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SICKO, a novel gaming platform to teach surgical decision-making
Upper Lobby
SICKO, a novel gaming platform to teach surgical decision-making
Curriculum Director, Goodman Simulation Center, Stanford School of Medicine
Gamification, defined as the use of game mechanics, dynamics, and frameworks to promote desired behaviors, is increasingly leveraged in education because of its power to engage, motivate, and create an... Read more

Description

Gamification, defined as the use of game mechanics, dynamics, and frameworks to promote desired behaviors, is increasingly leveraged in education because of its power to engage, motivate, and create an immersive learning experience.  This project sought to apply gamification theory to the clinical and operative management of classic surgical diseases that physicians frequently encounter.  The resultant product, SICKO, is the second and more sophisticated iteration of the original Septris engine, which was initially developed to teach clinicians how to manage a potentially lethal disease state known as sepsis.  SICKO is built in JavaScript and HTML5 to facilitate cross-platform use and is optimized for desktop browsers and tablet devices.  Patient case scenarios are structured in XML, enabling easy expansion and editing of cases.

In SICKO, the player is presented with acutely ill virtual patients whose cartoon faces appear on a game screen like falling Tetris squares.  Their deteriorating vital signs are displayed in real-time to the right of their portraits along with a clinical vignette.  A dashboard at the bottom allows the player to select various diagnostic and treatment modalities to diagnose, stabilize, and definitively cure the patient.  Test results such as lab values and radiographic findings are posted in the chart as they are ordered, with bonus points rewarded for running key tests.  As appropriate interventions are initiated, the patient’s health (and cartoon tile) is boosted; conversely, if inappropriate or harmful actions are chosen, the patient’s status plummets.  Once the player commits the patient to surgery, the game transitions to an “OR mode” where the player is tested on intra-operative decision-making in response to changing clinical scenarios as well as surgical technique.  The player receives ongoing, immediate, and educational feedback (positive and negative) based on his/her treatment choices.   As in real life, the player toggles between two or even three “falling” patients at a time, challenging him/her to effectively triage and prioritize attention and care to the sickest patient.  The game itself is comprised of three levels of increasingly complex clinical scenarios; players must successfully heal the patients in each round before advancing to the next.

Surgery is a high-stakes enterprise where there is no room for error.  Compounded by the pressure of limited work hours and patient safety concerns, the need is greater than ever to train clinicians efficiently and create modalities that level the learning curve and optimize the acquisition of critical skills.  Live scenario-based training in a physical simulation center, while educationally effective, is time-consuming, resource-intensive, and can train but a limited number of individuals.  In contrast, a virtual patient simulator like SICKO can be easily accessed via Internet, played whenever and wherever is convenient for the trainee, and reach a far more expansive learner population.  As an educational tool, SICKO delivers a fun, interactive, and gratifying learning experience where trainees can treat and make life-or-death decisions on sick patients, make errors without the fear of the actual consequences, and receive real-time, customized feedback on their clinical skills.

Dana Lin, MD was born and raised in upstate New York and received her medical degree at University at Buffalo School of Medicine.  She completed her general surgical residency at UMDNJ-Robert Wood Johnson University Hospital, subspecialty training in endocrine surgery at the Massachusetts General Hospital, as well as a fellowship in surgical education at Stanford School of Medicine.  She is currently the curriculum director of the Goodman Simulation Center at Stanford, where she is invested in designing and implementing skills curricula for medical students and residents, creating mobile software to enhance surgical training, and conducting research in surgical education.  She also holds a faculty position at the VA Palo Alto where she practices general and endocrine surgery.

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