Intended for healthcare professionals


Use doctors’ competitive nature to drive improvement, researchers say

BMJ 2016; 352 doi: (Published 18 February 2016) Cite this as: BMJ 2016;352:i1021
  1. Matthew Limb
  1. BMJ Careers
  1. limb{at}

Team based games increase doctors’ participation in learning about quality improvement, researchers have found.

A US study found that methods such as “game mechanics” can be effective and “powerfully motivating” in leading to more learner involvement in quality improvement education. A team from the University of California Los Angeles and other institutions has published their findings in the International Journal for Quality in Health Care.1

The researchers said that the results “suggest an important role for the social context of education as a lever to increase learner engagement.” Game mechanics, including team based competition, can be powerfully motivating, they said.

The researchers said that there had not been any research into quality improvement that looked at the role of game mechanics—such as team based competition, status indicators, and social collaboration—in driving behaviour change.

They created an online course for quality improvement and patient safety, and 422 resident physicians drawn from nine training programmes—anaesthesia, emergency medicine, family medicine, internal medicine, ophthalmology, orthopaedics, paediatrics, psychiatry, and surgery—took part.

The residents all accessed the same content in the same format, and were emailed questions twice a week that were linked to clinical scenarios. They were randomly allocated to two groups—a team competition environment (200 residents) or a control group (222).

The competition group participants were among colleagues in the same specialty. They were given a “rock band alias” and got feedback on their relative standing through a “team leader board” to encourage competition. They were eligible for small cash prizes based on team performance.

The control group residents only had feedback about their individual progress.

The results showed that the physicians in the competition group showed greater participation than the control group. More participants in the competition group (79% [SD ± 32]) tried to answer the questions at least once than in the control group (68% [SD ± 37]). Median response time was also faster in the competition group (P=0.006).

“Across several measures, residents exposed to a team based competitive environment participated to a greater extent,” the researchers said. “Moreover, we observed a dose-response effect. That is, the longer the participants were exposed to the competitive environment, the greater the difference from the control group.”

Leader boards created a social competition dynamic that might have affected reward processing neural systems and given a sense of status that motivated participation, the researchers said. “The fact that the response times among competition group residents improved over the duration of the game in contrast to those among control residents—which actually worsened over the course of the game—provides further evidence as to the power of team based game mechanics to drive engagement.”


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