Journal of Education and Teaching in Emergency Medicine

Audience: The target audience includes individuals involved in the education and training of emergency medicine (EM) residents, such as program directors, assistant program directors, core faculty, and academic attendings, as well as learners including residents, physician assistant (PA) fellows, and medical students (MS).

Introduction: Gamification has increasingly been incorporated into emergency medicine (EM) residency education to enhance learner engagement, motivation, and active participation. Prior studies have demonstrated benefits of game-based learning across multiple areas of medical education, including improved knowledge retention, teamwork, communication, and learner satisfaction.^1-4 However, most gamification interventions in EM involve isolated activities rather than comprehensive, multi-station conference curricula. To address this gap, we developed a casino-themed, multi-station educational conference designed to reinforce core EM knowledge, procedural skills, and clinical reasoning through competitive, team-based learning. The intervention incorporated simulation, rapid-response scenarios, board-style trivia, and wagering poker chips during a protected half-day residency conference. 

Educational Objectives: By the end of this educational intervention, participants will be able to: 1) demonstrate airway management skills through simulation, including equipment setup and timely interventions for both adult and pediatric cases, 2) interpret various electrocardiograms (EKGs) in high-pressure scenarios, 3) analyze cases and apply evidence-based management in various rapid-response scenarios, 4) demonstrate rapid recall of EM knowledge by answering board-style trivia questions, and 5) demonstrate increased confidence in team-based decision-making, effective communication under pressure, and leadership in high-stress emergency situations.

Educational Methods: This prospective educational innovation was delivered as a single, four-hour casino-themed EM conference session featuring interactive stations modeled after casino games and held during the residency program’s weekly Wednesday educational conference. The session featured interactive, competition-based stations designed to replicate high-pressure ED scenarios. Learners rotated through four game-based stations: “Play Your Cards Right” for rapid-recall trivia using EM board-style questions, “Diagnostic Craps” for EKG interpretation and management, “High Stakes Airways” for hands-on airway management using mannequins and rapid sequence intubation scenarios, and “Rapid Response Roulette” for discussion of ED cases focusing on team dynamics, leadership, resuscitation, and escalation of care. The games were designed to reflect real-world ED challenges, with content and expectations tailored to postgraduate years (PGY) levels. Participants wagered poker chips based on confidence in their responses, reinforcing self-assessment and accountability. This method encouraged active participation, peer-to-peer learning, and application of clinical reasoning in high-pressure scenarios.

Research Methods: The casino-style conference featured six tables each with an EM attending facilitator. Participants included EM residents, physician assistant (PA) fellows, and medical students. Learners started with 15 poker chips and engaged in four game-based sessions over four hours. The games “Play Your Cards Right,” “High Stakes Airways,” “Diagnostic Craps,” and “Rapid Response Roulette” incorporated either case-based simulation, procedural skill stations, rapid decision-making, EKG interpretation, and/or evidence-based medicine (EBM) trivia. Learners wagered chips based on confidence, with gains/losses tied to performance. Faculty provided real- time feedback and facilitated discussions. Pre- and post- conference surveys (Appendix A) assessed educational value, skill improvement, confidence, and clinical applicability. Instructors also evaluated feasibility and effectiveness. The study was Institutional Review Board exempt.

Results: Of the 33 learners who attended the conference, 32 completed surveys (97% response rate) including 26 EM residents (10 PGY-1, 8 PGY-2 and 8 PGY-3), 4 medical students, and 2 physician assistants. One hundred percent of participants answered “yes” when asked if they would recommend this type of conference to peers and 100% preferred this learning style to traditional didactics. Eighty-eight percent of the respondents reported they are “very likely” to incorporate skills learned from this activity into future practice.

Facilitators rated the game-based learning activities as highly effective teaching tools, with 92% rating 4 or 5 (on a 5-point scale). Facilitators were also asked if they found the games easy to implement, and 83% answered rating a 4 or a 5 (on a 5-point scale). Responses derived from the open-ended questions emphasize the conference’s effectiveness in engaging participants, providing meaningful learning experiences and fostering a positive and well-organized environment.  

Discussion: This casino-style, game-based learning conference was highly rated for both educational value and engagement. Participants reported increased confidence in managing emergency scenarios, particularly in EKG interpretation and team-based critical decision-making. The format was viewed as feasible and effective, with most participants preferring game-based learning over traditional didactics, supporting its continued use in EM education.