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Objective:
Gamification is the application of gaming elements in a nongame context. It has been shown to improve motivation and performance and increase short-term and long-term knowledge retention. Gaming is an engaging method for learners to apply knowledge. Millennial and Generation Z learners are the largest percentage of students in graduate medical education. Gamification is a method they are comfortable with and may enjoy. Kaizen Education, a gamified learning software, is one example of how gaming elements can be integrated into radiology education. Kaizen administers multiple choice questions and incorporates gaming elements to increase learner engagement. We hypothesize that gamification will increase engagement and result in positive feedback.

Materials and Methods:
This is an IRB-approved prospective cohort study evaluating the impact of a month-long optional app-based game involving learning outcomes and engagement among diagnostic radiology residents at a tertiary care academic radiology program in the southeast. Resident ”families,” made up of a resident from each class, were used as teams for the game. Questions were created by radiology attendings from body, breast, neuroradiology, emergency, musculoskeletal, nuclear medicine, and cardiopulmonary/chest. Questions were then reviewed by a radiologist experienced in radiology education. Informed consent was acquired from all participants. Questions were delivered by Kaizen’s secure online app. Data analytics were performed on player and question answers (points earned per team/player, correct answers, time to answer, correct/incorrect answers), awards given (correct answers in a row, consistently answered questions, preset point-levels reached). A validated Likert survey was administered at the conclusion of the study to assess participant engagement, motivation, clinical and board preparation, satisfaction, and likelihood to play again.

Results:
Survey participants were 1st-year(1/12, 8.3%), 2nd-year(3/12, 25%), 3rd-year(1/12, 8.3%), and 4th-year (7/12, 58.3%) residents. Most (9/12, 75%) enjoyed the game and (10/12, 83.3%) would participate again. Team collaboration and question feedback significantly increased motivation for most. Most participants felt the game enhanced their radiology knowledge and was beneficial for daily work and core preparation. Many rarely accessed the game's linked resources (Twitter links, podcasts). Core exam preparation was the top motivator, while competition ranked lower. Team spirit and question diversity were positive features, and recommendations were to diversify question difficulty and fix website issues. Game data analytics will be assessed as the second phase of this study, and data is forthcoming.

Conclusion:
Gamification is an educational tool that may better target the expectations of younger generations. The radiology Kaizen game appears to be well-received among residents with positive feedback on content, design, and perceived educational benefits. The gamification elements, especially Twitter updates and question feedback, seem to play a pivotal role in maintaining engagement and motivation.