A randomized, controlled trial of team-based competition to increase learner participation in quality-improvement education

Charles D Scales Jr; Tannaz Moin; Arlene Fink; Sandra H Berry; Nasim Afsar-Manesh; Carol M Mangione; B Price Kerfoot

doi:10.1093/intqhc/mzw008

A randomized, controlled trial of team-based competition to increase learner participation in quality-improvement education

Int J Qual Health Care. 2016 Apr;28(2):227-32. doi: 10.1093/intqhc/mzw008. Epub 2016 Feb 7.

Authors

Charles D Scales Jr¹, Tannaz Moin², Arlene Fink³, Sandra H Berry⁴, Nasim Afsar-Manesh⁵, Carol M Mangione³, B Price Kerfoot⁶

Affiliations

¹ Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholars Program, University of California, Los Angeles, CA, USA Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA Present address: Duke Clinical Research Institute and Division of Urologic Surgery, Duke University School of Medicine, Durham, NC, USA.
² Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA HSR&D Center of Excellence for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
³ Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholars Program, University of California, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
⁴ RAND Corporation, Santa Monica, CA, USA.
⁵ Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
⁶ Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, USA.

PMID: 26857941
DOI: 10.1093/intqhc/mzw008

Abstract

Objective: Several barriers challenge resident engagement in learning quality improvement (QI). We investigated whether the incorporation of team-based game mechanics into an evidence-based online learning platform could increase resident participation in a QI curriculum.

Design: Randomized, controlled trial.

Setting: Tertiary-care medical center residency training programs.

Participants: Resident physicians (n = 422) from nine training programs (anesthesia, emergency medicine, family medicine, internal medicine, ophthalmology, orthopedics, pediatrics, psychiatry and general surgery) randomly allocated to a team competition environment (n = 200) or the control group (n = 222).

Intervention: Specialty-based team assignment with leaderboards to foster competition, and alias assignment to de-identify individual participants.

Main outcome measures: Participation in online learning, as measured by percentage of questions attempted (primary outcome) and additional secondary measures of engagement (i.e. response time). Changes in participation measures over time between groups were assessed with a repeated measures ANOVA framework.

Results: Residents in the intervention arm demonstrated greater participation than the control group. The percentage of questions attempted at least once was greater in the competition group (79% [SD ± 32] versus control, 68% [SD ± 37], P= 0.03). Median response time was faster in the competition group (P= 0.006). Differences in participation continued to increase over the duration of the intervention, as measured by average response time and cumulative percent of questions attempted (each P< 0.001).

Conclusions: Team competition increases resident participation in an online course delivering QI content. Medical educators should consider game mechanics to optimize participation when designing learning experiences.

Keywords: graduate medical education; quality improvement; randomized controlled trial; spaced education.

Published by Oxford University Press in association with the International Society for Quality in Health Care 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Publication types

Randomized Controlled Trial

MeSH terms

Competitive Behavior
Education, Medical, Continuing / methods*
Education, Medical, Continuing / organization & administration
Female
Humans
Internship and Residency
Male
Patient Care Team / organization & administration
Patient Care Team / standards
Quality Improvement* / organization & administration
Quality Improvement* / standards