The Problem

One of my greatest fears in medicine is that within my lifetime we will face a time when drug-resistant pathogens have escalated to the point where most of our antibiotics are ineffective. While there has been a push for the development of new antibiotics to keep up with the progressive nature of bacterial resistance, the issue of time and testing is of concern. The main concern currently is the smart use of available therapy to prevent further resistant patterns from developing.

As such, educating students and practitioners on how antibiotics (or more specifically antibacterials) work and what they are effective against is tantamount. When I have been asked to teach students and residents about antibiotics, I often find myself challenged to make it engaging. Drug X mechanism of action is such and such, and because of that it is effective against bacteria Y. Case based solutions are one way, but often I find students struggle with the basics. Secondly, tying this together with a suitable approach regarding empiric therapy and descaltation of treatment once cultures and sensitivities are available are also challenging topics to teach.

The Gamification Idea

Recently, my thoughts have ranged to how to make a game integrating fun mechanics, and antibacterial education. One area that caught my attention is the game mechanic of Tower Based Defense (TBD) games.

For those unfamiliar with TBD games, it essentially boils down to several mechanics:

• The player starts on a predefined map, where a route is present that enemies travel along in waves
• The objective is for the player to prevent as many of the enemies from reaching the end (often times 'lives' are given, and after so many enemies pass, the player loses)
• The player is allowed to build towers (which cost money) on predisignated spots on the map to combat the enemies, as each enemy is killed, the player gains more money to build further towers
• Towers have different abilities, and may be stronger/weaker against different enemies
• The strategy relies on the player balancing their money/income on towers that will defeat the enemies that appear in each subsequent waves

How Does This Deal with Antibacterial Education?

Replace enemies with bacteria and towers with antibacterials and you suddenly have a game mechanic that follows closely with current basic antibacterial education. 

This could be an easy way to teach students about which antibacterials are effective against different bacteria. Take for instance S. Aureus, a common gram-positive bacteria that causes many infections. We take it and turn it into an identifiable enemy.

Next, you take a common antibiotic, say Pennicillin, which has effectiveness against S. Aureus, and turn it into a tower.

And now put the two together into a TBD game landscape, and you suddenly have a game centered around teaching students which antibacterials are effective against which bacteria.

Gaming Mechanics

While the premise may be interesting, there are alot of bugs (no pun intended) to consider. How do you design a game that encompasses the broad spectrum of antibacterials and pathogens out there? How do you make this something other than match one tower against one enemy and make it fun? 

My thought ranges from making this game based on difficulty level, which would help students playing learn as they go along, for instance:

• Pre-Med - The player is given missions or levels focused on teaching the player about which towers (antibacterials) are effective against which enemies (bacteria). This could be almost an introductory level that is optional depending on who is playing. At the very least, it introduces the gaming mechanics and teaches what stops what. This could be done thought a helper (maybe an ID expert avatar explaining what the player should use) or an in-game guide.
• Med Student - The player is now given levels where waves of enemies will be sent, and they must choose appropriate towers for each wave. This will help the player understand more critically which drugs hit what pathogens. Levels could have themes, such as a level on the skin, where the player is fighting primarily gram-positive bacteria. The topic and idea of drug resistance can now occur, and the player must adapt and choose appropriate towers to fend off the bacteria.
• Resident - Now the fun really begins. At this point, cases could be introduced and advanced concepts. Imagine a level in the lung, where unknown enemies start to appear. The player must choose the correct empiric therapy to target suspected bacteria. After so much time, the results of a cultures and sensitivity would arrive and then the player could modulate therapy accordingly.
• ID Specialist - The most extreme version, where the player has to factor in other topics such as drug-toxicities to the surrounding tissue or organ systems (nephrotoxic effects), sepsis, and body temperature. This version would be very unforgiving, demanding the player to allocate their resources perfectly, and not let a single pathogen through.

Engaging Mechanics to Learn From

While such a game could help the player learn about which bacteria are impacted by which antibacterials, I feel another advantage would be an identification of appropriate use of therapy.

For instance, the player could choose to use broad spectrum antibacterials in the game, but the cost would be to high, and they wouldn't have enough towers to fight the enemy. Only by selecting the most appropriate towers will the player actually be able to finish. This would hopefully (as a by product) help reinforce in future practitioners to practice diligently and help reduce inappropriate drug use.

Other possible outcomes could be introducing players that are not medical, to the topic of antibacterial resistance, and help teach the public about the role antibiotics play in healthcare. Think of it as a potential PR possibility. 

Lastly, this type of gaming mechanic could be used for other diseases, such as oncology or other systems that utilize a disease-drug approach such as antibiotics.

Final Thoughts

This is an idea I have played with for a bit, but really never tried to bring to light. I think the biggest limiting factor is cost and making this a success. I hope someone makes this work, and I could use it for my students as a resource. Best case scenario would to get a company that makes TBD apps to design and program and team up with clinical experts to build the content, and even team up with a public agency or society (e.g. IDSA) to help push the game. 

Thank you for reading, and I look forward to comments!