Serious games may improve physician heuristics in trauma triage

Deepika Mohan, Baruch Fischhoff, Derek C. Angus, Matthew R. Rosengart, David J. Wallace, Donald M. Yealy, Coreen Farris, Chung Chou H. Chang, Samantha Kerti, Amber E. Barnato

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Trauma triage depends on fallible human judgment. We created two “serious” video game training interventions to improve that judgment. The interventions’ central theoretical construct was the representativeness heuristic, which, in trauma triage, would mean judging the severity of an injury by how well it captures (or “represents”) the key features of archetypes of cases requiring transfer to a trauma center. Drawing on clinical experience, medical records, and an expert panel, we identified features characteristic of representative and nonrepresentative cases. The two interventions instantiated both kinds of cases. One was an adventure game, seeking narrative engagement; the second was a puzzle-based game, emphasizing analogical reasoning. Both incorporated feedback on diagnostic errors, explaining their sources and consequences. In a four-arm study, they were compared with an intervention using traditional text-based continuing medical education materials (active control) and a no-intervention (passive control) condition. A sample of 320 physicians working at nontrauma centers in the United States was recruited and randomized to a study arm. The primary outcome was performance on a validated virtual simulation, measured as the proportion of undertriaged patients, defined as ones who had severe injuries (according to American College of Surgeons guidelines) but were not transferred. Compared with the control group, physicians exposed to either game undertriaged fewer such patients [difference = −18%, 95% CI: −30 to −6%, P = 0.002 (adventure game); −17%, 95% CI: −28 to −6%, P = 0.003 (puzzle game)]; those exposed to the text-based education undertriaged similar proportions (difference = +8%, 95% CI: −3 to +19%, P = 0.15).

Original languageEnglish
Pages (from-to)9204-9209
Number of pages6
JournalProceedings of the National Academy of Sciences of the United States of America
Issue number37
StatePublished - Sep 11 2018


  • Decision making
  • Heuristics
  • Judgment
  • Serious games
  • Triage


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