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Serious play: Training for critical thinking in EMS

In the low- stakes environment of play, theory meets practice, allowing students to cultivate adaptable analytical and interpersonal skills


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By Judyth Brown, EMT, M.S.Ed

Not long ago, an instructor complained that our EMS students were “having too much fun.” I wasn’t sure what that meant, so my first thought was to check our data. The class in question had a good record on our rigorous unit tests and they were all on track with their required reading. Since they were doing the work, I was left with a contradictory picture of engaged students, excelling in assessments – and a dissatisfied instructor. This needed a closer look.

Five years ago, our project flipped the EMS training classroom. Students’ lectures moved online and we revamped our class time with an eye toward improving entry-level competence. The new classroom activities promote the application of lecture topics while building good intellectual skills. While they may appear playful, these activities are carefully built to hone clinical and professional skills. Our goal is to train practitioners who could walk the walk, not just pass the test.

So, this instructor’s remark had weight. While the statement was a personal observation, it sparked a question: How do we prove that having fun isn’t just frivolous entertainment? Serious play trains the bedrock skills of good clinical practice, it’s a hidden gem for cultivating critical thinking.

Traditional EMS classrooms use simulation and lecture to train and refine skills. They offer structured learning, controlled environments and measurable skills practice in simulated real-world settings. Simulation provides an excellent opportunity for students to practice critical thinking, and traditional lecture conveys information. But these techniques often fall short when it comes to developing critical intellectual skills. Playful learning addresses these limitations in training for critical thinking skills like adaptability and decision-making.

As any athlete knows, serious play is already part of our learning vocabulary. Think of active playful learning as building mental muscle. Imagine simulations as the regular pre-programmed workouts, the situational learning tools that train practical skills we expect to need. If that’s the case, then learning games are the open gym, where students can experiment, adjust their approach, even try a new routine. Here, they develop the well-informed mental agility needed to thrive in the field. As games need participation from all players, they can enhance classroom management, bringing reluctant students into active learning. Ultimately, that active, invested mindset fosters retention and deeper understanding of information. Sweeten the instructional benefits with an environment that allows students to step past the risks of being wrong and the underperforming learner may find an opportunity to shine.

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How gamification, play influence learning

As healthcare providers, our work is notoriously variable. We need mental agility to analyze, evaluate and adapt our actions in response to a patient’s evolving presentation. Good diagnosis relies on imagination and deduction, but we don’t have many opportunities for students to safely refine gut feelings and test a theory. We turn to serious play to train for this dynamic reality, building the intellectual agility we need in the field.

And the research bears this out. One study states findings suggest “it is possible to improve learning outcomes in health professions education by using gamification, especially when employing game attributes that improve learning behaviors and attitudes towards learning” [1].

A study on playfulness and workplace productivity finds “playfulness relates to a set of psychological traits, including cognitive spontaneity and creativity … playfulness related positively to work outcomes, including task evaluations, perceptions, involvement and performance, and provided more predictive efficacy than other psychological constructs” [2]. By its nature, game-based learning leads to greater student interaction and higher retention.

Playful learning provides a low-stakes crucible for experimentation. Through serious play, students are free to improvise, solve problems, test mental models and refine decision-making skills. Unlike simulations and scenarios with their implied real-world pressures, playful learning allows for dynamic exploration, experimentation, hypothesis building and feedback without negative consequences. Serious play builds the kind of adaptable thinking we need in emergency care.

In the low-stakes environment of play, theory meets practice, allowing students to cultivate adaptable analytical and interpersonal skills. In an active learning environment, it’s not about having “too much fun,” it’s about the right kind of fun – the kind that fuels engagement, creates community and fosters critical thinking, preparing our students to thrive in the real world. Play transforms lifeless facts into a fully realized human experience.

Lectures and simulations will always have a place. But adding instructional games builds a learning environment that cultivates clinical skill for all learners. Look at learning activities as an opportunity for students to:

Collaborate and communicate. Learning activities require teamwork and negotiation, building essential communication and interpersonal skills.

Embrace uncertainty. Play offers unpredictable situations, helping students develop adaptability.

Develop mental models. Play is inherently engaging, fostering a desire to explore and master new ideas, extrapolate outcomes and project plans.

When students engage in playful learning, don’t mistake it for laziness or frivolous self-indulgence. Serious play offers an opportunity to experiment and build the clinical skills complimenting the technical expertise, qualifying our students as entry-level competent. And if they have fun in the process, well who’s to say that’s a bad thing.

About the author

Judyth Brown has 15 years of experience as an EMT. She holds an M.S.Ed in Instructional Design working with HMH Jersey Shore Medical Center. In 2017, she helped flip the classroom for the EMS training project creating over 200 activities that support real world skills. She has presented at NAEMSE, EMS Pro, EMS World Expo, Vital Signs Academy and National Conference on EMS.


1. Alves LC, Rodrigues TC. 2018. Gamification in emergency medical services training: A systematic review. BMC Medical Education, 18(1), 39.

2. Glynn MA. Webster J. 1992. The adult playfulness scale: An initial assessment. Psychological Reports, 71(1), 83-103.

3. Hwang Y, Lee JK, Lee MJ. 2020. Gamification in emergency medical services training: A systematic review. Prehospital and Disaster Medicine, 35(4), 521-533.

4. Van Gaalen AEJ, Brouwer J, Schönrock-Adema J, Bouwkamp-Timmer T, et al. Gamification of health professions education: a systematic review. Adv Health Sci Educ Theory Pract. 2021 May;26(2):683-711. doi: 10.1007/s10459-020-10000-3. Epub 2020 Oct 31. PMID:33128662; PMCID: PMC8041684.