Gamified learning tool promoting Antimicrobial Stewardship

Insight

Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites develop and use resistance strategies by changing over time in response to the use of antibacterial drugs used against them, so that they no longer respond to antibacterial medicines such as antibiotics (1). As a result, antibiotics and other antimicrobial medicines do not work as well, or at all, and infections become increasingly difficult or impossible to treat.

In the UK, the total number of antibiotic-resistant infections in 2024 equates to an average of nearly 400 newly reported cases per week (2).  According to the World Health Organization, AMR is already harming our health, food systems, environment and economies: drug-resistant infections are increasing, but our current level of awareness, investment and action are insufficient (3).

Intervention 

Clinicians and health care professionals involved in prescribing, play a critical role in the fight to reduce AMR by following best clinical and prescribing practices. Working towards the aim of improving the safety and quality of patient care and make a significant contribution to the reduction in the emergence and spread of AMR, NHSE East of England Regional team commissioned Health Innovation East to explore opportunities for gamified learning for AMS and whether gamification of AMS learning could support improved awareness, engagement and knowledge of AMS.

The project was delivered in partnership with staff from East and North Hertfordshire Teaching NHS Trust, Royal Papworth Hospital NHS Foundation Trust, Cambridgeshire and Peterborough Integrated Care System (ICS), and NHS England East of England region (herein referred to as the ‘AMS Project team’).

The AMS Project team developed the concept of a gamified training tool in the form of an escape room, to educate clinicians and health professionals on the importance of AMR in practice. Content areas covered included microbes; Urinary Tract Infection/C diff; antibiotic adverse drug effects; allergies; and antibiotics. Elements of game design applied to the educational content included establishing a game environment, challenge proposition, progress narrative and reward.

Game play took place in a (virtual) hospital. Players were presented with the concept of being trapped following a power-cut and were required to apply their AMS knowledge in a series of challenges in order to escape.

A survey was used to evaluate the impact and effectiveness of the gamified learning tool. Data was collected during the month of November 2025 using a snowball approach. The target population was prescribers and healthcare professionals in the East of England.

Impact 

The gamified learning tool received a total of 1424 responses, of which 749 (52.6%) were complete responses. The following data analyses have been conducted on complete responses only.

• Out of the 749 responses, 43.8% participants were from an ICB in the East of England with 56.2% outside of the region, including a small number of international participants.

• The evaluation of participant understanding and knowledge of AMS principles before and after the game showed a statistically significant positive difference, indicating that participants’ reported scores for understanding after the training were generally greater than before the training.

• Likewise, participants’ self-reported scores for their confidence in applying AMS principles in practice before and after the training showed a statistically significant positive difference before and after.

• When reflecting on how engaging they found the game, participants gave a median score of nine out of ten.

Overall feedback on the game indicated that the majority of participants found the game content to be clinically relevant and useful:

• “Scenarios relevant to practice”

• “It was very useful in making me consider and refresh Knowledge on AWaRe classification of antibiotics rather than rely on clinical experience[sic]”

Participants found the game to be fun, innovative and engaging:

• “I found it entertaining”

• “Fun to try a game rather than usual q&s”

The gamified AMS learning tool was found to be effective as a learning tool for AMS amongst clinicians. The escape room concept and quiz content was received positively and demonstrated high levels of acceptability for the participants who took part. Overall, the AMS game had a positive impact on AMS awareness and demonstrated clear potential for changes in prescribing practices by supporting prescribing clinicians to feel more confident in their application of AMS knowledge, particularly in hospital-based settings.

Next steps

Following the success of the pilot, the AMS gamified learning tool has been reopened on an ongoing basis for health care professionals.