This JAMA Viewpoint article discusses the cognitive processes that inform clinical judgment and suggests that video games training might improve cognitive abilities and reshape clinical intuition, promote self-efficacy, and improve clinical decision making among physicians.
Serious games, which attempt to transform behavior deliberately, are being adopted in several arenas. The military has spent hundreds of millions of dollars in recent years on games for tactical training and skill development.5 The Transportation Security Administration wants to use games to improve threat detection by baggage screeners.6 The aviation industry has a long history of using simulators for pilot training. Although most of these games transmit information or promote the acquisition of new skills, a few have taken on the challenge of improving intuition. For example, Peacemaker, a simulation of the Israeli-Palestinian conflict, attempts to alter how players judge possible solutions to the problem. Practice reduces the correlation between religious-political affiliations and how people resolve conflict within the game.7
Serious Games in Health Care and Medicine
Over the last decade, serious games have gained traction as a method of influencing health outcomes. For example, NeuroRacer, a 3-dimensional driving game developed by researchers at the University of California–San Francisco, improves executive functioning in older adults, with gains lasting up to 6 months.8 However, fewer than 10% of serious games are designed for clinicians, and none explicitly attempts to recalibrate heuristics.9 This is a missed opportunity.
Serious games have 3 attributes that make them ideal for the task. First, games facilitate the retention of new data. People remember stories. Instead of forcing physicians to process data, games present that information within an overarching narrative, thereby facilitating its integration into a mental model of the decision problem. Second, games promote self-efficacy and response efficacy. By practicing desired behaviors in a safe environment, players can obtain confidence in their skills and experience the benefits of behavioral change. Third, games engage players both cognitively and emotionally. Identification with a character allows the player to absorb the message about best-practice decision principles in a way that transcends traditional forms of education. Using narrative engagement and character identification as surrogates for exposure to difficult cases, games can allow the player to create archetypes or patterns that serve as a reference in real life. Consequently, serious games have the potential to succeed where other methods have failed.
Will Physicians Play Video Games?
Video games are no longer the province of adolescent boys. More than 150 million people in the United States play video games, the average gamer is 34 years old, one-fourth (27%) are older than 50 years, and almost half (44%) are female.9 Statistics do not exist on the number of physicians who play games. However, states and professional organizations already require between 20 to 50 hours a year of continuing medical education—typically acquired through attending lectures, reading journals, or viewing online presentations—as a condition for licensure. Games could easily become part of the roster of accepted educational activities.
What Is Next?
There are early efforts to use games to recalibrate physicians’ heuristics. For example, a new adventure video game (Night Shift) is meant to change how physicians think about the “typical” trauma patient. Players take on the persona of an emergency medicine physician who accepts a job in a small town. Through a series of cases that go awry, players learn the characteristics of severely injured patients and experience the consequences of their diagnostic errors. Preliminary results suggest that physicians enjoy playing the game. The challenge ahead is to ensure they change their practice. If successful, games could potentially disrupt the current approach used for continuing medical education and, in doing so, may help to leverage the potential of the physicians at the heart of the patient-care relationship.