In emergency medicine, triage is square one. Every patient management decision begins with an assessment of urgency and the prioritization of patients’ needs. If a health care provider in the emergency department isn’t capable of fast, competent triage, he or she is in the wrong profession (or at least the wrong part of the hospital).

And yet, for all its importance, triage is an imprecise science. Several systems exist to put the patient in the right place at the right time — but to use any system, the health care provider must first know how to assess and prioritize, and how to do it well. And fast. How does a doctor learn how to do this?

How We Teach Ourselves to Make Decisions

Doctors have long learned the art of triage in lectures and in practice, and now, there’s a way to reinforce that learning and make it stick — a video game that improves the practitioner’s triage skills dramatically.

In Night Shift, a collaborative effort of the University of Pittsburgh and Schell Games, the practitioner assumes the role of an emergency physician who must make rapid judgments and quick decisions. The game draws upon the brain’s tendency to recognize patterns and associate them with lived experiences in order to make decisions. This subconscious process, known as heuristics, is useful in triage because it automatically brings together the elements that underlie effective decision making.

Interactive and immersive experiences build memories that are more solid than the memories we establish when we’re listening or reading. The more solid the memory, the more automatic the retrieval when we really need that knowledge in a hurry. But most physicians don’t see enough trauma cases to build those automatic associations, and the judgment they eventually render may be based on information that’s lacking in details. And most ED physicians don’t follow the patient throughout the treatment journey, meaning that they don’t see the results of their assessments. Feedback is a mechanism that helps to strengthen the heuristic connection, and ED physicians don’t always get it.

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Ready, Set, Recalibrate

This lack of opportunity to build on heuristic abilities can lead to under-triaging, which is a problem: if a patient isn’t assigned the correct level of care in the appropriate part of the hospital, outcomes can suffer. Deepika Mohan, MD, who practices in the Department of General Surgery at UPMC and also serves as an associate professor at the University of Pittsburgh, was working with her team to address the issue by finding ways to recalibrate physicians’ heuristics to improve their triage skills. Her research led her to the conclusion that involving people with a story is a key to reshaping their memories. Storytelling can be a training tool.

With funding from the National Institutes of Health, Dr. Mohan teamed up with Schell Games to develop Night Shift. Because good storytelling requires memorable details, they decided to give the game’s character a name and a story. Throughout the game, “Dr. Andy” treats patients while also trying to solve a mystery about his grandfather. The story elements engage players’ empathy, which helps them retain information.

Dr. Mohan and her team at the university tested the game in a national trial of 368 emergency medicine physicians practicing at hospitals without trauma centers (although many of the participants were certified in the Advanced Trauma Life Support® program from the American College of Surgeons). Half of the participants played Night Shift; the other half revisited their triage training through videos and written materials. And, in a victory of empathy and heuristics over tradition, the Night Shift players under-triaged 53 percent of the time vs. 64 percent for the non-players. Six months later, the players under-triaged 57 percent of the time compared to 74 percent for non-players.

“An hour of playing the video game recalibrated physicians’ brains to such a degree that, six months later, they were still outperforming their peers in recognizing severe trauma,” said Dr. Mohan.

The research appeared in The BMJ in December 2017.

Endgame

So what’s next? Will physicians start playing video games to strengthen other skills? If other health care organizations embrace the unconventional approach of visionary physician-researchers the way the University of Pittsburgh and UPMC have, maybe so.