Context Wrong‐sided procedures represent some of the most catastrophic errors in health care. Although errors in laterality are multifaceted in origin, human error is considered to be an important root cause. Evidence suggests that a significant proportion of the population, including medical students, experience difficulty in left–right discrimination (LRD). Given that not all medical students have equal LRD ability, there have been calls to raise awareness of this issue in medical education. The experiences of medical students with LRD, including those who have difficulty, remain unknown. Objectives This study was designed to gain deep insights into the lived experiences of medical students in LRD. Methods A qualitative study was conducted using hermeneutic phenomenology. Medical students with a wide range of abilities in LRD were invited to participate and to be interviewed. Interviews were transcribed and analysed using template analysis to generate research themes. Members of the research team were continually reflexive when remaining firmly rooted in the data and in the principles of the hermeneutic process. Results Analysis yielded four main themes: (i) discriminating right from left: an unconscious or a conscious task? (ii) ‘What … you can't tell right from left?’: an undesirable skill deficit; (iii) concealment, and (iv) ‘But you're going to be a doctor!’: impact on professional identity formation. Conclusions This study challenges normative expectations that LRD is an effortless task for all. Individuals who are challenged in LRD must engage in a complex conscious process to determine right from left. For the most part, this process is relatively effortless. However, the context of being a medical student can impose extra demands and heightens the risk associated with potential error. Medical education needs to respond by raising the profile of this challenge, with which many of our medical students are confronted, and by extending support to assist them in the interests of safe patient care.

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Introduction Gamification is becoming increasing utilised in technology-enhanced learning activities based on its success within business and management activities. There is general anxiety about adopting gamification into projects due to concerns over aesthetics and reliance on games. Gamification, done well, focuses on promoting learner-centred intrinsic motivation elements and enhance engagement and performance. This project utilised gamification to review the impact of points, leaderboards and badges on learner performance, feedback and perceptions of the activity. Method Over the course of 2 years during routine Foundation Year (FY) doctor simulations, candidates were randomised into intervention and control groups, with and without visible gamification elements respectively. Group sessions had between 2-8 participants depending on attendance and were randomly allocated. 8 sessions were run per cohort, with 2 cohorts per year for both FY1 and FY2 doctors. Scenarios covered a range of clinical scenarios with each cohort experiencing the same simulations for standardisation across years. Badges, representing learning outcomes were identified during the debrief. Points were awarded post-scenario by the debrief-lead based on subjective performance via Likert-scale scoring sheets. Groups were ranked on a leaderboard with team-names to maintain anonymity and published to learners after each cohort finished. Focus groups were held to review learner experiences.Results Feedback from 230 participants responses were collected over 2 years. Overall, gamification aware groups performed slightly better in leaderboard ranking compared to the unaware groups. Overall, learners subjective scores ranged from 68% to 94%, suggesting overall high performance of trainees and relative consistent marking from the debrief-lead. Learner feedback groups commented upon memorability of gamification aids and an element of fun. Discussion Gamification, when used appropriately, can have a significant impact on learner performance, improve scenario and debrief structure without negatively impacting on the experience of the session. It provides a novel method for reliably scoring and ranking learner performance across cohorts and year groups to increase feedback available, maintain records of activity and standards, while preserving learner anonymity and safety to undertake simulations. Conclusion Gamification, as a process, enhanced the scenario content overall, but the enhanced visual components and awareness of points, leaderboards and badges did improve learner performance, without negative effecting their experience or how they provided feedback. This project demonstrates one process for delivering a gamification designed simulation session.

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