Hospital Drives Clinical Excellence With Gamification

Inova Fairfax Medical Center is using a mobile, game-based platform to improve the continuing medical education of its clinical staff.

In healthcare circles, the term “gamification” most generally brings to mind images of patients leveraging Xbox Kinect-type programs to aid in physical rehabilitation or treatment. However, healthcare providers are finding that games just don’t deliver value at the patient level — clinicians can also benefit from game-based technology solutions. Inova Fairfax Medical Center (IFMC) is a perfect case in point. The Virginia-based provider recently applied a mobile, game-based technology program in its new Advanced Surgical Technology and Education Center (ASTEC) to improve the clinical knowledge of its interdisciplinary OR team.

Clinical Education Measurement Drives Gamification Approach
As a Level 1 trauma center, IFMC is forced to comply with a variety of safety domains, including universal protocols and fire safety in the OR. Furthermore, surgical residents are required to pass national SCORE (Surgical Council on Resident Education) curriculum and the companion ABSITE (The American Board of Surgery In-Training Examination). Historically, this type of educational material was delivered solely through standard lectures at IFMC. Hospital executives could identify which clinicians completed a course or module, but little more.

"We had very little feedback that would allow us to assess what our clinicians actually learned or retained from the course materials,” says Paula Graling, education and clinical director of the IFMC ASTEC facility. “We needed a better way to evaluate the clinical knowledge of our staff and promote ongoing education.”

A main driver for this initiative was a directive from The American College of Surgeons to identify new and novel approaches to faculty development. In particular, the College wanted to know how IFMC was not only developing learners, but how the provider was measuring that its learning programs are effective.

As luck would have it, Graling came across an article on a mobile, gamebased curriculum delivery program by Qstream while reading a copy of The Joint Commission Journal on Quality and Patient Safety. She was intrigued by the concept and contacted Qstream for a demo in late 2013.

Real-Time Results Drive Clinical Competition And Improvement
Over the past year, IFMC has deployed four customized Qstream programs as part of ASTEC’s initiatives to improve patient safety and surgical curriculum retention with technology. These programs were deployed to IFMC surgeons, nurses, anesthetists, and surgical residents via their personal mobile devices (e.g., smartphones, tablets, etc.) in conjunction with the traditional lectures. Using Qstream, clinicians respond to scenario-based questions and challenges that are pushed directly to their mobile devices at random every few days. The program then analyzes response data in real time to deliver predictive and actionable insights to supervisors. This data allows IFMC supervisors to assess clinician comprehension and performance and identifies areas for improvement.

For example, as part of the research and statistics course in preparation for the ABSITE, surgical residents may be presented with the following question at random on their mobile devices in the hours or days after a lecture: What type of study design is suitable for rare exposures? The resident is also provided with a list of possible responses (e.g., A. Observational Study Designs, B. Cross-Sectional Study, C. Cohort Study, or D. Case Control Study). The resident is prompted to answer (the correct answer is D. Case Control Study) and provided with immediate feedback as to why the answer they provided is correct or incorrect. As mentioned, results are also delivered to supervisors to assess individual performance.

The Qstream platform enhances the gaming aspect of continuing education by allowing supervisors to create staff leaderboards that allow clinicians to see how they’ve performed on course questions relative to their coworkers.

“The leaderboards have created a competitive atmosphere among our clinicians,” says Graling. “It helps keep them engaged with information they might not otherwise care about or, at the very least, wouldn’t necessarily be top of mind.”

Gamification Makes Ongoing Clinical Education More Fun And Effective
According to IFMC, Qstream’s game-based approach to continuing education is convenient, fast, fun, and effective. It’s convenient because the mobile delivery method allows clinicians to respond to questions on their own timeline on a device that they all have readily available and use regularly.

“The residents of today learn much differently than surgeons and nurses did a few short years ago,” says Graling. “Where technology was foreign to many older staff members, today’s residents are comfortable with mobile technology and are inclined to leverage it for educational purposes.”

The Qstream solution is fast because results and feedback are delivered instantaneously as part of the program. The fun factor comes in due to the competitive atmosphere the leaderboards create.

As for effectiveness, the numeric data is still being calculated, but there are several anecdotes that Graling shares that illustrate how effective the platform has been to date. First, IFMC supervisors now have a tool that provides them with feedback on how much of the course work is being comprehended and retained by staff members. This allows them to identify problem areas, reinforce key concepts, and help residents better prepare for upcoming exams. Second, the Qstream platform helps keep the coursework fresh in the minds of clinicians. No longer are residents simply presented with a large chunk of information and expected to retain it by memory alone. With the gamification platform, residents are learning more by example. They are regularly asked to apply what they’ve learned by answering important questions related to the course material.

“Oftentimes, an employee will answer a question incorrectly that they were confident they understood,” says Graling. “This prompts them to go back and review the course material to learn why their answer was incorrect. The Qstream platform has really helped to promote continued educational improvement.”

Once IFMC residents complete the ABSITE this year, the provider will compare the test scores to those from the previous year to see if there was a marked improvement this year over last. This would add more credence to the effectiveness of the game-based continuing education strategy. In the meantime, IFMC plans to roll out additional Qstream platforms that cover methicillin-related staphylococcus aureus (MRSA) infection control and fundamental surgical knowledge for its simulation lab.

“Our clinicians have a very limited amount of time in the simulation lab,” says Graling. “Most of the time, they only have about an hour or so to spend in the lab. Currently, they are forced to spend about 30 minutes of that hour reviewing didactic content. This reduces the time they can be involved in hands-on simulations. We hope that we can use Qstream to deliver much of this didactic content to clinicians up front. That way they can enter the lab with the knowledge required and get right to the simulation.”