Gamification of robotic simulation to train general surgery residents

Gamification applies game design elements to non-game contexts in order to engage participation and increase learner motivation. Robotic surgery is gaining popularity in general surgery but requires specialized technical skills. We sought to determine whether gamification of robotic simulation training could increase robotic simulator utilization among general surgery residents. General surgery residents were recruited and sent weekly progress on simulator performance including leaderboards for 4 weeks during the intervention periods. There were also two control periods setup in an ABAB study design. Usage time and mean scores were compared between the control periods and intervention periods. A post-study qualitative assessment interview using semi-structured interviews determined barriers and motivational components of simulator usage. Fifteen general surgery residents enrolled in the study (n = 15). Intervention increased total simulator usage time 9.7-fold from 153 to 1485 min. Total simulator days increased threefold from 9 to 27 days. Resident participation increased from 33 to 53%. Median average scores were higher during the intervention periods (58.8 and 81.9 vs 44.0). During the first intervention period, median individual-level simulator usage time increased 17 min (P = 0.03). However, there was no individual-level increase in median usage minutes or days during the second intervention period. Qualitative assessment determined barriers to be limited time due to clinical duties, and simulator availability while motivational factors included competitive factors such as leaderboards and gaming aspects. Potential improvements were increasing attending visibility of scores to increase recognition of progress by the residents and creating dedicated time for training. Gamification of robotic simulation training increased general surgery resident participation, usage time and scores. Impact was not durable. Instituting dedicated practice time and more attending engagement may increase trainee motivation and performance.