JMIR Publications

ABSTRACT

Background:

Diagnostic reasoning in clinical practice is often characterized by rapid intuitive judgments that can stabilize early and become difficult to reconsider, particularly within team-based settings where social dynamics influence decision making. While serious games have been proposed to support reflection, little is known about how such interventions can be designed to make these processes visible and discussable.

Objective:

This study aims to design and evaluate a metaphor based serious game that operationalizes diagnostic reconsideration by making early commitment visible, introducing opportunities for reopening alternatives, and surfacing relational dynamics in team-based reasoning. In addition, the study explores whether such a design can expose and explicate implicit reasoning and group processes that are typically difficult to access in practice.

Methods:

Using the Design Research Framework, the intervention Strong but Wrong was developed through iterative co creation with medical professionals and academic experts across three phases: exploratory prototyping (Phase 1), iterative calibration through gameplay sessions (Phase 2), and exploratory qualitative evaluation in a clinical learning context (Phase 3; n=18). Data from Phase 3, including audio recordings, field notes, and verbatim transcripts of gameplay and debrief discussions, were analysed using a hybrid deductive inductive thematic approach focusing on early commitment, cognitive recalibration, and social influence.

Results:

Participants rapidly formed coherent early interpretations and narrowed alternatives with confidence. Reconsideration did not arise spontaneously but was typically triggered by structural features of the game, particularly delayed reversibility, and varied depending on relational dynamics such as confidence, majority alignment, and perceived hierarchy. During debrief discussions, participants explicitly related these dynamics to their own clinical practice, recognizing parallels with diagnostic reasoning and team-based decision making.

Conclusions:

The findings suggest that a metaphor based serious game can make otherwise implicit cognitive and social mechanisms in diagnostic reasoning visible and open to examination. Rather than preventing intuitive reasoning, the intervention exposes how early interpretations stabilize and how difficult they are to reopen. By deliberately staging commitment and reconsideration within a metaphorical context, the intervention creates a reference point that can support recognition and potential transfer to professional practice. Beyond the specific intervention, this study contributes to the field by explicating how design can be used to operationalize and examine complex reasoning processes within serious games for health. Clinical Trial: Not applicable.