Games for learning, sometimes referred to as “Serious Games,” are becoming increasingly popular at all graduate medical education training levels. Some of the noted virtues are that they help engage and challenge learners, address complexities, and provide ongoing feedback. Furthermore, they add an element of “fun” that is likely to grow into a motivational force. To help educate faculty about the large variety of possible games, we developed a card game that highlights the pros and cons of each modality and provides an opportunity to match specific games with specific curriculum development challenges. The challenges are organized by the 6 Accreditation Council for Graduate Medical Education (ACGME) Core Competencies and are presented in the form of brief scenarios. The types of games offered as potential solutions were derived from various references, websites, and conference presentations. Their selection followed an iterative process. The inspiration for the game came from Simpson and colleagues' “From Madness to Methods” faculty development exercise (

“Games Squared” consists of 36 cards in total. Eight of them are Problem Cards, 6 of which are based on the ACGME Core Competencies (eg, to illustrate a Professionalism Education Problem, learners take on the role of a hospital academic affairs leader to address an ongoing concern about professionalism in team settings). Two additional Problem Cards are “wild,” allowing learners to introduce their personal curriculum concerns. The remaining 28 cards are Solution Cards that describe different serious game or gamification options, such as audience response trivia, board games, virtual patient, or video games. Each solution card consists of a brief description and bullet points for pros and cons. The Solution Card set also includes 6 wild cards to spur faculty's creativity and help expand their toolbox beyond the cards provided. The game requires 2 to 4 players to fully benefit from this learning opportunity.

To play, the Problem Cards are placed in the middle and each player gets 5 to 7 Solution Cards. Any leftover Solution Cards are also placed in the middle. The person who starts (can be anyone) picks up a Problem Card, reads it aloud, and places it face up in the middle. Each player then selects one of the Solution Cards from those that were dealt and attempts to convince the rest of the group that their chosen method would best solve the curriculum problem. At the end the group decides the value and usefulness of each solution. To make the game more fun and layer on a team development component, we prepared little bags with chocolates that are divided by the group based on the merit of the solutions offered. The group can decide whether to give all chocolates to one or several players, or whether to divvy them up equally. Once a round is completed, the used Solution Cards are replenished from the stack in the middle, and someone else picks up the next Problem Card. Optimally, the game continues until all cards are reviewed and discussed. The goal of the game is to expand the learner's toolbox of game-based educational strategies, while participating in a metacognitive exercise.

Currently, we have piloted Games Squared at several professional conferences. We also developed an abbreviated version for a webinar on game-based learning. Via online polling, participants can select 1 of 3 solution options for a provided Problem Card (see the figure). Regardless of venue the game has been received positively. Program evaluation comments included, “It has certainly piqued my interest in using games in problem-solving education” and “Although I had fun, there were still deep thoughts that came out of it.” The cards can be downloaded from