Video Games, New Media Have Place in Training, Say Medical Students

Games Must Build Skills With Patients, Be Fun

January 26, 2011 05:10 pm Barbara Bein

It doesn't take being a parent to figure out that kids like video games. And a growing body of research shows that college students do, too. Moreover, certain types of games and related new media can enhance the learning experience compared with traditional teaching techniques. It's less clear, however, whether the nation's medical students can be counted among these video-engaged learners.

Now, a study conducted by two family physician-educators has found that medical students are indeed enthusiastic about the idea of using new media -- including video games -- in their medical education. But, they say, it's got to be fun.

In the study(, which was published in the open-access online journal BMC Medical Education, family physicians Frederick Kron, M.D., of Verona, Wis., and Michael Fetters, M.D., M.P.H., of Ann Arbor, Mich., found that medical students think educators could make better use of new media technologies.

For example, the students said they'd happily use a health care simulation game that followed the current "massively multiplayer online role-playing game," or MMOG, model if it helped them accomplish an important goal. That is, they noted, as long as the simulation game was, first and foremost, fun, and second, if it helped them build skills in patient interactions.

Family Medicine, New Media Can Merge in Education

For the first two decades of his professional life, Frederick Kron, M.D., of Verona, Wis., worked as a general medical practitioner, physician educator and television/multimedia writer. Now, he's a board-certified, practicing family physician -- after returning to residency training in mid-career -- and president and founder of Medical Cyberworlds Inc., a company that is developing medically themed virtual learning applications.

Kron recently told AAFP News Now that it was during his teaching experiences that he discovered how many medical students worry about being unprepared to talk with patients.

"The most important things you can teach medical learners are professional skills, patient-centered skills and, especially, doctor-patient communication," he said. "You don't want someone having crucially important conversations with patients without a solid knowledge of important conversational tools."

The solution he's found is to leverage his knowledge of video games and related new media as he seeks to develop curricular tools that give students practice in patient communications and interactions.

Kron said his medical and media backgrounds have been helpful in "trying to figure out the challenges of how to create engaging new learning platforms that really address critical issues, that meet the strictest teaching standards and that will be fun for learners." In fact, he sees plenty of commonalities in family medicine and writing for new media.

"In writing, you want to know about your characters. What are their strengths and hopes? What are their flaws and fears? In patient-centered medicine, you do the same. What is the back story? What are their beliefs? If you understand those aspects of your patients, you will begin to understand what drives them and how to relate to them," said Kron.

By playing so-called serious games, medical learners can engage in challenging scenarios with virtual patients who evoke empathy and compassion. That experience helps learners understand why conversational skills matter, and ignites within them a desire to master those skills, Kron said.

A total of 217 medical students from the University of Wisconsin, Madison, and the University of Michigan, Ann Arbor, participated in the study. Most participants (78 percent) considered themselves basic or intermediate users of computers; only 22 percent considered themselves advanced users.

Nearly one-quarter said they typically play video games several times a month, although they noted that they've been playing less since starting medical school. The most commonly owned game platform among student participants was a personal digital assistant, with the Sony PlayStation (version 2 or 3) a distant second.

Although the researchers also identified a number of gender differences in participants' demographic profiles (e.g., more men than women were advanced computer users and men were more than four times as likely as women to play video games), the students' overall attitudes about new media were similar in several ways:

  • 98 percent said they liked the idea of using technology to enhance the current health care education experience;
  • 96 percent thought that education should make better use of new media technologies;
  • 80 percent said video games can have educational value; and
  • 77 percent said if a multiplayer online health care simulation helped them accomplish an important goal, they would use it -- even on their own time.

"Overall, medical student respondents, including many who do not play video games, held highly favorable views about the use of video games and related new media technology in medical education," the study concluded.

Both study authors told AAFP News Now that even they were surprised that students were so enthusiastic about incorporating video games and other new media into their medical education.

"Today's medical learners are immersed in all these cool technologies like social media, the Internet and computer games, but we couldn't just assume that they also want those things in their medical education," said Kron, who formerly was an assistant professor in the department of family medicine at the University of Wisconsin, Madison, and now is president and founder of Medical Cyberworlds Inc. "The study, however, clearly shows that they do."

Fetters, who is an associate professor in the family medicine department at the University of Michigan, Ann Arbor, said he was taken aback by the similar reaction among both "gamers" and "non-gamers."

"I expected that medical students who play computer games would be very supportive," he said. "But I was quite surprised by the high level of interest and support -- virtually indistinguishable -- from medical students who are not gamers."

One study finding was particularly heartening, said the authors: that medical students want digital media to help them increase their skills and comfort in dealing with patients. MMOGs, they said, can accomplish this.

Technology Big in Medical School, Says Student

Kevin Bernstein, a fourth-year student at Drexel University College of Medicine, Philadelphia, and the student member of the AAFP Board of Directors, says technology -- including new media -- has an important role in his medical education.

Bernstein told AAFP News Now that he and other medical students have software that allows them to log patient encounters directly from their smart phones. They also use point-of-care clinical reference tools on their mobile devices.

Many faculty lectures are converted to podcasts, which then are stored in a huge database. The database can be accessed from any computer and is especially helpful during the last two years of medical school when students are at clinical sites, he said.

Bernstein said social media platforms, such as blogs, Facebook and Twitter, are underutilized and concerns about their use "overemphasized" by faculty. Blogs, in particular, "keep students interested and keep faculty and attending physicians engaged in their knowledge and motivated in educating future generations," he said.

According to Bernstein, students at his institution currently engage in single-user simulations that allow them to work through the process of taking a patient history, performing a physical exam, ordering and evaluating the results of diagnostic testing, determining treatment and performing appropriate follow-up. But these are just single encounters, he said, and he sees a real need to incorporate such simulations longitudinally during medical school so students can build a "patient panel" to follow throughout their four years.

As for video games, Bernstein said he plays them only to relax. And although he doesn't rule out their potential role in patient simulations, he emphasizes that students who are not involved in new media cannot have their educational experience compromised, either.

For example, a so-called serious game, known as "Tactical Iraqi,(" is used to train U.S. soldiers deployed to culturally unfamiliar and potentially hostile areas to become better thinkers and communicators while under stress.

"One sees here a compelling similarity to medical practice, where physicians' professional skills are regularly tested as they venture into culturally unfamiliar and high-stress, high-stakes situations," said the study. "Medically themed MMOGs may have similar training utility for medical students."

According to Kron, such role-playing games also may be ideal for imparting the best professional principles of family medicine.

"Good professional skills, especially good communication skills, really do have an effect on outcomes," he said.

Fetters agreed. "As family medicine serves as a discipline on the front lines and deals with the complex sociocultural issues that naturally arise, role-playing games have the potential to really engage students into the challenging and enjoyable aspects of family medicine."

Fetters said several features make new media-based learning superior to traditional techniques. For example, educators can manipulate variables within a game to examine student reactions to patients of diverse backgrounds. Educators also can standardize content and feedback.

The two authors call for "blended learning" that incorporates new media technologies with traditional approaches such as didactic small-group discussions and the use of standardized patients. Although they acknowledge that there are visionary medical educators who see the promise of new media, obstacles remain.

"I think a challenge will be wedging (these technologies) into a curriculum that is very dense. In the current environment of evidence-based teaching, the challenge is to develop new media (learning tools) that engage students and can demonstrate equal or better outcomes than traditional approaches," Fetters said.