The Mystery Dinner RCA: Using Gamification and Simulation to Teach Root Cause Analysis

Andrea Smeraglio, Matthew DiVeronica, Christopher Terndrup, Jacob Luty, Garrett Waagmeester, Shona Hunsaker

Research output: Contribution to journalArticlepeer-review


Introduction: Root cause analysis (RCA) is a widely utilized tool for investigating systems issues that lead to patient safety events and near misses, yet only 38% of learners participate in an interdisciplinary patient safety investigation during training. Common barriers to RCA education and participation include faculty time and materials, trainee time constraints, and learner engagement. Methods: We developed a simulated RCA workshop to be taught to a mix of medical and surgical specialties from over 11 GME programs and to third-year medical students. The workshop was a single 90-minute session formatted as a gamified mystery dinner including characters and sequentially revealed clues to promote engagement. Participant satisfaction and subjective knowledge, skills, and attitudes were assessed with a pre/post survey. Results: The workshop was completed by 134 learners between October 2018 and October 2019. The short workshop duration and premade simulation allowed a small number of faculty to train a wide variety of learners in various educational settings. Participants' presurvey (124 out of 134, 92%) versus postsurvey (113 out of 134, 84%) responses showed that attitudes about RCA were statistically improved across all domains queried, with an average effect size of 0.6 (moderate effect); 91% of participants would recommend this course to a colleague. Discussion: A 90-minute, gamified, simulated RCA workshop was taught to medical students and multiple GME specialties with subjective improvements in patient safety attitudes and knowledge while alleviating faculty time constraints in case development.

Original languageEnglish (US)
Pages (from-to)11165
Number of pages1
JournalMedEdPORTAL : the journal of teaching and learning resources
StatePublished - Jun 21 2021


  • Games
  • Gamification
  • Health Systems
  • Interdisciplinary Medicine
  • Interprofessional Education
  • Quality Improvement/Patient Safety
  • Root Cause Analysis
  • Simulation

ASJC Scopus subject areas

  • Medicine(all)


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