The House Cup: Using Longitudinal Gamification to Improve Didactic Attendance

Abstract

OBJECTIVE Determine if a point-based attendance system combined with longitudinal gamification is feasible and improves didactic session attendance and learner perceptions at our internal medicine residency. METHODS A prospective before–after cohort study. Weekly attendance was tracked from June 2022 through April 2023 at our university-affiliated internal medicine residency program. We implemented a point-based longitudinal game incentivizing residents to attend didactics with positive reinforcement in July 2022 (C: carrot). We added tiered positive reinforcement and positive punishment to the game in January 2023 (CS: carrot and stick). Attendance during these periods was compared to pre (P) and postintervention (S). Perceptions were assessed during the P, C, and CS periods with Likert scale ratings. RESULTS CS was associated with higher attendance than other study periods ( P = .002). Median attendance was P—51% (IQR 37.5-64.5), C—65% (IQR 50-74), CS—81% (IQR 78-94), and S—66% (IQR 63-71). Perceptions were similar during pre and intervention study periods, including perceptions of camaraderie (P—4.4, C—4.4, CS—4.5; P = .56), interest in attending didactic sessions (P—3.7, C—3.4, CS—3.2; P = .21), and mandate as the primary reason for attending didactics (P—3.1, C—3.1, CS—3.2; P = .96) CONCLUSIONS A point-based attendance system combined with a longitudinal game that included tiered positive reinforcement and positive punishment was feasible and associated with higher didactic attendance but not associated with changes in resident perceptions.