(TNS) — In the video game Night Shift 2024, an emergency room physician is trying to solve the mystery of his missing grandfather, while also getting through his hospital shifts diagnosing and triaging patients.

The game is the brainchild of UPMC trauma surgeon Deepika Mohan — part of her continuing quest to teach doctors how to make the best decisions to help patients.

During her fellowship in critical care medicine at the University of Pittsburgh, Mohan would often wonder why certain patients were getting transferred to UPMC Presbyterian from smaller hospitals, and others at greater risk were not.

“You’d just get trauma after trauma after trauma,” she said. “And many of them didn’t need to be here. The people who did need to be here would come by the wrong mode of transport. They’d come by ground instead of being flown. The people who were being flown were people who didn’t really need to be here at all.”

An elderly person with a rib fracture is statistically more likely to die than a young person who has shot themselves in the foot, she said, and yet about 95% of gunshot victims are transferred to trauma centers, versus only about 30% of old people with rib fractures.

Venting to her research mentor one night about the problem, he challenged her to try to understand the thought process that physicians at smaller hospitals were using in deciding which patients to transfer.

That research led her to explore work on decision sciences pioneered by Nobel Prize-winning economists. Those scientists, such as Herbert Simon and Daniel Kahneman, came up with theories on heuristics, or mental shortcuts used to make decisions, and showed that those decisions weren’t always rational.

The problem in medicine, Mohan thought, was that, sometimes, doctors leaned too heavily on a preconceived notion — the severity of gunshot wounds, for example — while failing to recognize less-obvious patterns, such as the many times that an elderly patient with a broken rib has ended up with life-threatening pneumonia.

To change that thought process, Mohan learned about research on the role of storytelling in altering behavior, and also about a video game that had helped older adults improve their cognitive functioning.

With the hypothesis that a video game might be a better way to essentially rewire doctors’ brains than a textbook, she approached Pittsburgh-based video game design company Schell Games to develop Night Shift — the first iteration of the game. It has since been updated to the more robust Night Shift 2024.

“We spend $3.2 billion in continuing medical education in this country and very little of it is evidence based,” she said. “Very little of it is designed specifically to change behavior.”

The video game is not available for widespread use at this time, and has predominantly been used by doctors participating in the study.

Mohan received her first grant for the project a decade ago, in 2015, and began building the video game in 2016. By 2017, she published her first paper on the game’s effectiveness, working with other researchers at Pitt, Carnegie Mellon, Dartmouth and the RAND Corporation.

The study measured how often the physicians in the study “under-triaged” their patients, or failed to send them to a hospital that was appropriate to handle their medical condition.

She found that physicians who played the Night Shift video game under-triaged 53% of the time, compared with 64% for those who read educational materials instead.

Mohan recently finished collecting data on an expanded study involving the video game, with a larger sample size of physicians and a more extensive research question. In her current study, she plans to use Medicare claims to assess the real life medical outcomes in patients treated by physicians who played the game versus a control group of physicians who did not.

Early data from the new study published online last month in the journal JAMA Network Open found that physicians who played the video game were more likely to be willing to transfer patients to higher-level trauma centers.

Convinced of the potential of video games to change decision-making, Mohan is exploring other areas to use them in the medical field. She recently applied for a grant to use video games as modules in a training program to coach physicians. She and a colleague also submitted a grant application for a game that would help older adults with dementia make plans for advanced care.

“One question is, does it work?” she said of the concept of the Night Shift game. “And if it works, how does it work? And is it just the principle that works? Or will it work in other domains?”