In a medical emergency, every moment counts — and decisions made under pressure can have life-or-death consequences. That’s why one local physician wanted to create a way for emergency room doctors to sharpen their triage skills in a low-stakes environment.

Dr. Deepika Mohan says the idea for Night Shift — a video game she developed with Schell Games — came from research that showed people learn through storytelling.

The game’s protagonist, Andy Jordan, is a young emergency department doctor. He’s busy solving a mystery about his grandfather, while treating patients like Steven, who arrives at the hospital with a gunshot wound. Physicians use clues to help Jordan decide which patients require urgent care.

In pre-testing, Mohan discovered that players who identified with Jordan were better able to retain the game’s clinical lessons.

“I felt like immersion in the story was the crux of the issue,” says Mohan, assistant professor of critical care medicine and surgery at the University of Pittsburgh’s School of Medicine. “The game was designed as a way to deliver a storytelling experience.”

A screenshot from Night Shift. Image courtesy of Schell Games.

And besides, “if individuals are going to be playing games anyway, why not give them the opportunity to play games that can teach them something?” asks Dr. Brooke Morrill, director of education at Schell Games, who worked with Mohan to build the game over a nine-month period.

It’s not the first time Schell’s developers have worked on games related to emergency medicine. The company received a Small Business Innovation Research grant from the National Institute of Health (NIH) to develop a prototype of a game to increase middle school students’ interest in the field.

The NIH also supported Night Shift through a special funding mechanism for innovative research.

“I pitched the idea that we could improve heuristics through a video game and they said, ‘OK, we’ll give it a try,’” says Mohan, who received funding to develop the game in May 2015.

Documenting proven progress

Statistics show that their investment is paying off. Of the 368 emergency medicine physicians who participated in a study, half played Night Shift and half read traditional training materials. Six months later, the group that relied on traditional methods was 17 percent more likely to underestimate the seriousness of a patient’s symptoms.

Late last year, Mohan and an interdisciplinary team consisting of physicians and public policy researchers from Pitt, Carnegie Mellon and RAND Corporation published their findings in the British Medical Journal.

“We all brought different strengths to the table,” Mohan says, adding that the team will continue refining the game.

“We saw an 11 percent improvement in a controlled, simulated environment,” adds Mohan. “Now the question is: ‘Can the intervention be more effective?’”

One challenge, says Schell Games designer Michal Ksiazkiewicz, is that doctors don’t always see the value in gaming.

“Games are still widely perceived as something for kids,” says Ksiazkiewicz. “In our playtests, doctors struggled to understand why the game has them engage in things that are not directly related to their craft.”

Mohan believes the basic premise of Night Shift can be applied to other scenarios when physicians are required to deliver quality care under intense pressure — think heart attacks, strokes and sepsis, as opposed to routine screenings like breast exams.

“If we can show that it’s effective in trauma, we’d like to expand the method to other kinds of decisions that doctors need to make,” she says. “We want them to take advantage of their naturally occurring cognitive processes and allow them to be the best version of themselves.”