How to fit games into your medical study routine
The first semester arrives with classes, lab work, tutoring, scheduled exams and a reading list. Those who have just started usually know what they need to study, but struggle to decide what to do when they sit down at the desk: reread the summary, open the question bank, review the flashcards or start the new chapter. In this scenario, a daily game is easy to fit into your phone and easy to drop from your week. It only truly helps when it has a fixed place in the routine and a clear connection to the rest of your studying.
NEXO is a daily medical diagnosis game: one clinical case a day, six progressive clues, and ICD-10 proximity feedback across five levels.
This text shows how to build a Medical school study routine in which the game has a defined role. The foundation is what studies in cognitive psychology and medical education say about testing memory, receiving correction and building habits. The effects cited here come from studies on these methods; the game is a way to put them into practice.
Key points
- Testing your memory and then correcting the error are among the best-rated study techniques; rereading and highlighting were among the least useful.
- The game works as a short test: you produce an answer before seeing the answer key, and the error points to what to study.
- A fixed time and context help studying become a habit, and failing one day does not undo the path.
- The gain appears when the case of the day connects to the textbook, the Anki flashcards and exam questions.
- The example week in this text is an editorial guideline: adjust it to your semester and your time.
Summary
- Why the routine matters as much as the game
- Test, miss and correct
- Where the game fits into the day
- Connecting the game to the textbook, Anki and exam questions
- An example week
- Common mistakes
- Frequently asked questions
- Checklist for a routine with games
Why the routine matters as much as the game
A study game can be well designed and still deliver little if it only shows up on boring days. What matters for learning is how often you retrieve the material from memory and what you do with the error, and both of these depend on the routine.
The feeling of knowing deceives you
During studying, what you see is your performance in the moment: the page looks familiar, the summary looks clear. An integrative review shows that this immediate performance is an unreliable indicator of lasting learning, and that people often confuse one with the other (Soderstrom and Bjork, 2015). In a classic experiment, rereading increased students' confidence in their own memory, while testing produced more retention on exams taken days later (Roediger and Karpicke, 2006). In another, students' predictions about their own performance had no correlation with the actual exam result (Karpicke and Roediger, 2008).
In practice, this means the routine needs to include moments when you answer without consulting anything. The game is a simple way to guarantee that moment every day.
A routine is a decision made in advance
When the decision about what to study is left until the moment, it competes with tiredness, messages and the easiest subject. Deciding in advance, with a day, time and task, takes that competition out of the way. The section Where the game fits into the day shows what studies on habits say about this.
Where this text fits in
If you are still choosing which type of game to use, start with the guide to types of games for Medical students. To understand what the evidence says about points, rankings and achievements in teaching, see the text on gamification in medical education. And to learn how the diagnostic game works, read what NEXO is. Here the focus is different: at what point in the day the game fits in and how it connects with the rest of your studying.
Test, miss and correct
The cycle that sustains a good routine has three steps: you try to remember, you find out where you went wrong and you correct it with the right source. Each step has its own support in the studies.
Test: remember before reviewing
Retrieving information from memory strengthens that information. In science texts, students who practiced retrieval retained more than those who reread, even without any correction after the test (Roediger and Karpicke, 2006). In another experiment, repeating the study of an already learned item did not change later recall, while repeating the test produced a large effect (Karpicke and Roediger, 2008). Retrieval practice also yielded more learning of concepts than studying by building concept maps, including on inference questions (Karpicke and Blunt, 2011).
In a large review of study techniques, practice testing and distributed practice were the two techniques classified as having high utility (Dunlosky et al., 2013). A meta-analysis on practice tests concluded that they benefit learning more than restudying and more than the other comparison conditions (Adesope et al., 2017).
Why a case counts as a test
A case with clues demands the same effort as a test: you search your memory for what you know about signs, exams and epidemiology, and you need to produce a name. The difference from reading is that the case does not show the answer until the end. It is this effort of retrieval, and not the game format, that studies link to greater retention (Karpicke and Blunt, 2011).
Testing also works in health care
The results were not restricted to the psychology lab. In the BEME 48 systematic review, on health professions, 21 of 23 retention outcomes favored learning with tests compared with studying the same material (Green et al., 2018). The formats included open-ended questions, multiple-choice questions, simulation and standardized patient, and the effects also appeared in transfer to clinical situations (Green et al., 2018).
