In emergency medicine, triage is square one. Every patient management decision begins with an assessment of urgency and the prioritization of patients\u2019 needs. If a health care provider in the emergency department isn\u2019t capable of fast, competent triage, he or she is in the wrong profession (or at least the wrong part of the hospital).\nAnd 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?\nHow We Teach Ourselves to Make Decisions\nDoctors have long learned the art of triage in lectures and in practice, and now, there\u2019s a way to reinforce that learning and make it stick\u00a0\u2014 a video game that improves the practitioner\u2019s triage skills dramatically.\nIn 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\u2019s 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.\nInteractive and immersive experiences build memories that are more solid than the memories we establish when we\u2019re 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\u2019t see enough trauma cases to build those automatic associations, and the judgment they eventually render may be based on information that\u2019s lacking in details. And most ED physicians don\u2019t follow the patient throughout the treatment journey, meaning that they don\u2019t see the results of their assessments. Feedback is a mechanism that helps to strengthen the heuristic connection, and ED physicians don\u2019t always get it.\nRELATED: Pushing Health Care into a New Realm of Possibility \nReady, Set, Recalibrate\nThis lack of opportunity to build on heuristic abilities can lead to under-triaging, which is a problem: if a patient isn\u2019t 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\u2019 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.\nWith 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\u2019s character a name and a story. Throughout the game, \u201cDr. Andy\u201d treats patients while also trying to solve a mystery about his grandfather. The story elements engage players\u2019 empathy, which helps them retain information.\nDr. 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\u00ae 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.\n\u201cAn hour of playing the video game recalibrated physicians\u2019 brains to such a degree that, six months later, they were still outperforming their peers in recognizing severe trauma,\u201d said Dr. Mohan.\nThe research appeared in The BMJ in December 2017.\nEndgame\nSo what\u2019s 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.