November 30, 2012

Games in Healthcare

by Melissa Weaver, Pharm.D., PGY1 Pharmacy Practice Resident, Carroll Hospital Center

I love Angry Birds. Fire the slingshot to send the single-minded birds on their mission!  Victory comes when the evil pigs die! Getting engaged in the game is so easy.  On level 1-1, the player gets three angry birds to kill one evil pig in a wooden and ice structure.  Usually, the player needs only one angry bird to succeed at the mission and feels like a “rock star” after the victory. The story and feelings build with each episode and level.1

But how do suicidal birds relate to healthcare and education?  Think of the last time you sat in a class and were captivated by the topic.  Compare that to the last time you played a video or computer game and were completely engrossed. In which situation were you more engaged and involved?  I’ll admit, I often feel more involved when I play Angry Birds than when I listen to a lecture.

So what exactly is a game?  The definition seems to be evolving, but Roger Caillois, the French sociologist, said that games have six elements: (1) non-obligatory (2) separate in time and place (3) uncertain course (4) unproductive (5) governed by rules and (6) make-believe.2  Games are designed with multiple ways of keeping the player participating and involved.  Most presentations I have seen lack that level of engagement. The lecture is thought by some to be an inefficient, stifling, and clunky means of delivering instruction; a blunt tool in an age of laser precision.3

Why do games make a difference now?  Games are not new to healthcare education.  In 1995, one of my preceptors played Jeopardy! during her pharmacy residency at the University of Illinois, Chicago.  But technology has improved significantly since 1995.  The proliferation of mobile devices such as tablets and smart phone pave the way for using these devices to teach.  These devices are the first to overcome the limitations of handsets as learning tools.3 The technology also allows the speed and scope of information to be more current than is typically seen in academic courses.4 

How are games being used in healthcare?  Currently, there are more than 300 health-related games on the market aimed at patients in two general themes – physical exercise and brain fitness games.5  But disease-specific games are also available such as Re-Mission, a video game for young people with cancer.  The lead characters for Re-Mission include Roxxi, a microscopic robot that fights infections and cancer at the cellular level; Smitty, a retired nanobot who provides holographic guidance to Roxxi; and Dr. West, creator of the self-aware artificial intelligence nanobots and the nanotech chronic illness treatment program.6  From a patient education standpoint, the game addresses the importance of taking oral chemotherapy regimens, prompt reporting of symptoms and side effects, proper nutrition, as well as anxiety, nausea, and pain management.7 A randomized controlled trial compared adolescents and young adults who played a standard commercial video game versus Re-Mission.  Participants were asked to play the game at least one hour per week for the three-month study period. The conclusion of the trial is that treatment adherence and indicators of cancer-related self-efficacy and knowledge were significantly improved in those who played Re-Mission.8

Games are engaging.  They can be used to teach by allowing the learner to apply newfound knowledge to new situations.  Game scenarios can be easily modified to reflect the continuous influx of healthcare information updates.  While playing the game, the learner has the opportunity to make decisions and instantly see the results of those decisions.  The ability to recreate the scenario allows the learner to practice this decision-making skill. Better decisions in healthcare result in better healthcare.


1  Angry Birds [Internet]. Finland: Rovio Entertainment Ltd. Accessed 2012 Oct. 16. 
2  Caillois R. Man, Play and Games. University of Illinois Press: 2001. pp. 9-10. Accessed on 2012 Nov 26. 
3  Galagan P. From Pie in the Sky to the Palm of Your Hand: The Proliferation of Devices Spurs More Mobile Learning. T+D [serial online]. March 2012;66(3):29-31. Accessed 2012 Oct 11.
4  Kalman F. Social Media: Learning's New Ecosystem. Chief Learning Officer [serial online]. August 2012;11(8):42-45. Accessed 2012 Oct 11.
5  Gaming in Healthcare. Digitome Corporation. Accessed on 2012 Nov 26.
6  Re-Mission Characters. HopeLab, A Part of the Omidyar Group. Accessed on 2012 Nov 26.
7  Re-Mission For Clinicians. HopeLab, A Part of the Omidyar Group. Accessed on 2012 Nov 26.
8  Kato PM, Cole SW, Bradlyn AS, Pollock BH. A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults WithCancer: A Randomized Trial. Pediatrics 2008; 122:2 e305-e317.

1 comment:

Stefan Kac said...

Playing Devil's Advocate, re: lectures...

Constantly finding lectures "boring" or whatever is a good indication that a student is in the wrong major; whereas students who are in the process of discovering a genuine rapport with a field of study will rarely be "bored," even if the lecture and/or the lecturer are lacking in this and any number of other respects.

Obviously there is a balance to be struck between encouraging interest in essential professions and discouraging unqualified candidates. But finding a "balance" does not seem to be the goal of most of these sorts of discussions. Rather, everyone wants to grow and recruit and fundraise like mad, and "gamifying" is a really good way to do that.

Personal anecdotes aren't worth much here, but I'll add anyway that one of the biggest differences I noticed in myself when I returned to school at age 28 after six years away was that nothing was boring.