Using Observation to Determine Teachable Moments Within a Serious Game: A GridlockED as Medical Education (GAME) Study

Background: The use of serious games as an educational tool may be an effective strategy to improve knowledge and skill among health care trainees. GridlockED is a serious board game designed to simulate a shift in the emergency department (ED) that incorporates concepts such as prioritization in a multipatient environment and stewardship of finite resources. Serious games can present concepts to learners that are not easily accessible through other teaching methods. GridlockED was designed to demonstrate the principles behind ED flow and how to prioritize in a complex multipatient environment. The objective of this study was to identify teaching points to which learners are exposed while playing the GridlockED game. Methods: We conducted a prospective, observational study from May to August 2017. Practicing emergency physicians, residents, and nurses were recruited as participants to play GridlockED. Participants were instructed on how to play the game and then engaged in playing GridlockED, during which their gameplay was video recorded. The videos of the play sessions were qualitatively analyzed using an interpretive description technique. All teaching points explicitly stated by players or implicitly observed by researchers were recorded. Results: Teaching points were identified in the GridlockED play sessions centered around the concepts of patient prioritization and staff placement. Major themes present in gameplay, as well as deviations from reality and frequent misconceptions about emergency care, were also identified. Conclusion: Observations of experienced ED practitioners reveal that the GridlockED board game creates opportunities for engaging medical learners in systems-level teaching. Our findings will help create the basis for future education modules, but further study is required to ensure that junior trainees actually learn when playing the game.