Doctors learn to better triage trauma patients by playing video game

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A randomized controlled trial led by the University of Pittsburgh School of Medicine has found that playing a video game in which physicians treat severe trauma patients was better than text-based learning in helping doctors to make improved triage decisions.

With funding from the National Institutes of Health, Deepika Mohan, MD, assistant professor in Pitt’s Departments of Critical Care Medicine and Surgery, and Pittsburgh-based Schell Games teamed to create Night Shift, a game that puts doctors in the shoes of an emergency medicine physician who is placed in different situations requiring quick recognition of the patients who need higher levels of care.

However, the video game centers on a series of trauma patients who arrive with “non-representative” severe injuries or cases in which the injuries do not fit the popular archetype for the problem.

Specifically, the game challenges a player’s heuristics—the part of the brain that uses pattern recognition and previous experience to make snap decisions using subconscious mental shortcuts—and forces them to re-evaluate how they think of severe trauma patients through the use of storytelling to promote behavior change, which has shown promise in recalibrating heuristics.

Mohan and her research team put the game through its paces with 368 emergency medicine physicians from across the U.S., primarily working at non-trauma centers, with half assigned to play the game and half asked to read the educational materials. The trial focused on doctors at non-trauma centers because on average 70 percent of severely injured patients who present at those medical facilities are under-triaged and not transferred to trauma centers, as recommended by clinical practice guidelines.

“We found that people who used the game made fewer diagnostic errors on a virtual simulation than people who did the text-based education,” says Mohan, who points out that 30,000 preventable deaths occur each year after injury, in part because patients with severe injuries who initially come to non-trauma centers are not promptly transferred to a hospital that can provide appropriate care.

Also See: Johns Hopkins develops electronic triage tool to better prioritize ED patients

Doctors who played the game under-triaged—or failed to send severe trauma patients to hospitals with the resources necessary to handle them—53 percent of the time, vs. 64 percent for those who read the educational materials. And in a reassessment six months later, physicians who played the game under-triaged 57 percent of the time, while those who read the text-based materials did so 74 percent of the time.

“An hour of playing the video game recalibrated physicians’ brains to such a degree that, six months later, they were still outperforming their peers in recognizing severe trauma,” adds Mohan.

Results of the trial were published last week in The BMJ.

“We developed a novel intervention that combined video game technology with narrative engagement to recalibrate physician heuristics and tested its efficacy in reducing diagnostic errors in simulated trauma triage,” concludes the article. “Our results suggest that narrative based video games have the potential to influence physician behavior, although the real world implications remain unclear.”

At the same time, Mohan says one of the interesting findings of the study is that a significant number of physicians who played the game enjoyed it less than those assigned to text-based education. She believes that if researchers can find a better strategy for engaging doctors, the already favorable results might be amplified.

“If we could build different kinds of games, and let people pick their own games so that we can personalize the intervention, we might see an even greater effect,” Mohan concludes.

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