A review written for medical students summarizes the same idea in three recommendations: test yourself, learn actively and repeat at intervals (Augustin, 2014). A meta-analysis of 225 studies in science, technology, engineering and mathematics courses showed higher grades with active learning in class than with traditional lecture (Freeman et al., 2014). This data comes from classes, not from individual study, but it points in the same direction: producing the answer teaches more than just receiving it.
Getting it wrong: the error shows what to study
Answering and getting it wrong seems like a waste of time, but the error is the most useful information of the day. It points out which part of the subject needs to go back to the book. A diagnostic game makes this visible: if you confused two similar diseases, you already know which comparison to review.
The error is also safe in the game. Getting a daily case wrong costs little and teaches the same kind of thing as an error on an exam, with the advantage of happening before it.
Correcting: the feedback closes the cycle
Testing without feedback helps, but feedback completes the effect. In two experiments, giving the answer key after the test corrected wrong answers and doubled the retention of correct answers given with low confidence (Butler et al., 2008). This applies to your case of the day: when you get it right by guessing, reading the explanation and checking the reasoning is what consolidates the correct answer.
In NEXO, the case arrives in up to six clues, and each guess shows the proximity in ICD-10, which indicates whether you are in the right group of diseases before getting it right. On the third clue the area of the case appears and, on the fifth, the ICD range, and you can skip a clue whenever you want to move forward. This format provides a short test and immediate feedback, the first two steps of the cycle. The third step, correction with the source, is up to you and your book.
Where the game fits into the day
The practical question is when to play. The answer that studies on habit suggest is: always at the same time and in the same context.
Same context, every day
In a study with 96 volunteers who repeated a daily action in the same context, such as "after breakfast", for 12 weeks, the action became more automatic with repetition (Lally et al., 2010). The time to get close to maximum automaticity ranged from 18 to 254 days among people (Lally et al., 2010). This helps to understand why the same habit catches on quickly for a colleague and takes longer for you: the pace varies, and what helps is keeping the same trigger.
The same study brought good news for those with an exam week: missing a single opportunity did not significantly affect habit formation (Lally et al., 2010). One day without playing does not reset the path. What matters is coming back the next day.
Decide beforehand: "when X, I do Y"
A meta-analysis of 94 independent tests showed that planning in advance the when, the where and the how of a goal, in the format "if situation X happens, I do Y", had a medium to large effect on goal attainment, with d of 0.65 (Gollwitzer and Sheeran, 2006). For the routine, this becomes simple and concrete sentences:
- "When I sit on the bus to college, I play the case of the day."
- "When I finish the case, I write down the diagnosis I got wrong."
- "When I get home, I open the chapter of the disease I got wrong."
Choose a trigger that already exists in your week. The commute, the break between classes and coffee are good candidates because they repeat.
One case per day fits the routine
NEXO's Daily mode renews at midnight and brings the same case to everyone. This helps the routine in two ways: you know there is a new case waiting, and you can compare the result with the class the next day. The streak and its freezes record the days you played, and the achievements mark the path. For those who like to study in a group, the ranking has Global, Universities and Group tabs, the latter with an invite code for your class or league.
When there is time left, the Archive gathers the previous daily cases, good for reviewing an area before the exam. Adrenaline asks you to choose the dose before starting and offers one case per day to train reasoning with time. To understand the limits of each mode, see the NEXO economy page.
Connecting the game to book, Anki and exam questions
The game pays off more when it works as a gateway to the rest of the study. The logic is that of the cycle from the previous section: the case tests, the error points to the topic, the book corrects, the card stores and the exam question checks.
| Step | What you do | What the studies say |
|---|---|---|
| Case of the day | Answer without consulting and record the error | Testing yields more retention than rereading (Roediger and Karpicke, 2006) |
| Book | Read only the part that explains the error | Feedback corrects errors and firms up insecure correct answers (Butler et al., 2008) |
| Anki | Create a card with the point you missed | Anki use associated with a higher score on a licensing exam (Deng et al., 2015) |
| Exam questions | Do questions on the same topic days later | Number of questions done associated with a higher score on the same exam (Deng et al., 2015) |
| Spaced review | Return to the topic over the weeks | Spacing study improves retention (Cepeda et al., 2006) |
From the case to the book
After the case, open the book or your course material at the disease you got wrong, or the one you confused it with. Read with a question in mind: what differentiates the two? This short reading, guided by the error, is different from rereading the whole chapter. If you want to go deeper into the method of comparing hypotheses, the text on VINDICATE in differential diagnosis shows an organized way to list causes. And the text on case-based learning explains why studying from a case helps connect theory and clinical practice.
