The Problem: Urogenital diseases are commonly encountered in the emergency department [1]. Both the WHO and CDC recommend early identification and timely management of such diseases, to prevent morbidity and mortality [2, 3]. Additionally, the sensitive nature of this topic as well as cultural factors can limit the exposure and bedside teaching by emergency physicians (EPs). Novel learning methods are needed to prepare EPs to manage urogenital diseases effectively and efficiently.

The Innovation

The Learning Urogenital Diseases in Oddity (LUDO) gamification-based, timed activity teaches and assesses clinical practice essentials in the management of urogenital diseases among emergency medicine (EM) residents. This acronym plays off of the age-old game enjoyed across generations in Pakistan, also called Ludo. Adopting this popular game format with EM education enhances learning, facilitating the quick digestion of factoids [4]. The format is simple, adaptable, and can be used to teach topics in an engaging way to any learner group.

The Learners

Emergency medicine residents of all class years

Figure 1: LUDO game with team colors, designated by hats. Team red is listening to the question on data interpretation.

Group Size

LUDO requires a total of 3 facilitators for 4 teams, each marked with colors as per the LUDO board (green, red, blue, and yellow).

The 3 facilitator roles:

1. One handles the laptop
2. One marks the number of times each group has sought additional resources (limited to 5) on the whiteboard
3. One serves as an assessor, who monitors the group whose turn it is in the game, as the throw the dice and move their color piece once they answer the question correctly.

Equipment

Figure 2: Traditional Ludo board with desk bell

Our activity utilizes simple, cheap, and readily available materials, including the following:

• LUDO board: A square-shaped, strategy board game for 2-4 players [Ludo game on Amazon] with a pattern on it in the shape of a cross. In this game, the players race their tokens from start to finish according to the rolls of a single die.
• LED stopwatch: An LED stopwatch was placed on the side of the projector screen. A 1-minute timer was started after the question was read to the team by the facilitator at the laptop and was reset before the next team’s turn.
• Laptop and projector: A laptop and projector were utilized to display PowerPoint slides as a part of the activity. For example, participants had to view images, true/false questions, multiple choice questions, fill-in-the-blank questions, and rapid-fire questions on the slides. These questions prompted them to identify different aspects of urogenital diseases, as well as differentiate images of genital ulcers that patients may present at urgent care clinics or emergency departments.
• Colored caps: Four different colored hats, matching the game pieces, were distributed to each person to designate which team they were on.
• Desk bell: A desk bell could be rung by the team member in the “hot seat” if they wanted to answer the question differently from their team’s consensus answer.

Description of the Innovation

LUDO is a strategy board game for 2-4 players, in which teams race their 4 tokens from start to finish according to single-die rolls. A video description of the traditional Ludo game rules is below. This IDEA innovation mirrored these rules with slight modifications and took place over a 2-hour period.

Before the start of the activity, the activity director provided an introduction regarding the rules and regulations of the program that were also shared through email and WhatsApp a week before the activity.

In our LUDO variation, we assigned 4 team captains to take the “hot seats”, who were responsible for rolling the dice and had the final say in answering their team’s questions. To begin moving their tokens out of the home base circle, they must roll a 6, as in the actual game. After this, they can only move forward if they can answer the pre-prepared questions assigned to each side of the die. If they cannot answer the question, they stay where they are, and the turn proceeds to the next team. For each question, the captain has a minute to answer the question after consulting their team. An LED digital clock adjacent to the projector screen allows all participants to see the remaining time. If the captain desires to answer the question differently than the team’s consensus answer, he or she must ring the desk bell and then provide the alternative answer.

Figure 3: Ludo game token path – this example shows movement of the blue token

‘Getting their token home’ is the main objective of the game, but that is only part of the final evaluation to decide who is the winner. Other vital skills the assessor observes include teamwork, time management, the use of outside resources (i.e., books or the internet), and strategy. For example, there may be times when it is advantageous to answer a question wrong to increase one’s chances of landing on the other team’s token. This would send the other team’s token back to their starting position and force them to restart their travels around the board!

Each team has an option to seek additional resources to answer the question including use of our core textbook of emergency medicine or utilizing their mobile phones to access internet resources. Outside resource usage is limited 5 times per team, as tracked by a facilitator.

Figure 4: Yellow team captain joyfully removing a red team’s token piece after answer the question correctly

During the activity, the assessor facilitator judged each team’s performance through a questionnaire with Likert scales measuring the following:

1. Knowledge of urogenital diseases
2. Leadership skills of the team captain
3. Problem-solving
4. Communication among the team members
5. Time management

At the end of the activity, each team completed an evaluation form to provide feedback about the activity to the organizers. Participants were also given timely feedback by facilitators immediately following the activity during a debriefing session, where the activity director identified gaps in knowledge and skills and provided suggestions for how to translate lessons learned to future clinical practice.

Downloadable forms:

• Room Dimensions
• Program Schedule, Rules, and Regulations
• Assessment form LUDO
• Feedback LUDO

Lessons Learned

• The activity allowed the faculty to assess core EM skills in addition to medical knowledge, such as communication, collaboration, leadership, and problem solving. EM residents also practiced navigating team dynamics and working in a group within a safe learning space promoting collegiality among junior and senior residents.
• The activity utilizes a popular game as a mode of introducing engagement and interest among residents and facilitates learning on a topic that does not tend to generate significant interest on its own.
• 360-feedback was obtained:
  1. Faculty assessed learning outcomes via a Likert scale for resident feedback.
  2. Residents participated in mini-interviews at completion of the activity for educator feedback.
  3. The LUDO game’s activity and learning outcomes were assessed through a questionnaire, which was piloted prior to use during the game. The validation of the assessment tool is in process. The assessment form is available upon request by contacting Dr. Shahan.
• The LUDO activity was well received by the EM residents, who requested to repeat the same format for other modules as well. Participants shared their feedback that this activity offers them a unique educational experience with a team-based approach.
• Game dynamics can be altered by adjusting the complexity of the case and related questions, but any adjustments should align with the intended learning outcome. To conform to the principles of gamification, it is important that the core principles of the game should not be altered much.

Theory behind the innovation

This activity incorporated gamification and competition-based learning theory to create a positive, impactful educational experience for learners. Teaming participants in small groups facilitates collaboration and development of new knowledge through a social constructivist approach.

Figure 5: Happy faces at the completion of LUDO (left) and the winning group – Team Green (right)

Led by series editor, Dr. Mary Haas, the IDEA series showcases examples of what programs worldwide have been doing to make residency conference more entertaining, engaging, and most of all, educational for residents. Read more publications from the series.

References