Introduction. As serious games are a relatively new phenomenon in medical education, there is little data on end user demographics or usage. In this study our goal was to describe the demographics and usage for purchasers of the GridlockED board game, a serious board game for teaching about a systems approach to managing care in the emergency department. Methods. We conducted a two-phase survey of individuals interested in purchasing GridlockED. Users were asked to complete a brief demographic survey before accessing the purchasing site. A follow-up survey was performed 3-6 months after the initial survey. That survey was to assess participants’ usage, play patterns, and what changes to GridlockED they would like to see. Individuals who did not purchase the board game were asked about their barriers to purchase. Results. After one year of sales, 213 games were purchased, 560 individuals had completed the intake survey with 408 consented to follow-up. Responding purchasers were from 16 different roles in healthcare in 11 countries. Our follow-up survey collated 53 responses (out of 408 individuals, 14% response rate). The majority (63%) of respondents reported having played the game, with the most common use cases being for fun (40%), teaching trainees (21%) or training with colleagues (13%). Price of the game unit was cited as the largest barrier to purchase (60%). Conclusion. GridlockED attracted interest from a wide range of medical professionals around the world. Users reported using the game for fun and for teaching/training purposes. The main barrier to purchase was the game’s price.
Further playtesting will be needed to fully examine learning opportunities for various populations of trainees and for various media. GridlockED may also serve as a model for developing other games to teach about processes in other environments or specialties.
Even before starting your evening shift you know it's going to be busy. Ambulances are lined up in front of the hospital, and the charge nurse already seems stressed out. The senior Emergency Medicine (EM) resident is standing in the physician office, ready to start her shift as well. You have worked with her a few times during this rotation. She is competent, you trust in her management plans for all her individual patients. Together you both review the patient tracker: a variety of patient presentations ready to be seen, plus an additional 20 patients in the waiting room. Negotiating the learning objective for the shift, the resident indicates that she would like to work on more efficiently managing patient flow and the administration of the emergency department (ED). But…isn't that a skill you just learn from experience? You wonder what evidence-informed strategies might exist for training her for this next step.
Objectives
Patient volumes are increasing in emergency departments (ED), causing issues with long wait times and overcrowding. One strategy to cope with this phenomenon is to focus on improving patient flow through the ED. Building on earlier work that identified how staff physicians manage flow and what techniques they employ to teach managerial skills to residents, we aimed to determine when it was most appropriate to implement these teaching strategies in a resident’s training.
Methods
We employed a Canada‐wide cross‐sectional survey of experienced emergency medicine (EM) teaching faculty to determine when they felt our previously identified teaching strategies would be appropriate to implement. The survey was piloted with local educational experts.
Results
A total of 21 EM (38% female, 62% male) educators from 11 programs responded to the survey. The respondents provided an average of 42.5 endorsements per participant for specific teaching techniques across the stages of training. The core of discipline (35.9%) and transition to practice (39.7%) were the stages of training that received the most endorsement. The top two teaching techniques included the observational teaching technique “attitudinal role modeling (i.e. a strong work ethic)” and the conversational teaching technique “teacher provides clinical pearls, tips, pointers.” The participants showed fairly high agreement, with the advanced in situ techniques showing fairly high reliability as measured by intraclass correlation coefficients ranging from 0.88 to 0.90.
Conclusions
Our results show a trend toward faculty utilizing more didactic and observational teaching techniques early in residency and then progressing toward more experiential techniques in the senior stages of training. This is consistent with a graduated increase in responsibility as residents demonstrate competency and progress through their training. The results of this study will help inform faculty development around teaching managerial skills in the area of competency‐based medical education.
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