From the book to Anki
The point you missed becomes a card. Good cards ask one thing only and require the answer from memory. In NEXO, the Anki button creates the card directly from NEXO and opens it in the Anki app, searches for the cards you already have and, when the case has an image, takes the image to the card. So today's error enters your review without you having to copy everything by hand.
Spaced repetition, with Anki or another method, deserves a text of its own. Here it is enough to know that reviewing at intervals helps retention, as the meta-analysis on distributed practice shows (Cepeda et al., 2006).
From Anki to exam questions
Days later, answer questions on the same topic. The questions test the content from another angle and show whether what you corrected stuck. In a study with 72 medical students at a school in the United States, the number of questions answered and the number of unique Anki cards seen were associated with a higher score on the licensing exam (Deng et al., 2015). It is an observed association, not an effect measured in a trial, but it matches what the experiments show about testing.
Cases spread across the weeks
Short cases distributed over time have also been tested in medical education. In a randomized trial, third-year students who received clinical cases and questions by email every week, after a urology rotation, retained more knowledge at the end of the school year on the topics they received (Kerfoot et al., 2007). The format is different from a game, but the idea of returning to cases regularly is the same one that sustains the case of the day in the routine.
Image and sound in the same cycle
The NEXO Multimedia brings cases with image, audio and other exams. They enter the same cycle: if you misread a tracing or a sound, look for the explanation in the book and create the card with the image. Continents mode, with cases linked to Africa, the Americas, Asia, Europe and Oceania, is a good choice for when you study diseases that vary from region to region.
An example of a week
The week below is an editorial guideline, not a prescription supported by a study. It shows how the steps fit together; the time for each one depends on your semester, your classes and your pace. The principles behind it, testing frequently, correcting the error and returning to the topic at intervals, come from the studies cited in the previous sections.
| Day | Trigger | What to do |
|---|---|---|
| Monday | Commute to college | Daily case; write down the diagnosis and what confused you |
| Monday night | After dinner | Read in the book the part that explains the error; create the card in Anki |
| Tuesday to Thursday | Same commute trigger | Daily case; same routine of writing down, reading and creating a card |
| Thursday night | Before reviewing Anki | Exam questions on the topics you got wrong on Monday and Tuesday |
| Friday | Break between classes | Daily case; compare the result in your group ranking |
| Saturday | Free morning | Archive cases in the area of the next exam, or Adrenaline with the dose chosen beforehand |
| Sunday | Late afternoon | Reread the week's notes and choose the topics for the following week's questions |
How to adjust the week
In an exam week, keep the case of the day and swap the Saturday cases for questions on the exam content. In the internship, with shifts, the trigger can change from day to day; in that case, tie the case to a fixed event, such as the end of the shift handover. The guide to types of games for medical students brings combination suggestions for each stage of the course.
Mixing similar topics
When reviewing, it is worth mixing examples from similar categories, instead of studying an entire block of just one disease. In an experiment with paintings, interleaving works by different artists helped recognize each one's style in new paintings, although the participants thought studying in blocks worked better (Kornell and Bjork, 2008). The review of study techniques classifies interleaved practice as of moderate utility (Dunlosky et al., 2013). In the week, this means answering questions on two diseases you confuse in the same block.
Common mistakes
The mistakes below appear frequently in study routines and have a simple fix. The basis is the review of study techniques that compared what students use most with what works best (Dunlosky et al., 2013).
Rereading and highlighting as the main study method
Rereading and highlighting were classified as of low utility in the review of study techniques (Dunlosky et al., 2013). They give a feeling of mastery because the text becomes familiar. Use reading to correct an error that a test showed, and leave most of the time for answering questions.
