Serious Play: Gamifying Education on Health-Related Social Needs

Setting and Problem

The US health care system is complex, and overall health care literacy is low among incoming residents.¹ Anecdotally, we have noticed a lack of understanding of insurance plan coverage, the financial burden of health care, and budget limitations of many patients. New residents need education on health-related social needs (HRSNs) that many patients face and how to meaningfully engage with these difficulties in the health care setting.

We reviewed many existing tools, such as the United Way’s ALICE (Asset Limited, Income Constrained, Employed) simulator and poverty simulators, and while useful, none that we reviewed captured the complexity or detail that a physician must understand to deliver effective, high-value care. In one study, a panel of health policy experts including medical educators and health care providers identified “health insurance,” “US health care system, financing, and payment,” and “health disparities” as top priorities for health policy instruction in graduate medical education (GME).²

Beyond knowledge gaps, we recognize that our standard orientation curriculum can suffer from low engagement with lecture-based didactics. Therefore, gamification can increase interaction between residents, build empathy for patients, and improve overall retention of key health care information, with the goal of increasing the residents’ understanding of HRSN.

Intervention

Inspired by our work with the Alliance of Independent Academic Medical Centers National Initiative IX, we developed a board game–style simulation, A Year in the Life. Each team of 2 to 3 residents was given 1 of 4 characters who met the ALICE definition; we provided income and monthly budget details. Each team then chose a health care option from a customized list based on real-life modeling from locally available plans. Multiple options from a federal exchange plan, employer-sponsored insurance plan, and government (Medicare) insurance were offered, or the team could decide to remain uninsured.

Every turn represented a month, and on each month the team drew an event card (see Figure for examples). At times, the event card’s impact depended on their insurance coverage (eg, the cost of an emergency department visit). A 20-sided die was also used to add uncertainty to calculations.

Figure.

Sample Event Cards

Note: Each character has a customized set, and health care event costs are calculated by the game facilitator based on the insurance coverage chosen by the team.

Teams were successful if they maintained a positive net worth at the end of the game without major adverse health outcomes. After the simulation, there was a facilitated discussion on what the residents learned and how to apply this knowledge at the bedside. Finally, we reviewed key elements of different types of health insurance and distributed a 1-page handout summarizing this information.

Outcomes to Date

The initial pilot with 3 facilitators and 12 family medicine residents took place in June 2024 during a 2-hour session in residency orientation. Informal verbal feedback during the pilot was positive, with high levels of engagement during the simulation and debriefing session. Some residents were motivated to brainstorm with their colleagues on how they can increase screening for HRSN in their clinical areas and improve knowledge around community resources.

In 2026, we will repeat the game with first-year residents in the internal medicine and neurology residency programs, and we will collect pre- and post-intervention data. We will use this information to further refine the game. While initial development was time consuming, we aim to create a toolkit that could easily be customized and replicated in other programs and other institutions with minimal effort and cost.

To the best of our knowledge, this is a novel application of gamification in GME. By using realistic scenarios built by practicing health care professionals, we can educate our residents while also building empathy for patients and increasing engagement with their colleagues. We believe this intervention can be broadly applied across many GME programs and practice settings.