USU Medical Students Experience Healthcare Complexity Through Interactive Gameplay

The Preventive Medicine and Biostatistics department at the Uniformed Services University introduced Friday Night at the ERⓇ, a systems thinking board game, to the medical class of 2028 to help students understand the interconnectedness of the Military Healthcare System. 

“Unexpected things happen all the time in life,” says Baldovich “and this game is no different.” Baldovich and Hawks, co-course directors of the Leadership Health Systems at USU introduced Friday Night at the ERⓇ, a systems thinking board game, to the incoming medical class of 2028. Through gameplay, students gained understanding of the interconnectedness of the Military Healthcare System. (Photo credit Tom Balfour).
“Unexpected things happen all the time in life,” says Baldovich “and this game is
no different.” Baldovich and Hawks, co-course directors of the Leadership Health
Systems at USU introduced Friday Night at the ERⓇ, a systems thinking board
game, to the incoming medical class of 2028. Through gameplay, students gained
understanding of the interconnectedness of the Military Healthcare System.
(Photo credit Tom Balfour)

November 7, 2024 by Hadiyah Brendel

The Preventive Medicine and Biostatistics (PMB) department at the Uniformed Services University (USU) has taken an innovative approach to teaching systems thinking by incorporating the board game Friday Night at the ER® into its medical curriculum. 

Aimed at the medical school class of 2028, the department’s Leadership in Health Systems (LHS) course directors, Navy Cmdr. (Dr.) Beth Hawks and Air Force Col. (Dr.) Kevin Baldovich,  and the Military Medicine 100 course faculty, selected this experiential learning tool as part of a broader, more creative effort by the PMB department to enhance understanding of complex healthcare dynamics and the interconnectedness within the Military Health System (MHS).

The simulation game challenges teams of four to manage a busy hospital during a 24-hour period. Players manage one of four departments–emergency, surgery, intensive care unit, and the step-down unit—as they navigate patient admissions, discharges, and transfers. Spikes in demand, limited resources, and other scenarios emphasize the importance of teamwork and adaptability. By presenting these realistic healthcare scenarios, it encourages students to think strategically, collaborate effectively, and understand the interconnectedness of different roles within complex systems. 

Health Systems Science (HSS) is one of the three pillars of medical education at USU, along with the traditional pillars of Basic Science and Clinical Science. HSS focuses on how healthcare is delivered, how healthcare professionals collaborate, and how to improve the system. Systems thinking bridges these domains, emphasizing a holistic approach to the complexity of healthcare. (Photo credit Tom Balfour)
Health Systems Science (HSS) is one of the three pillars of medical education at USU,
along with the traditional pillars of Basic Science and Clinical Science. HSS focuses on
how healthcare is delivered, how healthcare professionals collaborate, and how to improve
the system. Systems thinking bridges these domains, emphasizing a holistic approach to
the complexity of healthcare. (Photo credit Tom Balfour)

The PMB department chose to use the game to introduce new medical students to the concept of systems thinking from day one of their education. Faculty members underwent formal facilitator training from the game’s creators and invested in additional game resources to make the activity a lasting component of the curriculum. This integration is a key part of USU’s focus on Health Systems Science (HSS), one of the three foundational pillars alongside Basic and Clinical Sciences, which collectively equip students with the skills to improve healthcare delivery and patient outcomes. 

Systems thinking is a philosophical approach that emphasizes understanding the interconnected components of a system, such as the healthcare system, and how they influence outcomes. By seeking to understand the big picture, such as observing patterns and trends, changing perspectives, and making meaningful connections, healthcare professionals can navigate the complexities of the healthcare system and positively influence patient outcomes. 

Systems thinking isn’t unique to healthcare, but it is a valuable skill for any complex organization. Reflecting on how systems thinking can enhance decision-making in clinical settings, Baldovich, vice chair for Medical Education in PMB, says, “Unexpected things happen all the time in life,” and adds, “this game is no different.”

Baldovich continues, “in order to provide truly patient-centered care, healthcare professionals need to look beyond a discreet clinical encounter and completely view their patients and all of the systems of which they are a part.”

Health Systems Science (HSS) is one of the three pillars of medical education at USU, along with the traditional pillars of Basic Science and Clinical Science. HSS focuses on how healthcare is delivered, how healthcare professionals collaborate, and how to improve the system. Systems thinking bridges these domains, emphasizing a holistic approach to the complexity of healthcare.

“It is not always as simple as you have diagnosis X and are prescribed medication Y to get the desired outcome – healthcare is complex,” Baldovich continues. 

His words echo the American Medical Association who classify health professionals as having “two jobs: delivering high-value care to patients and improving the processes and outcomes of care. Systems thinking is needed to make these improvements.”

Student feedback was overwhelmingly positive, says Hawks. Many found the game an “insightful and entertaining” introduction to systems thinking, others were “excited about the LHS curriculum” and even commented that the game “shows how progressive and invested USU is in preparing us to be problem-solving physicians.” (Photo credit Tom Balfour)
Student feedback was overwhelmingly positive, says Hawks. Many found the
game an “insightful and entertaining” introduction to systems thinking, others
were “excited about the LHS curriculum” and even commented that the game
“shows how progressive and invested USU is in preparing us to be
problem-solving physicians.” (Photo credit Tom Balfour)

With plans to expand this experiential learning strategy to other graduate programs, the PMB department is leading the way in integrating practical systems thinking training into healthcare education, reflecting USU's dedication to cultivating skilled, adaptable, and systems-minded medical professionals.  

Prior to the one-hour gameplay, students receive a brief introduction to LHS, HSS, and systems thinking. After playing, teams are scored based on the financial, quality, and efficiency outcomes. Faculty then facilitate a debrief discussion that explores the effects of students’ decisions. 

Student feedback was overwhelmingly positive, says Hawks. Many found the game an “insightful and entertaining” introduction to systems thinking, others were “excited about the LHS curriculum” and even commented that the game “shows how progressive and invested USU is in preparing us to be problem-solving physicians.” 

The game was previously used in USU’s Master of Health Administration and Policy degree program to apply data-driven decision making. LHS plans on utilizing the game not only with medical students, but integrating the approach into other graduate courses within the School of Medicine and the Graduate School of Nursing. 

By incorporating it into their curriculum, educators at USU are able to “get at experiential learning and [the gameplay] is reflective of the military health systems where we work with others at a moment’s notice and are expected to solve problems or operate as a high performing team to project medical power,” says Baldovich.