Duckworth on Education: The Value of Gamification

This was all supposed to be different. When the National EMS Education Standards rolled out in 2009, they encouraged educators to find new ways to help students to connect with the content.¹ Many instructors struggled to find innovative but practical methods to improve students’ engagement, so many continued primarily with the lecture approach.

This problem was not unique to EMS training. Physician, nursing, and allied health programs across the world wrestled with the same issue.² As modern medical education courses sought new student-centered, outcomes-focused teaching methods, one surprising idea was to start bringing video games into the classroom. If students struggled to pay attention in class but could focus on an engaging game for hours on end, why couldn’t games be used in medical education?

While many instructors bristle at the idea of students engaging with a game on their smartphone or tablet instead of listening to a lecture, the AMA Accelerating Change in Medical Education Consortium schools, among others, have found success in advancing physician training by adopting point-and-click, virtual reality, and other computer-based simulation experiences into the curriculum.³ Henry Curtis, MD, emergency medical clinical instructor at the Stanford University School of Medicine, uses a virtual reality (VR) game to train physicians to properly triage and manage pediatric patients in a mass-casualty scenario.³ Correct selections allow users to earn points and rewards. Curtis says, “Once you gamify it, it adds another level to the immersion of the VR experience. Gamification motivates people.”

Professor Barry Fishman of the University of Michigan says the best games build on motivation theory, increasing engagement with the materials by giving the student a sense of autonomy and recognition for good performance as well as immediate feedback when something doesn’t work.⁴ Fishman emphasizes, however, that not all gaming experiences work well in the classroom: Not only must games be pertinent to the course and focused on achieving measurable educational objectives, they must be properly designed and balanced. If the games are too hard, students get frustrated. If they are too easy, students get bored. If the interface is too complex, students can lose focus on the content as they struggle to use the controls.

Games are best used as an integral part of the education program rather than an add-on or entertaining diversion. Consider how many students neglect to read material before class because prior learning experiences have led them to expect they’ll just hear the “important stuff” when they meet. Similarly, there may be pushback against games as assignments that students see as nonessential. Students will not be engaged by so-called games they see as homework dressed up as something fun.⁵

Well-constructed electronic educational games can take many forms, but most will share features with recreational video games that can actually have great educational value.⁶ These include:

• Student (player)-centered focus;
• Self-paced learning;
• Multipath (sandbox or free-play style) self-directed learning;
• Emphasis on exploration and experimentation;
• Learn-as-you-play tutorials encourage a “performance in the face of the unknown” mentality;
• Student/player must optimize limited resources to maximize desired outcomes;
• Multiplayer games demand communication, coordination, and competition;
• Increased resilience as student players can fail and immediately try again;
• Computer evaluation of player performance identifies performance gaps;
• Performance assessments can be used to develop tailored learning plans;
• Reinforcement of key learning through different experiences and from different perspectives;
• Continuous learning and practice in and out of the classroom.

Providing benefits like these, medical education games may have use outside initial certification courses. In one study, experienced ambulance crews were surveyed after using a virtual emergency telemedicine simulation game, and results were primarily positive.⁷ While staff graded the controls as somewhat frustrating, they saw the educational value in such games and rated the experience as having value as a learning tool to increase providers’ clinical knowledge and problem-solving skills.

The Human Element

When provided with constructive feedback on their performance, students learn far more from their own active experiences than from passive absorption of reading or lecture materials.⁸ Electronic medical education games have the potential to be powerful learning tools for modern emergency medical services. But might they move students with poor social skills even further away from learning effective human interaction? And how effectively might students be able to apply what they’ve learned from the game to real patients in the real world? Unfortunately there are no definitive answers to these questions. However, a recent literature review on the application of gaming in higher education suggests this is where effective educators have an opportunity to help by supplementing what their students don’t get from the games.

There is no suggestion that gaming tools alone will replace every aspect of traditional medical education, but a growing body of literature, along with expanding availability and variety of games, suggests EMS educators might consider the advantages that the gaming world has to offer.

References

1. National Highway Traffic Safety Administration. National Emergency Medical Services Education Standards, www.ems.gov/pdf/National-EMS-Education-Standards-FINAL-Jan-2009.pdf.

2. Richards J, Sweet L, Billett S. Preparing medical students as agentic learners through enhancing student engagement in clinical education. Asia-Pacific J Coop Educ, 2013; 14: 252–63.

3. Henry TA. 3 ways medical schools are embracing gamification. American Medical Association, www.ama-assn.org/education/accelerating-change-medical-education/3-ways-medical-schools-are-embracing-gamification.

4. O’Malley S. More Than Fun? Inside Higher Ed, www.insidehighered.com/digital-learning/article/2017/07/19/educational-games-expand-classroom-learning.

5. Barr M. Student attitudes to games-based skills development: Learning from video games in higher education. Computers in Human Behavior, 2018 Mar; 80: 283–94.

6. Barr M. Video games can develop graduate skills in higher education students: A randomised trial. Computers & Education, 2017 Oct; 113: 86–97.

7. Nicolaidou I, Antonioades A, Constantinou R, et al. A virtual emergency telemedicine serious game in medical training: A quantitative, professional feedback-informed evaluation study. J Med Internet Res, 2015 Jun 17; 17(6): e150.

8. Vlachopoulos D, Makri A. The effect of games and simlations on higher education: a systematic literature review. Int J  Educ Tech Higher Educ, 2017; 14:22.

Rommie L. Duckworth, LP, is a dedicated emergency responder and award-winning educator with more than 25 years working in career and volunteer fire departments, hospital healthcare systems, and public and private emergency medical services. He is currently a career fire captain and paramedic EMS coordinator.