Table 1
Gamification attributes utilized during the pediatric rheumatology experience.
| ATTRIBUTE CATEGORY | DEFINITION | BINGO CARD APPLICATION |
|---|---|---|
| Rules/Goals | Clearly defined rules, goals, and information on progress toward those goals, provided to the learner. | A bingo card detailing how to “win” by completing five consecutive squares in any direction. Residents receive explicit instructions on what activity will result in completion of the square. |
| Challenge | The problems or barriers learners face, including the nature and difficulty of those problems. | Time constraints and the complexity of pediatric rheumatology cases create a built-in challenge. Residents have a single week to complete as many squares as possible to see a variety of high-yield clinical encounters to help focus learning on the variable presenting features of childhood rheumatic disease. |
| Control | The degree to which players can alter the game (or the game alters itself) and make decisions that influence outcomes. | Residents may independently select which squares to work on, guided by chart review, deciding how to prioritize patient encounters vs. knowledge-based tasks. This autonomy in choosing patient encounters and knowledge items fosters self-directed learning. Allowing some choice allows learners to prioritize things they feel are of more utility (e.g. budding pediatric pulmonologists may focus on trying to see a patient with a pulmonary renal syndrome) |
| Assessment | The method by which accomplishment and game progress are tracked. | Each square on the bingo card serves as a checkpoint. Faculty validate completion by initialing squares; the card visually tracks progress. Achieving “bingo” indicates successful engagement with high-yield content and practical application. Requiring a series of small tasks fosters more engagement than a single overarching goal such as “Learn about childhood rheumatic disease”. |
[i] Other game attributes not utilized in this intervention: action language, environment, game fiction, human interaction, and immersion. These were not included because they were not applicable to the intervention or setting.
Given the constraints of the clinical exposure, these four (of nine total) attributes were able to be incorporated [13].
Figure 1
Bingo squares and frequency of utility during academic year (AY) 2023–2024.
* The instructions given to trainees for squares directing them to see a particular clinical finding can be checked off if trainee sees a patient with these findings in person or if they are reviewed with a faculty member while in clinic. Squares including “apply”, “know”, “list”, “counsel”, or “explain” require verbal demonstration of the information in question. Tasks starting with “perform” should be witnessed by a faculty member.
** Initially these squares were separate, but given they are related to the same diseases processes were combined to create additional space for more high-yield topics.
*** These were elements not originally included in the card. Morphea was included in the initial card, but systemic scleroderma was added in the second iteration. With the combination of SLICC and EULAR criteria and Gottron’s and heliotrope rash, respectively, “Perform Beighton score” and “Perform counseling for a pain syndrome” were added.
Table 2
Summary of responses from surveys collected in AY 2023–2024.
| VARIABLE | N | MEAN | Std Dev | MEDIAN | LOWER QUARTILE | UPPER QUARTILE |
|---|---|---|---|---|---|---|
| I like using this gamified tool | 22 | 4.23 | 0.97 | 4 | 4 | 5 |
| I felt this tool helped me decide which patients to prioritize seeing | 22 | 3.86 | 1.04 | 4 | 3 | 5 |
| I felt this tool helped me see a variety of different patient types and encounters | 22 | 4.14 | 0.94 | 4 | 3 | 5 |
[i] Five-point Likert scale was included in an anonymous survey at the conclusion of the week, with overall favorable results.