# A Gamified Cardiometabolic Health Curriculum Utilizing a Student Response System for Internal Medicine Residents

## TL;DR

This study explores whether a gamified curriculum using a student response system improves internal medicine residents' learning of cardiometabolic health guidelines.

## Contribution

The study introduces a gamified virtual curriculum using KAHOOT!® to teach clinical guidelines to residents and compares it to traditional methods.

## Key findings

- Gamified and traditional formats similarly increased resident confidence in managing cardiometabolic conditions.
- Residents found the gamified format more engaging than the traditional format.
- Low survey response rates limited the study's generalizability.

## Abstract

Introduction: Cardiovascular disease is frequently addressed in primary care, and professional association guidelines dictating the standard of care frequently change. Teaching clinical practice guidelines to residents remains important to promote knowledge retention and subsequent implementation in patient care. Gamification utilizes social elements and technology to promote accessible and active learning that enhances learner confidence, engagement, and knowledge. Data assessing gamification in teaching guideline-based care remains limited. We evaluated a gamified cardiometabolic health curriculum utilizing a student response system (SRS) to assess the benefits of gamification in teaching guidelines to internal medicine residents.

Methods: We developed a gamified cardiometabolic health curriculum for categorical residents in internal medicine utilizing KAHOOT!® (Oslo, Norway). KAHOOT!® is an SRS where learners utilize their mobile devices to answer questions. Speed and accuracy contributed to placement on a digital leaderboard. Our curriculum consisted of one academic half-day with five 45-minute virtual didactics reviewing guideline-based management of type 2 diabetes mellitus (T2DM), hypertension, hyperlipidemia, metabolic-associated fatty liver dysfunction (MAFLD), and weight management. KAHOOT!® was selected to promote ease of participation. The gamified format was compared to a traditional slide-based format. Residents are randomly assigned one of five clinic groups. Three groups received the gamified format, and two received the traditional format, without crossover. Residents were invited to complete anonymous pre- and post-surveys, which collected quantitative data such as Likert scale ratings of confidence and satisfaction with learning and test performance.

Results: All residents (108 of 108) received the curriculum. Around 59% (64) received the gamified format, and 44 (41%) received the traditional format. Pre-post surveys were compared via a matched analysis. Anonymous surveys were matched via a code provided by each resident, and residents who completed only one of the two surveys were excluded. Likert scale ratings of confidence in management increased for hypertension, hyperlipidemia, MAFLD, and weight management, but not for T2DM, likely as T2DM had the lowest number of matched resident pairs analyzed. Comparing gamified and traditional formats, there was no difference in the post-curricular change in absolute score on board-style questions or increase in Likert scale ratings of confidence. A majority of residents (90.9%) who received the gamified format found it engaging, while a minority (14.2%) of residents who received the traditional format found it engaging. Analysis was limited by a low response rate of 21.6%. Anonymous pre-post surveys limited the assessment of non-response bias and whether respondent characteristics differed from those of non-respondents.

Discussion: A gamified format was similar to a traditional format in increasing resident confidence in managing cardiometabolic health conditions and knowledge of guidelines. A gamified format was felt to be more engaging. Although the low response rate limits generalizability, we present initial data supporting the efficacy of a virtual gamified curriculum utilizing an SRS to teach clinical practice guidelines. Future avenues for study include assessments of long-term knowledge retention and whether engagement translates to increased learner participation.