Rheum4Games: A Game-Based Board Review to Enhance Confidence and Knowledge in Rheumatology for Internal Medicine Residents

Introduction Internal Medicine (IM) residents have typically scored low on the rheumatology component of the In-Training Exam (ITE). While structured rheumatology electives can improve outcomes, these experiences are not always required. Interest in the role of gamification is growing, though application in the rheumatology component of the ITE remains underexplored. We developed a gamified rheumatology board review session to assess whether incorporating gamification into existing didactic curricula could improve ITE scores and enhance resident satisfaction. Methods We developed Rheum4Games (R4G) based on preexisting rules of the Snakes and Ladders board game. In total, 121 residents across 5 IM residencies participated over 12 sessions. Questions were developed using the American Board of Internal Medicine (ABIM) blueprint. We measured resident engagement, satisfaction, and confidence using pre- and postsession surveys. Rheumatology ITE scores were compared pre- and postsession utilizing Mann-Whitney U tests. Results R4G improved residents’ (n = 117) engagement and satisfaction, with significant gains in preparedness for the rheumatology content of the ITE/ABIM Certification Exam. Among residents with matched ITE data (n = 106), the median ITE score change was not significantly different between R4G participants and nonparticipants. However, score improvements were significantly greater in community-based programs than in university settings (9% vs 8%). Discussion While overall ITE score changes were not statistically significant, community-based programs showed statistically significant improvements compared to university programs. These findings suggest gamification can enhance rheumatology education and may serve as a valuable supplement to traditional didactics, especially in settings where traditional rheumatology teaching resources are limited.