Residents often feel unprepared for independent practice, citing an unfamiliarity with billing as a common cause. Gamification has been well studied as a means to engage learners but not as a way to improve resident knowledge of outpatient billing guidelines.
We delivered a session to incoming PGY 1 residents with a goal of improving billing proficiency. The session included a pretest and posttest questionnaire, a prerecorded PowerPoint lecture, and Billing Bonanza, a game with instructions and rules that used gamification to reinforce billing concepts.
Residents demonstrated improvement in percentage of correctly answered questions from 42% on the pretest to 67% on the posttest, which resulted in a statistically significant increase of 0.24 questions correct.
This session led to improvement in baseline billing knowledge.

Sports injuries have become a real health concern. Particularly noticeable is the increasing number of severe sports injuries among young people. Sports injury (SI) is a multifactorial event where many internal and external, proximal and remote factors play a role in a recursive way, including physical and psychological variables. Accordingly, many voices expressing the need of tackling that and several prevention programs have arisen. Nevertheless, different barriers and limitations prevent a wide extension of well-controlled programs, closely monitored by highly specialized professionals in ordinary sports grass-root organizations. These have helped flourishing different low intensity (LI)-interventions and e-Health apps focusing on both physical warmup, training and fitness, and mental skills aimed at reducing athlete\'s vulnerability to SIs. This kind of intervention usually uses self-administered techniques and/or non-specialized staff that can effectively monitoring the program. In fact, LI-interventions have shown to be effective coping with different health and psychological issues. However, these interventions face an important challenge: the lack of engagement people usually show. The current paper proposes how gamification can contribute to the engagement to such interventions. Based on the mechanics-dynamics-aesthetics framework to analyze game design, the paper suggests a set of guidelines app- and web-LI interventions aimed at preventing SIs should include to foster motivation and reduce attrition.

In health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so.
This study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions.
We used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field.
Our results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions.
Conceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions.

BACKGROUND: Gamification is the use of game elements and techniques in nongaming contexts. The use of gamification in health care is receiving a great deal of attention in both academic research and the industry. However, it can be noticed that many gamification apps in health care do not follow any standardized guidelines.
OBJECTIVE: This research aims to (1) present a set of guidelines based on the validated framework the Wheel of Sukr and (2) assess the guidelines through expert interviews and focus group sessions with developers.
METHODS: Expert interviews (N=6) were conducted to assess the content of the guidelines and that they reflect the Wheel of Sukr. In addition, the guidelines were assessed by developers (N=15) in 5 focus group sessions, where each group had an average of 3 developers.
RESULTS: The guidelines received support from the experts. By the end of the sixth interview, it was determined that a saturation point was reached. Experts agreed that the guidelines accurately reflect the framework the Wheel of Sukr and that developers can potentially use them to create gamified self-management apps for chronic illnesses. Moreover, the guidelines were welcomed by developers who participated in the focus group sessions. They found the guidelines to be clear, useful, and implementable. Also, they were able to suggest many ways of gamifying a nongamified self-management app when they were presented with one.
CONCLUSIONS: The findings suggest that the guidelines introduced in this research are clear, useful, and ready to be implemented for the creation of self-management apps that use the notion of gamification as described in the Wheel of Sukr framework. The guidelines are now ready to be practically tested. Further practical studies of the effectiveness of each element in the guidelines are to be carried out.