New findings support the selective gamification of radiology education

Radiology residents can receive meaningful clinical training via game playing—and they largely appreciate the experience, new research shows.

The study was conducted at the University of Alabama and published Aug. 15 in Current Problems in Diagnostic Radiology.

Corresponding author Stefanie Woodard, DO, and colleagues used a digital platform developed at their institution called Kaizen Education. The software, which first appeared in 2012, presents lessons as rounds of a competitive quiz game. 

For the present study, Woodard and fellow researchers incorporated questions drafted by experienced radiologists representing several subspecialties. 

The participants were 25 radiology trainees, grouped into teams. Each team had residents from various levels of training, first year to fourth. 

Along with registering their satisfaction with the Kaizen format, the participants compared the online Kaizen app with RadExam while the researchers compared scores between the two platforms. RadExam is used to prepare radiology residents for core skills assessment by the Accreditation Council for Graduate Medical Education.

Residents raised with digitized games

• First-year residents made up the largest percentage of class participation with 89% (eight of nine) answering at least one question. 
• Third-year residents answered the highest percentage of questions correctly, while the first-year class answered the lowest percentage correctly. 
• There was no significant difference between mean Kaizen and RadExam scores.
• There was also no significant difference between the RadExam and Kaizen scores separated by question category. 
• Most participants enjoyed the game, and 75% of survey participants said they would participate in a Kaizen game again. 

Further, team collaboration and question feedback “significantly increased motivation for most participants,” the authors report. A similar ratio of participants, they add, “felt the game enhanced their radiology knowledge and was beneficial for daily work and board preparation.”  

Safeguards against overheated competition 

In their discussion, Woodard and colleagues emphasize that they conducted the study in a program that highly values community bonds and mentoring relationships. 

In fact, every participating resident had a pre-existing mentorship relationship to “ensure a sense of psychological safety when they got a wrong answer.”

As a result, no flareups of over-competitiveness were observed. 

Still, the authors comment, the competitive nature of the Kaizen platform may not be suitable for all residency programs. 

“Variety in year of training in each group was felt to be important to the structure, as it allowed for peer-to-peer learning on the cases,” the authors add. 

If the game fits, play it  

The benefits of “gamifying” medical education include engaging learners through extrinsic and intrinsic motivators such as prizes, leaderboards and challenges in a risk-free environment, Woodard and co-authors note. 

“Gamification allows for learners to overcome challenges, receive immediate feedback and feel a sense of accomplishment,” they add. “These elements may enhance traditional learning methods, catering to the changing needs of current learners.”

Given that potential, they call for subsequent research looking at whether multi-institution participation through the Kaizen platform could “extend gamification to other programs” and “allow program-based team collaboration, building comradery in each institution.”

The authors also note the familiarity of Millennials and members of Generation Z—that’s most of today’s residents—with digitized games. 

Future studies, they point out, are needed to show whether or not Kaizen could be a surrogate marker for Core exam performance.

The study is posted here.