Monday, September 14, 2015

This game is frequently used in medical education settings to poor effect.

What is "Jeopardy!"?

Confession time: I despise presentations that involve the use of a PowerPoint Jeopardy! game. To be clear, I get uncomfortable when any game-like activity appears in a medical teaching presentation.

Not that I don't think games can have an important role in education - far from it. Heck, I once worked on a presentation that turned our residency conference room into a giant Game of Life board with the residents as life-sized game pieces. It seems to me, though, that most of the time teachers insert games into their presentations just to do it ("They're games! They're fun!") and not after careful thought about using games as an instructional strategy to further their educational goals. Because, at the end of the day, that's what games should be when we use them to teach - a deliberately chosen instructional activity designed to reinforce knowledge and/or skills.

When we did that Game of Life board, for example, it was part of a longitudinal series we created as faculty development fellows on "The New Health Care System."* In preceding sessions, we had taught the residents about different types of practice models, staffing ratios, and even the debate about whether to invest in an electronic health record.** For the game session, the residents had to make a series of decisions about how they wanted to build their "practice," all the while encountering occasional calamities and successes, just like in the original Game of Life.

We used our modified Game of Life to reinforce previously taught concepts; participants had the opportunity to practice knowledge and skills that they had already received. Most of the time, this sequence - first provide new knowledge, then reinforce new knowledge - is the right way to structure interactive presentations. Provide your audience with new knowledge and/or skills, and then let them practice.

The problem with Jeopardy!, most of the time, is that the audience is not provided with the relevant knowledge being tested beforehand. I would have no quibble with PowerPoint Jeopardy! presentations if they followed other presentations providing the knowledge to be reinforced first, but usually that's not what happens. My observations are that medical teachers, instead, use Jeopardy! as a tool to teach new knowledge. I've been told that "the residents can learn from each other when they're wrong" and this game will "reinforce what they already know." Unfortunately, most learners will not learn effectively in this environment.


1. Most people learn best in low-stress, emotionally safe environments. One emotionally unsafe example is "pimping;" most personality types experience a high level of anxiety related to the potential embarrassment of answering "pimp" questions incorrectly. Medical Jeopardy! presents the same risk; while a few residents and students will thrive in this competitive environment, most will internally cringe at the risk of revealing their perceived ignorance. Anxious, uncomfortable individuals do not retain new knowledge as well as calm individuals.

2. Jeopardy! often involves a vast amount of information that may be only loosely related. Most learners will only walk away from an educational session remembering 3-4 key concepts. A typical Jeopardy! board has 30 squares on it; multiply this by 2 if you've also got "Double Jeopardy!" - and remembering 60 facts after any presentation seems unlikely to me.

3. Most of the time I see Jeopardy! played in teams; that is, with 3-6 residents on a team competing against each other. Having observed several of these sessions over the years, very few audience members get actively engaged in these sessions. It's easy for more anxious, less experienced, and/or more introverted residents and students to take a silent role, and observing instead of participating decreases the educational yield even more.

If the goal of the presentation is to teach (and not just "have fun!"), then games should reinforce new knowledge, not provide it for the first time. Every instructional strategy should intentionally reflect the educational goals of the presentation, and the level of problem-solving inherent in the game should align with the presentation's objectives. The Game of Life, which involves a lot of application and analysis, made sense for teaching about decision-making in new models of office practice. Jeopardy!, which is fundamentally a game of information recall, would work better to reinforce basic knowledge such as antibiotic coverage or musculoskeletal anatomy.

But the key word in that last sentence is "reinforce" - using Jeopardy! to introduce new concepts is a flawed approach that will leave most learners uncomfortable, overwhelmed, and unengaged.

* These concepts preceded the Patient-Centered Medical Home model, so I am definitely dating myself here.
** Again, dating myself. *sigh*