title: A randomized, controlled trial of team-based competition to increase learner participation in quality-improvement education.
abstract: OBJECTIVE
  Several barriers challenge resident engagement in learning quality improvement (QI). We investigated whether the incorporation of team-based game mechanics into an evidence-based online learning platform could increase resident participation in a QI curriculum.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  Tertiary-care medical center residency training programs.
  
  
  METHODS
  Resident physicians (n = 422) from nine training programs (anesthesia, emergency medicine, family medicine, internal medicine, ophthalmology, orthopedics, pediatrics, psychiatry and general surgery) randomly allocated to a team competition environment (n = 200) or the control group (n = 222).
  
  
  METHODS
  Specialty-based team assignment with leaderboards to foster competition, and alias assignment to de-identify individual participants.
  
  
  METHODS
  Participation in online learning, as measured by percentage of questions attempted (primary outcome) and additional secondary measures of engagement (i.e. response time). Changes in participation measures over time between groups were assessed with a repeated measures ANOVA framework.
  
  
  RESULTS
  Residents in the intervention arm demonstrated greater participation than the control group. The percentage of questions attempted at least once was greater in the competition group (79% [SD ± 32] versus control, 68% [SD ± 37], P= 0.03). Median response time was faster in the competition group (P= 0.006). Differences in participation continued to increase over the duration of the intervention, as measured by average response time and cumulative percent of questions attempted (each P< 0.001).
  
  
  CONCLUSIONS
  Team competition increases resident participation in an online course delivering QI content. Medical educators should consider game mechanics to optimize participation when designing learning experiences.
authors: Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholars Program, University of California, Los Angeles, CA, USA Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA Present address: Duke Clinical Research Institute and Division of Urologic Surgery, Duke University School of Medicine, Durham, NC, USA.
authors: Charles D
authors: CD
authors: Scales
authors: Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA HSR&D Center of Excellence for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors: Tannaz
authors: T
authors: Moin
authors: Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholars Program, University of California, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
authors: Arlene
authors: A
authors: Fink
authors: RAND Corporation, Santa Monica, CA, USA.
authors: Sandra H
authors: SH
authors: Berry
authors: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors: Nasim
authors: N
authors: Afsar-Manesh
authors: Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholars Program, University of California, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
authors: Carol M
authors: CM
authors: Mangione
authors: Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, USA.
authors: B Price
authors: BP
authors: Kerfoot
mesh_terms: D003163:Competitive Behavior; D004502:Education, Medical, Continuing / Q000379:methods* / Q000458:organization & administration; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards
keywords: graduate medical education; quality improvement; randomized controlled trial; spaced education