Content area
Full Text
Introduction
The last decade has seen many changes in graduate medical education training in the USA. Among the most prominent, the Accreditation Council for Graduate Medical Education (ACGME) issued guidelines in July 2003, and again in July 2011, that placed restrictions on the number of hours worked by medical residents during their training. 1 Another important change is the arrival of millennial students to graduate medical education settings. This generation of learners has had ubiquitous access to information technology throughout their education. Studies of the educational impact of ACGME work hour guidelines have been inconclusive and questions persist among educators on how to best prepare millennial residents in this new work hour-regulated educational environment. 2-8 As educators are left to balance the more limited time available between patient care and resident education, new methods to augment traditional graduate medical education are needed to best prepare residents within the new ACGME-mandated environment.
Gamification is the use of elements of game design to increase user engagement. Gamification has been successfully incorporated into medical and scientific endeavours in recent years, from health/fitness and patient education applications, to genome comparisons (Phylo), protein structure prediction (Foldit) and malaria parasite quantification. 9-12 Due to its proven ability to improve motivation, participation and time investment across multiple settings, we incorporated elements of gamification into the design of software that allowed our residents to participate in a medical knowledge competition with their peers in order to encourage extracurricular learning. 13-15 We used the conceptual frameworks of user-centred design and situational relevance to achieve meaningful gamification, including connecting with users in multiple ways and aligning our 'game' with our residents' backgrounds and interests in furthering their education. The purpose of this study was to assess acceptance and use of a novel gamification-based medical knowledge software designed to supplement traditional graduate medical education among internal medicine (IM) residents and to determine retention of information on subsequent retest. 16 17
Methods
Setting
Our study was conducted at two IM training programmes in the USA: the Tinsley Harrison Internal Medicine residency programme at the University of Alabama at Birmingham (UAB) and the University of Alabama at Huntsville (UAH) programme. Inpatient rotations in both general medicine and subspecialties are completed at tertiary care centres, and teams consist of...