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Duke, Meet Serious Games
A new graduate course shows how games can reinvent training at Duke Health — and how students learn by building for real clients
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Students cluster at the front of a classroom in Duke’s Nello L. Teer Building as a storyboard fills the screen: boxes, arrows, moments of choice. It’s presentation day in Serious Games Design, and each team narrates how a clinician will experience a game they’re building for Duke Health.
It feels less like a lecture and more like a studio critique. Classmates and instructor lean forward. Questions and suggestions come quickly.
Offered for the first time this fall through the new Master of Game Design, Development & Innovation program in the Pratt School of Engineering, the graduate course asks students to design games not for entertainment, but for learning, training and measurable impact. Teams meet with clinical partners, develop storyboards and early builds, run playtests, collect user data and deliver functional games by the end of the semester.
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Providing feedback from the back of the room is instructor Enrique Cachafeiro, who has spent nearly two decades integrating games into education.
“Games have been a vehicle for me to innovate education for a long time,” he says. After years teaching high school, he saw how gameplay could unlock greater attention and deeper understanding.
“For Duke Health, that matters because one of the biggest issues is burnout in the clinical space. Using games for training is a great way to tackle topics in a fun, competitive way that is not burdensome. There’s a lot of research that shows it’s a better way to do training.”
He also sees the class as a springboard for students. “I’m hoping that, through the class, we can bring that functionality to our staff here at Duke Health, while giving our students a leg up and walking away with real‑world experience or even published work.”
More Like a Game Design Studio
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Serious Games Design is structured to mirror professional practice. Teams manage workflows, assign roles, hold meetings with clients and revise constantly.
“This class is about iteration,” Cachafeiro tells students. “It’s not about perfection.”
This fall, the students partnered with clinicians at Duke Children’s Hospital to develop games to address pressing training needs:
- Transfer Center Tycoon, a simulation to prepare new doctors to handle high‑stakes patient‑transfer calls
- Pick Five, a digital version of a diagnostic reasoning exercise used to train pediatric residents.
Each game tackles complexity not by simplifying it away, but by making it playable.
Transfer Center Tycoon
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For one team, the challenge came directly from Duke’s pediatric transfer center, where clinicians field urgent calls from outside hospitals seeking specialized care.
“Duke takes a lot of transfer calls,” says Brendan Engebretson, the team’s lead designer. “Sometimes nearby hospitals don ’t have what they need to treat the patient.”
The team’s browser‑based game recreates that experience. Players receive messages from an outside physician summarizing a patient case, then ask structured follow-up questions, review vitals over time and make a disposition recommendation — all while managing interruptions.
Design choices are intentional. Players can pull up a patient info tab to view vitals over time. They can write and move digital sticky notes anywhere on screen, reducing barriers between the learner and the information they gather and need. Then there’s the pager that buzzes and flashes, forcing the player to choose where to focus — just as in the real transfer center.
Cachafeiro pushes them to think about how distractions shape real-world decision-making.
“Maybe it’s not just losing points,” Cachafeiro suggests during feedback, “but a supervisor dressing you down because you missed the pager.”
For Engebretson, a longtime gamer, the project reinforces a core belief.
“People learn better when they’re engaged,” he says. “I think there’s a lot education can learn from video games.”
He also values the teamwork. “Making games is almost always collaborative. I far prefer working with a team rather than alone. There are a lot of benefits, accountability being one of them.”
Pick Five
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The other student team tackled diagnostic reasoning.
Players move through a simulated patient visit in three phases — history, physical exam and lab tests. In each phase, they are allowed to choose five questions or tests, encouraging them to prioritize the most clinically meaningful information.
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The phases unlock one by one, mirroring the flow of a real doctor visit, before players commit to a final diagnosis. Timers add pressure, and feedback at the end encourages reflection.
“Dr. Chandler had been using paper and spreadsheets, and this gives him a chance to make the game run smoother, and scale up,” says Diego Medina Molina.
The game’s 8‑bit pixel art is deliberate — approachable, not distracting. “We don't want super good-looking graphics to drive players’ attention away,” says Anlan Jiang, the lead for art and design, and also the overall project manager.
For many on the team, the course reshaped what game design can mean.
“I like when I can make my imagination come true. That gives me a huge sense of accomplishment,” says Zhao Jin, the engine lead. “I want to make something more than enjoyable but also meaningful to the players.”
“This class really helped resonate the impact game developers can have, not just with entertainment, but with education and medical research,” says Anlan Jiang.
The Science Behind the Play
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As the games evolved each week, Cachafeiro pushed students deeper into theory. His lectures covered cognitive load, flow state, inclusive design and evaluation strategies.
“For serious games,” he tells them, “The game guides the learner through the zone of proximal development — the gap between where the learner is at the beginning of a learning session and where they need to be. That’s the magic.”
Aesthetics matter, he says, but outcomes matter more. “If we’re not getting the results we want, we’re not accomplishing the task.”
A Vision Beyond the Classroom
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Cachafeiro sees the course as the seed of something larger — a resource for Duke Health, a spark for other interdisciplinary collaborations and a catalyst for new kinds of learning.
“I’m hoping this course allows prototypes to get grants, be researched and promote using this modality for instruction,” he says.
He envisions students from across Duke — engineering, education, sciences, humanities — joining future cohorts. “It doesn’t have to be just game development students.”
After students present their beta versions during the final class, Cachafeiro screens “The Remarkable Life of Ibelin,” a documentary about how games can profoundly shape human connection.
“Games are a modality to change education,” he says. “To change training. And hopefully, to change society.”
Main image: Students on the Pick Five team demonstrate their beta version to Mark Chandler, assistant professor of pediatrics, after the final class. (Photo: Carol Bales)
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(Photo: Carol Bales)
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