surgical skills is required for surgical residents to develop and maintain their technical skills. Even 2 weeks without practice on a minimally invasive surgical simulator can lead to a substantial decline in skills.1 In spite of the value of interval simulation training, incentivizing residents to engage regularly in simulation training can be a challenge for many institutions. Can gamification (the introduction of game mechanics to engage users, including but not limited to competition and leaderboards)2 boost residents’ engagement in simulation training? Although game-based learning is cited as an emerging technology likely to have a large impact on education in the next 2 to 3 years,3 little research has been conducted to demonstrate its efficacy for health professional training.4 We investigated whether the introduction of competitive game mechanics into simulator education among residents could significantly boost the use and cost-effectiveness of the da Vinci Skills Simulator (Intuitive Surgical Inc).

Methods: During weeks 1 through 7, residents were invited to use the simulator. A single elimination tournament was then announced via e-mail at the end of week 7. The 16 residents with the highest aggregate scores on 9 exercises on the simulator during weeks 8 through 14 would qualify. Leaderboards were posted via e-mail every 1 to 2 weeks. Tournament prizes ranged from $50 to an iPad (Apple Inc) for the winner. Over all 14 weeks, a $30 travel reimbursement was given to residents not on a VA rotation for each trip to use the simulator. The tournament compared ring-walk simulator and dry-laboratory performance among qualifying residents. Cost estimates include the price of the simulator ($85 000 amortized over 5 years), travel reimbursements, and prizes but not the salary expenses of a simulation coordinator.


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Results: Residents, sessions, exercises, and use duration increased by 7-fold, 17-fold, 58-fold, and 32-fold, respectively. After the announcement of the tournament, the estimated cost per hour of simulator use decreased 12-fold from $864 to $74.

Gamifying this training only took the organization of a tournament with the investment of prizes, so it can’t be too hard to replicate these results for your simulation program in key areas!

Read the full article on the JAMA website.


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