A Systematic Review of Serious Games in Training Health Care Professionals Ryan Wang, BA; Samuel DeMaria, Jr, MD; Andrew Goldberg, MD; Daniel Katz, MD Summary Statement: Serious games are computer-based games designed for training purposes. They are poised to expand their role in medical education. This systematic review, conducted in accordance with PRISMA guidelines, aimed to synthesize current serious gaming trends in health care training, especially those pertaining to develop- mental methodologies and game evaluation. PubMed, EMBASE, and Cochrane data- bases were queried for relevant documents published through December 2014. Of the 3737 publications identified, 48 of them, covering 42 serious games, were in- cluded. From 2007 to 2014, they demonstrate a growth from 2 games and 2 genres to 42 games and 8 genres. Overall, study design was heterogeneous and methodological quality by MERQSI score averaged 10.5/18, which is modest. Seventy-nine percent of serious games were evaluated for training outcomes. As the number of serious games for health care training continues to grow, having schemas that organize how educators approach their development and evaluation is essential for their success. (Sim Healthcare 11:41Y51, 2016) Key Words: Medical education, Health care training, Serious game, Simulation, Review. The motivating factors behind the incorporation of simu- lation into medical education have been well described. 1Y3 Features of simulation that lead to effective learning, such as providing standardized, repeated practice as well as specific feedback, were identified and analyzed in systematic reviews by Issenberg et al. 4 and Cook et al. 5 The use of simulation in medical education was associated with positive results in the acquisition of knowledge and skills and in patient out- comes by separate meta-analyses. 6,7 Although these benefits have been well documented and significant, the expensive human resources required to deliver mannequin or stan- dardized patient-based simulation and their availability with respect to busy trainee schedules 8 have led some to wonder what the next steps should be regarding what ‘‘simulation’’ is taken to mean in medical education and whether such resource-intensive modalities are needed. 9,10 For this reason, serious gaming, which falls under the umbrella of simulation, is poised to take on a greater role in health care training. Bergeron 11 defines serious games as ‘‘interactive computer applications, with or without signif- icant hardware components,’’ created for the purpose of imparting knowledge or skills, and which incorporate an element of scoring as well as challenging goals and engaging design. From conveying the sociopolitical forces underlying the American Revolution to helicopter pilot training, serious games have been used effectively as educational tools in a wide range of disciplines. 12,13 Graafland et al 14 have published 2 instructive studies on serious gaming in medical training. One develops and com- municates a framework for assessing medical serious games, those directed at either providers or recipients of health care, from an end-user perspective. This work presents a tool to address an important challenge to the use of serious games, namely, the lack of a structured understanding of a serious game’s purpose and effectiveness as well as attendant risks and benefits. The evaluation tool builds on their earlier sys- tematic review, which surveys serious games in medical edu- cation and organizes them by adherence to medical education assessment criteria. 15 The utility of an updated systematic review is supported by a number of factors. First, the inter- vening years allow us to quantify the assertion that serious gaming in medical education is a growing field. 14,16 Second, a survey of the current array of training goals, game genres used, and developmental approaches can guide the production of additional games. Third, serious games have been evaluated according to a range of outcomes; holistic quality assessment of study methodologies facilitates the identification of high- quality studies across the different outcomes. Thus, the objec- tives of this systematic review were to aggregate the available articles on serious games designed for health care professionals, investigate the developmental processes implemented, identify a number of effective games, and assess the evaluation meth- odologies used. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews Review Article Vol. 11, Number 1, February 2016 41 From the Icahn School of Medicine at Mount Sinai, New York, NY. Reprints: Ryan Wang, c/o Daniel Katz, KCC 8th Floor, One Gustave L Levy Place, Box 1010, New York, NY 10029 (e<mail: ryan.wang@mssm.edu). The authors of this study have no conflicts of interest to disclose. Drs DeMaria, Goldberg, and Katz are employed by the Mount Sinai Hospital System. This work should be attributed to the Department of Anesthesiology of the Icahn School of Medicine at Mount Sinai. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.simulationinhealthcare.com). Copyright * 2015 Society for Simulation in Healthcare DOI: 10.1097/SIH.0000000000000118 Copyright © 2016 by the Society for Simulation in Healthcare. Unauthorized reproduction of this article is prohibited.