Web-based game tests doctors' knowledge of sepsis

Jacob had a fever and his health was deteriorating quickly when he was admitted to the hospital. If left untreated, the 27-year-old would have died within two minutes of severe sepsis.

Fortunately for Jacob, however, a doctor could cure him just as quickly — and with only a few clicks of a button.

Playing Septris is free, and the game is available online. Doctors can take a post-game test to earn CME credits for a standard $20 fee. Septris runs best on iPad/iPhone or Android. On a desktop computer, it requires a Firefox, Google Chrome or Apple Safari browser.

Jacob is not a real person. He is a character in Septris, a Web-based medical game developed by physicians at Stanford University School of Medicine in California and released late last year. The game's goal is to offer doctors an engaging way to test their sepsis knowledge and improve their treatment of patients with the condition.

Septris can be played on a computer, mobile phone or tablet.

“This is a more versatile way of learning,” said Lisa Shieh, MD, PhD, co-creator of the game and a clinical associate professor of medicine at Stanford. “It's great to have a lecture, but you have to physically be there and oftentimes it's passive. We wanted to create something that was interactive and that you can do at any time.”

Septris is modeled after the popular computer and video game Tetris, which was released in the U.S. in 1987. In Tetris, players try to arrange falling puzzle pieces into a horizontal line of 10 blocks without gaps along the bottom of the screen.

Septris features cartoon images of two patients who sink down the screen with every passing second as their vital signs deteriorate. When players make a good medical decision, such as administering the proper antibiotic, the patient's image rises on the screen as his or her health improves.

Dr. Sepsis, a grinning character with tousled brown hair, also pops up on the screen and offers praise when players make a good treatment choice.

The game features a cartoon Dr. Sepsis who tells players, "Good job!" when they make a proper treatment choice.

“Good job!” one such compliment begins. “Appropriate antibiotic therapy for necrotizing fasciitis includes coverage for MRSA, gram negatives and anaerobes.”

The game's objective is not just to keep patients alive, but to cure them.

Playing Septris is free to try. If a physician wants to take a postgame test to earn continuing medical education credits, there is a $20 fee.

“Sepsis is a big concern nationwide because it's a very common diagnosis that our patients have, and it's really deadly,” Dr. Shieh said.

Identifying sepsis

Every year, about 750,000 Americans develop severe sepsis and as many as half die due to the condition, according to the National Institute of General Medical Sciences. In severe cases, at least one organ fails, according to the institute, which supports research that advances disease diagnosis, treatment and prevention.

Common sepsis symptoms include fever, chills, rapid breathing and heart rate, rash and confusion. Many of these symptoms, however, mimic those of other conditions, which can make sepsis difficult to diagnose in its early stages, the institute says.

That is one reason why it is critical that primary care physicians feel comfortable identifying the condition and starting treatment for it, Dr. Shieh said.

“It's really important that they just recognize sepsis and things you can do early like give antibiotics and then transfer the individual to the hospital,” where he or she can be monitored closely, she said.

Dr. Shieh and colleagues involved with developing Septris recommend that physicians play the game at least once because it provides an opportunity to practice identifying and treating sepsis. In the game, patients who die come back to life with the same symptoms, giving doctors an endless number of chances to save lives.

“Players had to be allowed to fail, but also to have a chance to fix their mistakes,” said Jamie Tsui, an instructional technologist in the medical school's Office of Information Resources and Technology.

Some people have raised concerns about using a game to teach such a serious subject, said the team that developed Septris. But the Stanford doctors say Septris is like other Web-based tools being used to train physicians at medical schools across the country.

“What you're talking about are ways to activate a learner's mind to engage and connect. You're trying to mimic the cognitive pressures and drilling around the application of concepts to clinical problems,” said Clarence Braddock, MD, MPH, professor of medicine and associate dean for medical education at Stanford.

During the summer, Dr. Shieh and her colleagues plan to study the game's effectiveness compared with more traditional training methods such as lectures. In the meantime, they want to get more people to play the game (link).

We're “teaching doctors about sepsis, but in a more fun and engaging way,” she said.