Summer 2024 Issue

Education: The Gamification of Coder Education
By Elizabeth S. Goar
For The Record
Vol. 36 No. 3 P. 6

Gamification has entered the educational mainstream, with a growing body of evidence demonstrating its positive impact on student motivation and academic achievement. This extends to medical education, where multiple studies have established its ability to enhance not only future clinicians’ learning but also their collaboration and communication skills.

“Gamification … provides students with hands-on experience in real-world situations, allowing them to learn in a more engaging and fun environment. It also provides students with technology-based experiences they are familiar with and may already use daily,” says Danelle Beale, MPH, CPCA, CBCS, an adjunct professor of medical billing and coding at Cowley College.

Yet despite its growing popularity in clinical education and the mounting evidence of its success at enriching students’ learning and comprehension, gamification’s inroads into medical billing and coding education have been limited.

What Is Gamification?
An important aspect of culture and society, games encourage engagement and motivation, which is why gaming elements—such as challenges, competitions, points, and rewards—are making their way into nongame contexts. In education, gamification is used to trigger students’ competitive nature and desire for achievement and recognition, thereby enhancing the learning process by making it more compelling and enjoyable.

According to researchers in “The Effectiveness of Gamification in Programming Education: Evidence From a Meta-Analysis,” published in Computers and Education: Artificial Intelligence, gamification has the largest impact on motivation and academic achievement. The greatest impact on students’ thinking skills and motivation comes from using games as a competitive mechanism.

“However,” the authors note, “when games were adopted as teaching tools or student works, the effects are mainly represented in academic achievement. Pedagogical agents have a limited effect on programming education. With regard to programming types, the effect of gamification is more pronounced in text-based programming rather than graphical programming.”1

In the context of medical education, gamification involves the use of interactive simulations, quizzes, or virtual patient scenarios to create a more dynamic and engaging learning experience for students. It aims to improve knowledge retention, problem-solving skills, and overall learner motivation by applying principles inspired by the mechanics of games.

In “Gamification in Medical Education: Identifying and Prioritizing Key Elements Through Delphi Method,” in Medical Education Online, researchers determined that the key elements of a successful gamification approach for medical students could be categorized into gamification design principles and game mechanisms. The following are the top five elements:

1. integration with educational objectives;
2. game rules;
3. rapid feedback;
4. fairness; and
5. points/scoring.

Experts interviewed for the study discouraged the use of software, digital platforms, board games. and teaching props as key gamification elements, and instead suggested that applying the key elements and mechanisms of gamification would be sufficient to redesign the curriculum, utilizing educational gamification while enhancing student engagement and motivation.

“Experts emphasized the importance of establishing game rules with learners as the basis for smooth progress, including how to group, how to score, and how the gamification course works, while being careful not to create an unfair or overly competitive environment. They also suggested utilizing team-building exercises and competitions to increase student engagement and reduce fear of failure. This is especially important in medical education, where mistakes can have serious consequences for patients,” researchers explain.

Along with allowing students to learn from their mistakes and improve their skills without fear of failure, the teamwork and collaboration involved with gamified learning teaches students “how to communicate and collaborate effectively with other health care professionals, which is important to the future of medical education,” according to the study’s authors.2

Gamification of Coding Education
Gamification in coding education remains sparse, despite solid—and growing—scientific backing of its efficacy. The precise reason for this remains elusive, although it is likely more about individual educators’ familiarity and personal preferences than it is about concern with its effectiveness.

“I would imagine that the only reason that we aren’t seeing gaming in the coding classrooms is because the instructor may just not know how to implement them. It can be challenging if the instructors don’t buy into the concept. You may have some instructors that are set in their ways of straightforward lecturing,” says Rose Farhat, Keiser University’s medical billing, coding, and medical assisting department chair.

“However, with the upcoming student population that we see, it’s easy to lose their attention without some sort of excitement,” she adds. “Many of these students grew up with technology—phones, computers, internet. They need to be engaged in a variety of ways.”

Which is why we are seeing some limited gamification in the field. For example, Kahoot!, which is a game-based learning platform; Student Feud, which is styled after the game show Family Feud; and Jenga, where the student must pull a log when they answer incorrectly.

“And then there are board games that can be made and played,” Farhat says. “The nice thing about homemade board games is that there are never any hard-set rules. Students can come up with their own. We even have an instructor on our campus that created an “Amazing Race” game for her [Associate of Science in Nursing] students.”

She also notes that there are more benefits to gamification in coding education than there are drawbacks, in particular the soft skills students gain from gaming.

“They learn to work as a team, communicate effectively, and build confidence together. Problem solving is also a huge benefit with many of the games. They retain the material much more so than just reading or hearing it because they are part of it,” Farhat says. “The only drawback that I can think of is that you may have one or two students who don’t see the benefit of playing games to learn. Mostly, the older generation.”

Beale points to several gamification models now used in medical billing and coding education. Exam and homework questions “are based on real-world patient note examples, along with medical coding textbook publishers using electronic coding and billing software to incorporate technology-enhanced active learning in conjunction with the textbooks,” she says.

Meanwhile, AAPC chief product officer Raemarie Jimenez, CPC, CDEO, CIC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, notes that while gamification remains on the periphery of coding education, she does expect it to start playing a more prominent role.

“I think that gamification helps with motivating adult learners,” she says. “We have not yet seen gamification for education delivery, but we are seeing [it] more [as] coders stacking or adding additional credentials.”

“I think that gamification helps with motivating adult learners,” she says. “I expect to see more gamification through badging and micro-credentialing [as] more coders stack or add additional credentials in order to set themselves apart or demonstrate competencies” in such areas as auditing and risk adjustment coding and in specialties such as emergency medicine, cardiology, and orthopedics.

AAPC is also developing a product that will leverage some aspects of gamification to measure a coder’s competencies, allow them to achieve different levels of proficiency, and rank them against their peers. Microlearning units will be recommended to close any skill gaps identified in the assessment.

Benefits Outweigh Drawbacks
In general, Jimenez says, gamification “helps keep the learner engaged, makes learning fun, [and] breaks up the monotony of traditional education.”

However, she adds, “If not done well, it could lose its impact and learners could develop fatigue. If it is made too easy to attain, they won’t see value in it. If you make it too difficult, they will lose interest.”

The reality that “not everyone is technologically adept” also comes into play when it comes to greater gamification in educating medical coders. That means learning curricula must necessarily include other learning models to maintain versatility, Beale says.

Too, some students may require additional training to learn how to use gamification software and enhanced learning materials most effectively. Further, the need for frequent software and technology updates to ensure they remain useful can be disruptive and costly, she adds.

Despite these drawbacks, Beale predicts gamification will rapidly gain favor within coding and billing education due to its documented benefits for learning.

“We are in a fast-paced, technologically advanced era where students can become more engaged with real-world scenarios while learning the material needed in their field of study,” she says. “As time progresses, I believe we will see gamification models used more frequently [in coding] and in other areas of learning.”

— Elizabeth S. Goar is a freelance health care writer in Wisconsin.

 

References
1. Zhan Z, He L, Tong Y, Liang X, Guo S, Lan X. The effectiveness of gamification in programming education: evidence from a meta-analysis. Comput Educ Artif Intell. 2022;3:100096.

2. Wang YF, Hsu YF, Fang KT, Kuo LT. Gamification in medical education: identifying and prioritizing key elements through Delphi method. Med Educ Online. 2024;29(1):2302231.