A novel gamified ambulatory curriculum to educate internal medicine residents on lifestyle medicine and counseling

Abstract

Background/Synopsis

Appropriate counseling of patients in nutrition and physical activity remains a cornerstone in cardiovascular disease prevention. Effective education of internal medicine residents on guideline-based dietary and exercise recommendations is essential in mitigating cardiovascular risk. Gamification is a useful tool given its potential benefits on engagement and knowledge in medical education.

Objective/Purpose

We compared a novel gamified ambulatory curriculum to traditional slide-based curriculum on test performance and ratings of confidence, knowledge, and motivation among categorical internal medicine residents.

Methods

At a single large academic internal medicine residency program, we compared a resident-led virtual gamified curriculum utilizing KAHOOT® to a traditional slide-based curriculum. Residents received a 1-hour case-based session summarizing American College of Lifestyle Medicine guidelines. Pre-post-surveys included knowledge questions, 5-point Likert scales (1 to 5) assessing self-reported confidence in lifestyle medicine counseling and referencing guidelines, motivation to adhere to guidelines, engagement, and a question regarding format preference. Matched pre-post test data and unmatched Likert scale data were analyzed with two-tailed students t-tests.

Results

65/108 (60.2%) categorical internal medicine residents received the gamified format and 43/108 (39.8%) received the traditional format. 22/65 (33.8%) residents in the gamified group and 8/43 (18.6%) in the traditional group completed pre- and post-tests and were analyzed as matched pairs. There was a significant increase in pre- to post-test performance in the gamified (pre- 0.34, post- 0.62, p<0.01) and traditional (pre- 0.35, post- 0.67, p = 0.02) groups. There was no significant difference in the post-pre change in test performance between groups. There were significant increases in Likert scale ratings of confidence in counseling patients in the gamified (pre- 2.61 to post- 4.0, p<0.01) and traditional (pre- 3.26 to post- 4.0, p=0.01) groups. There were significant increases in Likert scale ratings of confidence in referencing guidelines in both gamified (pre- 1.90 to post- 3.73, p<0.01) and traditional (pre- 2.47 to post- 3.90, p<0.01) groups. There was no significant difference between groups in post-survey only Likert scale ratings of engagement or motivation to adhere to guidelines. 16/22 (72.7%) of residents in the gamified group and 6/8 (75%) of residents in the traditional group preferred a gamified format.

Conclusions

The gamified ambulatory curriculum on Lifestyle Medicine was effective in improving resident knowledge, with similar outcomes to a traditional slide-based format. A gamified format was generally preferred by residents. Next steps warrant assessment of whether effective gamified educational curricula lead to significant ambulatory clinical outcomes in management of cardiovascular risk.