Study data published in the Proceedings of the National Academy of Sciences of the United States of America suggest that “serious” video game training interventions may improve physician performance during trauma triage.

Per the representativeness heuristic, theoretic construct, physicians compared their patients to the relevant injury archetype in assessing case severity. With this basis for trauma triage in mind, investigators developed 2 training games to enhance physician heuristics: a puzzle-based game engaging analogic reasoning, and an “adventure” game requiring narrative engagement. Game development used existing medical and clinical data, and a panel of experts were consulted for information on diagnostic errors. 

A cohort of physicians employed at nontrauma centers around the United States were randomized to 1 of 4 interventions: puzzle video game (n=66), adventure video game (n=66), traditional text-based materials for continuing medical education (n=73), or no intervention (n=63). Following intervention, each participant completed a virtual simulation in which they had to identify which patients required transfer to a trauma center based on given clinical information. The primary outcome measure was portion of undertriaged cases in the virtual simulation. Secondary outcome analyses assessed triage performance per each level of “representativeness,” or degree to which the injury represented its case archetype.

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Compared with physicians who received no intervention, those randomly assigned to both the adventure (P =.002) and puzzle (P =.003) game interventions undertriaged fewer cases. Specifically, physicians who participated in the adventure video game undertriaged 18% fewer cases (95% CI, -30% to -6%) and those who participated in the puzzle video game undertriaged 17% fewer cases (95% CI, -28% to -6%). Those randomly assigned to text-based intervention had no statistically significant improvement over those without intervention (difference, +8%; 95% CI, -3% to 19%; P =.15). For nonrepresentative cases, exposure to both adventure (P <.001) and puzzle (P =.01) games reduced undertriage rates compared with no intervention. For representative cases, however, only the puzzle game (P =.007) was effective in reducing the number of undertriaged patients compared with no intervention.

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Researchers emphasized the necessity of heuristics training for triage, given the limited timeframe and significant clinical uncertainties associated with trauma cases. Video game simulations may prove a helpful hands-on alternative to text-based education in exposing physicians to appropriate triage strategies. Although the implementation of such education methods could be expensive, researchers wrote, the investment could reduce the costly effects of undertriage in medical centers.


Mohan D, Fischhoff B, Angus DC, et al. Serious games may improve physician heuristics in trauma triage. Proc Natl Acad Sci USA. 2018;115:9204-9209.