Background: Every year, as many as 98,000 people die from medical errors within the hospital, making medical errors one of the top 10 leading causes of death in the United States(1). While the Accreditation Council for Graduate Medical Education (ACGME) has incorporated healthcare quality and patient safety into the Clinical Learning Environment Review (CLER) program to determine institutional accreditation, medical trainees have been found to have limited knowledge of basic quality improvement (QI) concepts in most clinical learning environments. Current QI and patient safety curricula commonly involves discussions and lectures, but notably lacks robust trainee engagement. Gamification is a strategy that has been shown to enhance learner engagement and improve perceived importance of material(2,3). Here, we describe results from the deployment of a novel, gamified patient safety and QI course entitled Safety Quest (SQ).

Methods: The SQ curriculum was developed based on the ACGME’s CLER. The core curriculum is structured as four levels that engages learners in topics such as communication techniques, QI tools, root cause analyses, failure modes effect analysis, and statistical process control charts (Table 1). Both medical trainees (residents, fellows, medical students) and Continuing Medical Education (CME) learners participated. We assessed the impact of SQ on two levels: learner satisfaction (Kirkpatrick’s level 1) and changes in learner attitudes and measures of learning knowledge (Kirkpatrick’s level 2). CME learners were assessed via pre- and post-test performance and satisfaction, which were analyzed with Fisher’s exact tests. Meanwhile, trainees’ preferences were collected, and thematic analysis of their feedback was conducted using two independent coders and corroborated using Cohen’s kappa coefficients.

Results: In 2018 alone, 1364 graduate trainees and 65 medical students completed a level of SQ, while 374 CME learners participated in 2019-2020. Among CME learners, 59% resided in North America, 19% in Asia, and 11% in Europe, and included physicians and trainees (51%), non-physicians (15%), nurses (3%), and allied health professionals (3%). Upon completing SQ, 98.6% of CME learners passed the post-test, whereas only 59.2% passed the pre-test (p < 0.0001). Among trainees, SQ outranked all other independent learning modalities with 45% of graduate trainees preferring SQ over video, HealthStream, PowerPoint, and articles (Figure 1). Cohen’s kappa for rating overall sentiment of comments was 0.90. Raters identified three major content areas: engagement, ease of use, and effectiveness. 87% of comments addressing engagement were positive, whereas 52% and 41% of comments addressing effectiveness and ease of use were positive, respectively. Among CME learners, 93% agreed or strongly agreed that SQ was engaging and interactive, 92% believed it contributed to their professional growth, and 90% believed it covered content useful to their practice.

Conclusions: SQ is an effective tool to promote engagement in learning critical information on patient safety and QI. While lectures and articles can be effective methods to teach QI vocabulary or share QI project examples, gamification allows users to apply the critical thinking skills of patient safety and QI that are required to reduce medical errors in clinical practice. Moreover, a virtual tool such as SQ allows for greater flexibility for learners to complete the curriculum and allows for national and international dissemination.

IMAGE 1: Table 1. Safety Quest curriculum content.

IMAGE 2: Figure 1. Preferred learning modalities amongst undergraduate medical trainees (medical students) and graduate medical trainees (residents/ fellows).