title: Gamification as a tool for enhancing graduate medical education.
abstract: BACKGROUND
  The last decade has seen many changes in graduate medical education training in the USA, most notably the implementation of duty hour standards for residents by the Accreditation Council of Graduate Medical Education. As educators are left to balance more limited time available between patient care and resident education, new methods to augment traditional graduate medical education are needed.
  
  
  OBJECTIVE
  To assess acceptance and use of a novel gamification-based medical knowledge software among internal medicine residents and to determine retention of information presented to participants by this medical knowledge software.
  
  
  METHODS
  We designed and developed software using principles of gamification to deliver a web-based medical knowledge competition among internal medicine residents at the University of Alabama (UA) at Birmingham and UA at Huntsville in 2012-2013. Residents participated individually and in teams. Participants accessed daily questions and tracked their online leaderboard competition scores through any internet-enabled device. We completed focus groups to assess participant acceptance and analysed software use, retention of knowledge and factors associated with loss of participants (attrition).
  
  
  RESULTS
  Acceptance: In focus groups, residents (n=17) reported leaderboards were the most important motivator of participation. Use: 16 427 questions were completed: 28.8% on Saturdays/Sundays, 53.1% between 17:00 and 08:00. Retention of knowledge: 1046 paired responses (for repeated questions) were collected. Correct responses increased by 11.9% (p<0.0001) on retest. Differences per time since question introduction, trainee level and style of play were observed. Attrition: In ordinal regression analyses, completing more questions (0.80 per 10% increase; 0.70 to 0.93) decreased, while postgraduate year 3 class (4.25; 1.44 to 12.55) and non-daily play (4.51; 1.50 to 13.58) increased odds of attrition.
  
  
  CONCLUSIONS
  Our software-enabled, gamification-based educational intervention was well accepted among our millennial learners. Coupling software with gamification and analysis of trainee use and engagement data can be used to develop strategies to augment learning in time-constrained educational settings.
authors.affiliation: University of Alabama, Birmingham, USA.
authors.forename: Christa R
authors.initials: CR
authors.lastname: Nevin
authors.affiliation: University of Alabama, Birmingham, USA.
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Westfall
authors.affiliation: University of Alabama, Birmingham, USA.
authors.forename: J Martin
authors.initials: JM
authors.lastname: Rodriguez
authors.affiliation: University of Alabama, Birmingham, USA.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Dempsey
authors.affiliation: University of Alabama, Birmingham, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cherrington
authors.affiliation: University of Alabama, Birmingham, USA.
authors.forename: Brita
authors.initials: B
authors.lastname: Roy
authors.affiliation: University of Maryland, Baltimore, USA.
authors.forename: Mukesh
authors.initials: M
authors.lastname: Patel
authors.affiliation: University of Alabama, Birmingham, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
mesh_terms: D000068:Accreditation; D002983:Clinical Competence / Q000592:standards*; D003194:Computer-Assisted Instruction / Q000379:methods / Q000639:trends; D004503:Education, Medical, Graduate / Q000592:standards* / Q000639:trends; D004521:Educational Measurement; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency; D016544:Patient Simulation; D012153:Retention, Psychology; D011795:Surveys and Questionnaires; D014481:United States; D018910:Video Games
keywords: INTERNAL MEDICINE; MEDICAL EDUCATION & TRAINING