Playing without looking at the error
Doing the case, seeing the result and closing the app wastes the most useful step. Feedback is what corrects the error and firms up the unsure right answer (Butler et al., 2008). Set aside a moment after the case to write down what you confused.
Studying everything at once before the exam
Focusing your study on the days before the exam seems efficient, but retention improves when the same study is spread out over time (Cepeda et al., 2006). The daily case helps you keep in touch with the material throughout the semester, far from the eve of the exam.
Trusting the feeling that you already know it
Confidence after rereading deceives: in experiments, it went up while delayed retention was lower (Roediger and Karpicke, 2006). Use the test result as the measure, not the feeling.
Changing method every week
A new method every week keeps any of them from becoming a habit. Automation comes from repetition in the same context (Lally et al., 2010). Choose a trigger, a game and a path for the error, and keep it for a few weeks before evaluating.
Measuring the routine only by the streak
The streak and the achievements help you come back every day, and that is what they are for. The measure of study, however, is what you correct: how many errors turned into reading, a card and a question. At the end of the week, look at your notes and see if the same themes came up again. If they did, they call for another cycle of book and questions.
Leaving the game disconnected from the rest of your study
The game alone exercises reasoning, but the bigger gain comes from the link with the book, the cards and the questions. If today's case did not generate any reading, any card and any question in the following days, the cycle stayed incomplete.
Frequently asked questions
How do you build a medical school study routine with games?
Choose a fixed daily trigger, such as the commute or coffee, and play the case at that moment. Then write down the error, read the part of the book that explains it, create a card and do questions on the theme days later. This cycle uses testing and correcting, two techniques with good evidence (Dunlosky et al., 2013).
How long should I play per day?
The ideal amount of game time per day is still an open question in the studies. What the evidence supports is regularity: testing often and returning to the theme at intervals (Cepeda et al., 2006). One case a day at the same time is a good starting point, and the rest of the time goes to the book, the cards and the questions.
What is the best time of day to play?
The best time is the one that repeats in your week. Actions done in the same context every day became more automatic over time (Lally et al., 2010). Commute, break between classes and breakfast usually work well.
What should I do when I miss a day?
Come back the next day. In the study on habit formation, missing a single opportunity did not affect the result in an important way (Lally et al., 2010). In NEXO, the streak has freezes, and the Archive keeps the previous cases for when you want to revisit a theme.
How do you connect the game to Anki?
After the case, create a card with the point you missed. The Anki button creates the card straight from NEXO and opens it in the Anki app, searches the cards you already have and, when the case has an image, takes the image to the card. The details of spaced repetition are left for a text of their own.
What is the role of the game alongside the question bank?
The game and the question bank complete each other. The case of the day trains you to reach the diagnosis from clues; the questions train the exam format and cover management, treatment and other points. In the routine, the case points to the theme and the questions check, days later, whether the correction stuck. Doing more questions was associated with a higher score on a licensing exam (Deng et al., 2015).
How do you use the game with your class or academic league?
Create a group in the ranking with an invite code and agree on a time for everyone to play the Daily case, which is the same for everyone. At the league meeting or during the break, each person tells which clue changed their guess. This conversation about reasoning is what the text on case-based learning describes as group discussion.
Does playing help with the medical school exam and residency?
Studies show that testing memory improves retention in health professions too (Green et al., 2018), and that doing questions and flashcards was associated with higher scores on licensing exams (Deng et al., 2015). The game is one of the ways to test yourself. If you research medical education and want to study the use of NEXO, check out NEXO Researcher; if you represent a medical school, interest group or residency program, NEXO Closer. Doctors who want to review cases can check out NEXO Curator, and Medicine content creators, NEXO Creators.
Routine checklist with games
- Choose a fixed trigger that already exists in your day, such as your commute or your coffee.
- Write the rule "when X, I do Y" for the case of the day.
- Answer without looking anything up and only then check the diagnosis.
- Write down the mistake and the disease you confused it with.
- Read only the part of the book that explains the mistake.
- Create an Anki card with the point you missed.
- Do questions on the topic days later.
- Mix similar topics in your reviews.
- Come back the next day when you miss a day.
- Keep the method for a few weeks before switching.
Want to start today? Play the case of the day on NEXO.
References
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