Imagine you are 80 years old and fall down a flight of stairs, fracturing many ribs. The doctor says your condition isn’t critical and sends you home with medication, but hours later you’re back at the hospital with respiratory failure and a life-threatening case of pneumonia.
This scenario is exactly what Dr. Deepika Mohan — assistant professor of critical care medicine and surgery at Pitt — described as a “classic example” of the use of problem-solving gone awry when triaging a trauma patient.
In an attempt to help physicians recognize patients in need of higher levels of care, Mohan created “Night Shift” — a medical simulation game. Players take on the persona of an emergency medicine physician named Andy Jordan and make critical decisions based on the symptoms of patients that arrive at the small community hospital.
Schell Games, a game development company located in Pittsburgh, collaborated with Mohan to design the program, which was funded by the National Institutes of Health. Mohan’s team of emergency medical physicians, trauma surgeons and behavioral scientists also helped with the project.
“[My team] was trying to figure out a strategy to change physicians’ heuristics in trauma, and there just isn’t really any good strategies out there,” Mohan said. “I came across different ideas through literature where people were trying to change heuristics through different domains, and one of them was storytelling.”
Mohan said she learned that creating a compelling narrative that people can engage with has the power to change people’s behavior. She knew she wanted to produce something interactive and immersive, so she decided a simulation video game that mimics a real-life hospital was fitting.
“The thing that’s happening in the game is that if you make a mistake you get immediate feedback from a family member,” Mahon said. “The idea is to make the feedback feel memorable and personally relevant [to] show doctors the consequences of their actions.”
Mohan said the crux of the problem is that physicians rarely see severely injured patients in small hospitals, such as UPMC St. Margaret — only one patient out of the hundreds and thousands they see may be badly hurt. These physicians also do not receive feedback on their decision-making because most of the time they do not oversee the patient’s entire stay.
For her study on the effectiveness of the game, Mohan gave iPads to and evaluated 295 physicians, half of whom were randomly chosen to play “Night Shift.” The rest of the physicians completed an educational application — an online review of chapters in a textbook with videos and multiple-choice tests.
She found that people who played the game made fewer diagnostic errors than those who used the educational application, accrediting some of the game’s effectiveness to its simplicity.
“We tried to stay away from giving a lot of facts and figures because people don’t learn that way,” Mohan said. “Instead, we gave them a very simple principle, like patients who have rib fractures are badly hurt.”
Michal Ksiazkiewicz, the project director and game designer for “Night Shift” at Schell Games, said the game is formatted like a two-dimensional dollhouse. Players can see a cross section of a building and walk left or right or take elevators to go to patients’ rooms. They then do a primary exam in the form of a chat.
“If you repeatedly tap on a spot, it performs chest compressions, or you can apply pressure somewhere and ask [the patient] if it hurts,” Ksiazkiewicz said. “Then you have your patient’s information sheets and you can put in orders, which can be labs, imaging, medications … it’s a similar thing you would do in real life scenarios.”
After assessing the condition of the patient, the player must decide whether to discharge them, admit them to the hospital or transfer them to a trauma center.
“Night Shift” also incorporates a mystery aspect to it, where players have to uncover the disappearance of Andy Jordan’s grandfather. Mohan this was included to make people identify with the characters in the game.
“If you get feedback about your performance and you don’t really care about the character, then it’s just irrelevant,” Mohan said. “But if you identify with the character then it becomes very relevant and therefore memorable.”
But Mohan said the reception of the game from physicians was somewhat mixed. She said 91 percent of the doctors who used the educational program were happy with their experience. Only 40 percent said they had a positive experience with the game. The other 60 percent found it frustrating.
“A lot of people said they don’t play video games and didn’t understand the purpose of it,” Mohan said. “People were like, ‘What’s up with Andy and his grandfather?’ People thought it was distracting, frivolous or annoying.”
Ksiazkiewicz said these mixed responses probably mean people like different types of games and that it is difficult to please an entire demographic. Despite some of the negative reactions, Mohan said she was proud that physicians were willing to participate.
Brooke Morrill, the director of education at Schell Games, also said she was excited about the game’s positive learning impact and the opportunity to receive feedback, which she said does not happen often in the game industry.
“As a studio we work on a really good mix of entertainment- and education-focused games and our goal is always to bridge those two,” Morrill said.
Mohan said she hopes to create more versions of the game and has already collaborated with Schell Games again to design a logic puzzle version of “Night Shift.”
“I think [the issue] has to do with how we recognize injury,” Mohan said. “I didn’t frame the game as a way to improve [physicians’] skills but as a way to help with decision-making. There’s not a lot of literature out there on how to build a game so we’re really doing something unusual.”