Placental Thunder. Abalation Nation. The team names in nursing lecturer Missi Trnka’s maternal health courses are pregnant with puns. 

Her methodology might sound silly but by pitting students against each other in friendly competition, Trnka is reinforcing serious learning on topics like preeclampsia and ectopic pregnancy.

In spring 2019, the School of Nursing instructor began integrating gaming into her undergraduate maternal health courses, a process known as gamification (adding gaming elements to another type of activity).  

Trnka uses a variety of game formats, combining digital and old-school elements. She started with Kahoot! and then adapted new versions of established games, like an online Jeopardy, an interactive HedBanz game, and even a clinical Family Feud. The games supplement and reinforce her traditional lectures and slideshows.

The Classroom Master

The students know in advance about an upcoming game day, but they don’t know the questions, and they can’t play without knowing the material. Trnka separates students into their clinical groups to enhance the camaraderie and build teamworking skills for the future workplace. 

“By putting them in their clinical groups, it breaks up cliques,” she says. “You see the same four or five people always sitting together. They rarely interact with anyone else. Now when I break them up into clinical groups, it gives them that opportunity to get to know somebody else, not just those same four people they always pal around with.” 
Additionally, Trnka makes sure the competitiveness doesn’t overshadow the purpose.

“This is a judgment-free zone,” she says. “This is just for learning. No one is to be belittled or put down because they don't know something or they weren't the highest scoring team.” 

Trnka changed her teaching model to boost student engagement. Though she felt connected with her students, she didn’t feel the same reciprocated. “I wanted somehow to bring them out of their shells,” Trnka says. “I wanted them to talk to me, [to] give me some indication [they] understand at least what I'm saying when I'm lecturing. 
And she recognized that lectures day-after-day failed to get students active in the classroom. “I also saw a few students sleeping in my class. I had to do something to get them up and moving.” 

Games offer an alternative to standard textbook reading and allowed her to focus their learning on the most important concepts within maternal health. She explains, “(The undergraduate nursing program) builds generalist nurses, so there's no reason for me to focus on some of those deep-seeded things they'll never even see on (the national licensure exam). By doing the gaming, instead of having 90% of my class saying, ‘I don't like anything about women's health,’ they can enjoy the game, and they're learning from what they're doing to have fun.”

To prepare her new curriculum, Trnka combed through nearly 200 articles to learn how other nurse educators approach teaching. Trnka found few studies on gamification in nursing education, the oldest being from 2017. But it wasn’t hard for her to find inspiration. Trnka is a gamer herself. 

“I have kids older than most of the kids in my classroom,” she says. “My kids grew up, not only having their video games, but we did family game night. My kids, as adults now with their significant others, we all still get together and do family game nights.” 

Achievement Unlocked

The gamification gamble paid off for Trnka. She says students are scoring higher on their tests, and just as importantly, they’re more involved. “When we use this gaming format, students I've never heard a peep from, they're the first ones popping up with the answers or trying to get their group to have that question,” she says. 

Faculty feedback has been mostly positive, though Trnka has received some skepticism on her gaming for potentially being too lighthearted about the subject matter, a similar opinion in some of her research. But Trnka stands by her results. “I see the evaluations from my students. I have students that come up to me and say they actually suggest gaming to their directors when they're looking at different things to help with education on the unit.” 

Supporting the argument for gamification is Tina Vo, a UNLV education professor who specializes in scientific models. “Gamification can build (students’) confidence; giving them a context they understand; giving them clear objectives of what they intend to learn,” she says. “Games inherently do a lot of these things in ways that students have experienced all their lives.” 

Vo also notes gaming in education is more common than we realize, going all the way back to awarding gold stars in class. “That is the very basic level of gamification,” Vo states. “The fact that we have to give kids grades at all is in the same tenets of what is gamifying, except for it's a boring game, high-stakes game. Gamification is a new word on top of structures we've already been doing layered with elements of motivation and instructional design.” 

Leveling Up Educators

Trnka is basing her doctoral dissertation on her classroom gamification efforts. She hopes her work will show “other educators that, although time-consuming, it is easy and worthwhile to bring gaming into their classrooms to help student engagement and academic achievement.”

And it supports lifelong learning for both student and teacher. “The main concept of being a nurse is to never stop learning and that doesn't just go for our students,” she says. “We're forever students. If we thought we knew everything at 18 and then never changed our lives, can you imagine what we would be? 

“We have to evolve, we have to learn and we are seeing a completely different group of students than we saw 20 years ago in education. We have to learn and evolve with these students, or we're not providing a service for them."