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When Tobi Saulnier went to the emergency room after a car accident this winter, she had a better idea than most what might happen next.

Saulnier and her company, 1st Playable Productions, had just finished an iPad video game they hoped would teach doctors what to look for when they’re deciding whether to transfer patients to a trauma center. Suddenly, she was living a version of the training exercise in her own game.


“Even though I had done this game, it had never connected with me how critical it is,” she said.

Doctors who played the game Saulnier designed did a better job on a separate virtual simulation designed to test their clinical judgement about trauma transfers than those who used a text-based app or nothing at all, according to new research published Monday in the Proceedings of the National Academy of Sciences. The study found a similar result for doctors who played a story-based adventure game from Schell Games, also for the iPad.

About 55 to 80 percent of patients who ought to be transferred to a trauma center aren’t, studies show, which means those patients aren’t getting access to some of the specialized care and equipment available at those facilities.


But “if you transferred all of the thousands of patients with minor injuries that you saw, you would overwhelm the trauma system,” said Dr. Deepika Mohan, a trauma specialist at the University of Pittsburgh who designed the study.

So Mohan worked with game designers like Saulnier to create games that would remind physicians which clinical characteristics should trigger a transfer to a trauma center. (Saulnier herself was lucky; an ambulance took her straight to a trauma center after her accident.)

“Emergency medical physicians already knew what the clinical practice guidelines were — they just don’t follow them,” Mohan said.

In Saulnier’s puzzle game, called “Shift: The Next Generation,” doctors must quickly triage a set of patients, all based on real data Mohan provided. Then the game asks them to detail the characteristics that the patients who needed to be transferred shared — things like low blood pressure or high heart rate measurements that can indicate shock. Finally, they’re asked to drag and drop characteristics to formulate statements about best principles.

The story-based game involves a scripted narrative with a mystery element, but it similarly asks physicians to make decisions about virtual patients’ care and explain them to virtual families. If the player makes the wrong decision, the patient returns with complications.

Both games are currently available for free on Apple’s app store in a beta version.

Though her results are promising, Mohan said researchers will need to conduct more studies before video games might be considered a gold-standard educational tool. Since the doctors she recruited for her PNAS paper were at a conference, they might have been more willing to learn and change their habits, she said. Rolling the games out to every doctor in a hospital might be a better test of the games’ true impact.

The games might not reflect limitations in the broader medical system that can influence physicians’ decisions, Mohan noted, like whether a given hospital has an ambulance available to make a transfer.

Getting doctors to change their habits could pay off in unexpected ways. In medicine today, there’s an “assumption that physicians are so prone to error that we should block them out of the decision-making process,” Mohan said.

But taking the human element out of decisions isn’t always the right choice, she said. “Human beings have this amazing capacity to deal with uncertainty and with complexity that no computer system that I know of at this point can replicate.”