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Objective: Assessment of the pedagogical effect and technological acceptance of the serious game, CODIFICO, which has been designed to train medical students in ICD-10 diagnosis coding. Materials and Methods: We designed the serious game, CODIFICO, as an alternative way to teach ICD-10 diagnosis coding to undergraduate medical students. To assess the pedagogical effect of the game, we used the quasiexperimental pretest-posttest design. The participants began by completing a knowledge pretest on Blackboard. After the pretest, the teacher presented the game to the students and invited them to play it for 1 week. Then, the students completed the posttest on Blackboard. We applied the Wilcoxon test to establish the difference between the pretest and posttest. We designed a questionnaire to evaluate the participants' technology acceptance toward the game. Results: Sixty-one undergraduate medical students from a large Colombian private university took part. There was no statistically significant difference between the pretest and the posttest. However, the game had some positive effects on knowledge. The game was well accepted among the participants. Conclusion: The game, CODIFICO, was useful to teach diagnosis determination, not diagnostic coding. Some of the reasons that caused this situation were insufficient attention to the pedagogical theory, excessive reliance on clinical aspects of the medical training, limited resources, and lack of experience at the medical school to design gamification strategies.

Introduction: The literature shows an optimistic landscape for the effectiveness of games in medical education. Nevertheless, games are not considered mainstream material in medical teaching. Two research questions that arise are the following: What pedagogical strategies do developers use when creating games for medical education? And what is the quality of the evidence on the effectiveness of games?, Methods: A systematic review was made by a multi-disciplinary team of researchers following the Cochrane Collaboration Guidelines. We included peer-reviewed journal articles which described or assessed the use of serious games or gamified apps in medical education. We used the Medical Education Research Study Quality Instrument (MERSQI) to assess the quality of evidence in the use of games. We also evaluated the pedagogical perspectives of such articles., Results: Even though game developers claim that games are useful pedagogical tools, the evidence on their effectiveness is moderate, as assessed by the MERSQI score. Behaviourism and cognitivism continue to be the predominant pedagogical strategies, and games are complementary devices that do not replace traditional medical teaching tools. Medical educators prefer simulations and quizzes focused on knowledge retention and skill development through repetition and do not demand the use of sophisticated games in their classrooms. Moreover, public access to medical games is limited., Discussion: Our aim was to put the pedagogical strategy into dialogue with the evidence on the effectiveness of the use of medical games. This makes sense since the practical use of games depends on the quality of the evidence about their effectiveness. Moreover, recognition of said pedagogical strategy would allow game developers to design more robust games which would greatly contribute to the learning process.

Objectives To characterize the perception of Diagnosis-Related Groups (DRGs) as an innovation among physicians, nurses and administrative staff in a hospital in Colombia. Methods A case study of innovative culture in a hospital. Surveys and focus groups were carried out with the medical, nursing and administrative staff. Descriptive statistics were calculated for the perceptions of innovative culture. Comparative analysis was done between professional groups. The results of the focus groups were transcribed and analyzed to deepen the findings of the surveys. Results Significant differences were found in perceptions of the innovative culture. The nursing staff were more enthusiastic than doctors when evaluating the innovative culture and leadership. Physicians felt more autonomy when discussing professional issues. Administrative staff assessed the Hospital's disposition to acquire new medical technologies as higher than that of physicians. The three groups know little about DRG's. Conclusions When implementing a health innovation it is advisable to analyze its effect on the professionals who participate in the implementation. Physicians perceive DRGs as a threat to their professional autonomy, while nurses see it as a pro-innovation force. It is important to involve nursing and administrative staff when implementing this kind of innovation.

The aim of this study was to explore the determinants of non-implementation of diagnosis-related groups (DRGs) by hospitals in Colombia. A qualitative case was carried out to analyze the directors' perceptions in six hospitals with and without DRGs in Bogotá. The interviews are based on the Innovation Diffusion Theory. The directors had similar perceptions of the determinates. DRGs were seen as positive, but encountered organizational and institutional obstacles. Without a targeted public policy, the likelihood of implementing DRGs in Colombia is slight.

Objective: Describing the extent and forms of use of pay for performance (P4P) in Colombian healthcare., Methods: This was a descriptive study based on interviews and surveys of health insurance agency managers in Bogotá, Colombia. The authors relied on transaction cost theory to interpret the results., Results: P4P was found to be used by contribution scheme insurers in an outpatient setting, basically in promotion and prevention; P4P is not being used in a hospital setting. Subsidized scheme insurers do not use P4P. Similarly, P4P is not being used in the case of so called associated users., Conclusions: P4P use in Colombia is limited. Colombian practice only partially validates the transaction costs theory approach to governance model attributes, one of which is incentive intensity.