Across all age groups and disciplines, increasing engagement and improving the learner experience is the universal holy grail of education. The core elements of gamification — action, challenge and reward — have been demonstrated to improve the learner experience by increasing engagement and positively impacting learning. When Array and Vindico Medical Education (Vindico) partnered to incorporate gamification into live continuing medical education (CME) activities, their primary goals were to improve the learner experience by increasing interactivity and knowledge transfer. However, after analyzing the data generated by these programs, the teams discovered that gamification also can provide a deeper understanding of healthcare professionals’ educational needs and desires, which is a powerful tool to deliver more meaningful CME to a targeted base of learners.

Methods and Results

In 2015, Array and Vindico developed a proprietary game called “Wheel of Knowledge.” The game is led by faculty experts, each representing a “team” that is chosen at random. The basic flow of “Wheel of Knowledge” is described as follows:

1. A carnival-type wheel is spun, landing on one of the predetermined educational categories.
2. A faculty member reads a question from the appropriate category to the audience of learners.
3. Attendees answer the question, utilizing an iPad that is provided to them. More points are given for incorrect answers than no answer at all, so participation is encouraged.
4. The correct answer is displayed after all attendees lock in their answers.
5. Points are accumulated on a per-team basis, and a leaderboard is displayed throughout the game.

After implementing this gaming strategy in a few programs, Vindico immediately was impressed with the positive impact on engagement and knowledge. Specifically, 97% of attendees who started the game finished the game, demonstrating high engagement. Also, knowledge scores at 30 days post-learning were 92%, which were similar to those immediately after the education, suggesting that this type of gamification impacts not only knowledge transfer but retention as well.

Beyond gamification’s impact on engagement and learning, Vindico found that the amount of data collected was extremely valuable. Therefore, Vindico began working with Array to develop more gaming styles that included additional dimensions of learning, which could provide deeper insights. “GameOn!” is a gaming activity based on the principles of confidence-based learning, which introduces an element of self-assessment, making the learner more aware of the educational objectives and knowledge gaps. The basic flow of “GameOn!” is described as follows:

1. Learners are asked a multiple-choice question, which they answer on a device.
2. Learners select how confident they are that the answer is correct, based on a scale of 1 to 5.
3. The correct answer, with rationale, is then displayed.
4. Points are given based on answer correctness and learner level of confidence, with points deducted for highly confident (i.e., “I’ve got this!”) answers that are incorrect, motivating learners to self-reflect accurately (Figure 1).

Figure 1.

Table depicting the scoring involved in the “GameOn!” CME activity.

As of June 2021, the “Wheel of Knowledge” and “GameOn!” activities can be implemented in both the live and web-based CME setting. Learner engagement is maintained in this context, with completion rates of gamified web activities being 25% higher on average than comparable non-gamified web-based programs. Similarly, 98% of learners reported that web-based gamified programs promoted knowledge transfer. Regarding confidence, only 5% of learners did not find “GameOn!” useful, whereas 95% of learners found the game useful in either increasing confidence, validating confidence or identifying areas of improvement (Figure 2).

Figure 2.

Graph depicting results of the impact of “GameOn!” on learner confidence levels.

Discussion

Gamification draws on the human needs to connect, compete and succeed, ideally positioning it as a powerful tool in the educational setting to engage and teach. In addition to the benefits of engagement and knowledge transfer, gamification allows for robust data collection that can provide essential insights toward the development of more meaningful CME without burdening the participant with additional surveys or evaluations.

Adding the dimension of learner confidence to gamification activities allows for the collection of three data points per question (knowledge, confidence and concordance between knowledge and confidence). With this data collection, essentially four possible outcomes can provide deeper insights into where educational deficiencies lie and what that could mean for the delivery of future education (Figure 3).

Figure 3.

Image depicting four possible combinations of knowledge and confidence as well as recommendations for future learning.

For example, a learner who demonstrates high knowledge and high confidence has demonstrated mastery of the topic and may not need further education on that subject. However, a learner with low knowledge, regardless of confidence, will benefit from further knowledge-based CME to address misconceptions related to the topic. Finally, a learner with high knowledge and low confidence understands the fundamental concepts but lacks the confidence to implement these skills in practice. For this group of learners, skills-based learning, such as the use of patient simulations or clinical cases, would be recommended.

In addition, all data collected can be further grouped (e.g., by topic, by learning objective) or segmented (e.g., by specialty, profession, years in practice) to provide even more insight that could further refine future educational endeavors.

Conclusion

The integration of gamification into CME has proven to increase engagement and transfer knowledge. Moreover, without burdening the learner with additional surveys or assessments, multiple dimensions of data collection and analysis are achievable, allowing for a deeper understanding of persisting educational needs. These educational models will be important going forward as essential tools, not only for an improved learning environment but to obtain more meaningful outcomes that can be used to shape future CME programs.