Playing doctor

Far far away, on the mythical world of Soma, an epic battle rages. Heroic warriors are locked in mortal combat with an army of depraved villains, hell bent on infecting the planet and wreaking awful destruction. The fate of Soma hangs in the balance.

Coxiella burnetti
Image: The Healing Blade,
Nerdcore Learning

Though Soma isn't real -- it's actually the setting for a new fantasy card game developed by two physicians/self-professed geeks -- it may help medical students learn important lessons about how and when to use specific drugs to vanquish an ever-evolving cast of real-life bacterial foes. Healing Blade was developed by linkurl:Nerdcore Learning,;www.nerdcorelearning.com a San Francisco based gaming company led by two physicians, Arun Mathews and Francis Kong. Players of the game can choose to be good guys, called Apothecary Healers, or bad guys, called Lords of Pestilence, each of whom has several weapons in their hand. The goal of the game, explains Mathews, is to give budding medical students a fun way to practice treating bacterial infections by administering the right antibiotic to combat specific pathogens. "Why couldn't we rehearse these types of decisions in an abstract manner, teaching good decision-making behaviors in the subtext of a compelling game?" he asks. Healers control a cast of characters -- such as Ceftriaxone and Chloramphenicol -- named after antibiotics, while lords of pestilence have at their disposal monsters -- such as Bacteroides fragilis, Clostridium perfringens, and Enterococcus fecalis -- who take their monikers from bacteria seen in hospitals and studied in labs worldwide. These characters are represented by single cards, which are played in turn to determine a winner. A Lord of Pestilence, for example, might play Pseudomonas aeruginosa, a highly opportunistic, gram-negative bacterium that commonly causes infections in hospitals. An appropriate counter-play by the Apothecary Healer would be to play ciprofloxacin or ticarcillan, two antibiotics that have action against P. aeruginosa. But the lord of pestilence may also play one of the deck's multi-drug resistance cards, which would provide him with added protection against the antibiotic card played by his opponent. The healer also has choices, including whether to use a narrow-spectrum or broad-spectrum approach to defeat the specific bacteria. So goes game play in Healing Blade.

Zach Landau, a graduating senior at Virginia Tech and a pre-med student, owns two copies of the game. "I absolutely love the concept and the game," he says. Mathews says he had the idea for Healing Blade one day while rounding in the intensive care unit at Lea Regional Medical Center in New Mexico, where he is a hospitalist and intensivist. While discussing which antibiotic to administer to a patient on the ward with one of the nurses, Mathews thought of linkurl:Mass Effect,;http://masseffect.bioware.com/agegate/?url=%2F a video game he was playing the night before. "I literally had a eureka moment," says Mathews. Mathews realized he was using the skills he exercised while playing Mass Effect, in which the player battles alien hoards as the soldier Commander Shepard, to make proper judgments about antibiotic treatment. Like negotiating a strange galaxy and seeking out enemies through the eyes of Shepard and his troops, Mathews says he was making medical decisions based upon "good reconnaissance information," such as cultures and knowledge of where the patient had come from, to determine the likely type of bacteria the patient was carrying and the best way to combat the infection. Mathews discussed his idea for a new game with Kong, a medical school colleague and former pediatrician. Kong quickly took to overseeing the project--creating a rule set and building a version of the game with artists. Mathews, his wife, Zeeba (also a physician) and Kong created a database of "known bacterial sensitivities" to a "core set of antibiotics, based on current management guidelines for infection," says Mathews. The group then continued to discuss what they felt these "creatures and heroes would look like," says Mathews, and sent their ideas off to artists, trying to include as many clues regarding pathophysiology as possible. Throughout the creative process, the team focused on constructing back stories "for adept health science students to pick-up on." Mathews and Kong launched Healing Blade at the American Medical School Association (AMSA) convention in March of this year. Due to a "communication error" with their printers, says Mathews, 100 games were shipped to the convention center, instead of the 30 they had originally intended to sell. Mathews and Kong sold 90 game sets in their 8 hours of booth time. The 10 remaining games might have also been sold if the team had arrived on time, Mathews says. "We'll be first to admit that we're complete amateurs at this." Given the success of the game's debut at this year's AMSA conference, Nerdcore Learning plans to make more copies of Healing Blade available in late May. Mathews says that they're also planning a series of expansion packs that will introduce elements of parasitology and virology into the game.
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[30th April 2010]