Gamifying Virtual Patients to Support Military Trauma Training

Introduction: Virtual patients (VPs) have the potential to support military medicine training. Gamification is at least as effective as traditional educational methods and is often more effective for improving knowledge, skills, and satisfaction in health professions education. In military trauma care, where medics must make both medical and tactical decisions, gamified VPs can offer active learning opportunities to better prepare them for providing medical care in austere environments. Despite the potential of VPs to improve military medical training, studies exploring the integration of gamification into VP design are limited. This study aimed to understand the reasoning and perceptions of Swedish military medics when interacting with VPs, offering insights and recommendations for designing VPs with game elements to support decision-making. Methods: Fourteen military medics from the Swedish Home Guard-National Security Forces participated in a tactical combat care course, engaging with three VP cases simulating military trauma scenarios. Data were collected through think-aloud sessions and semi-structured interviews. The participants’ reasoning processes and perceptions were analyzed using interaction analysis, along with reflexive thematic analysis. A second round of coding identified game elements that could enhance the VP design. Results: Our analysis indicated that mistakes in VP decisions, followed by feedback, facilitated the military medics’ reflection. The thematic analysis revealed six themes: motivation (“keep on trying”); agency in interaction with VPs; realistic tactical experience; confidence (“I know that the knowledge I have works”); social influence on motivation; and personalized learning. Game elements such as scoring, badges, progress bars, challenges, avatars, and leaderboards were suggested to make the learning experience more enjoyable and increase medics’ confidence. Conclusion: Overall, the VPs were positively received. Gamification in VP design appears to be a promising approach for military trauma training, encouraging the inclusion of game elements as well as consequences for wrong decisions to support military medics’ training.