who played Re-Mission over the 3 months of the study maintained higher levels of chemotherapy in their blood and took their prophylactic antibiotic medication more frequently as prescribed than patients in the control group. Patients who played Re-Mission also showed greater increases in knowledge about cancer and self-efficacy to manage their cancer than patients in the control group. The research showed that a tailor-made video game for young people with cancer can have an impact on important health behaviors that are related to survival outcomes. The evidence supports the use of tailor-made games for specific medical goals. These games vary widely in terms of their content and the platforms on which they are delivered, yet they all harness the power to focus, engage, and motivate players in an activity. They go beyond the strengths of commercial games in their ability to increase specific knowledge about self-care and disease. They are also useful because they can help patients manage embarrassing aspects of certain illnesses in a private way. They can help patients develop specific skills needed to manage illnesses in a cost-effective, easily distributed way. In addition, even though video game reviewers may find that these games for health do not meet their standards for graphics and gameplay (Atriou, 2009; Stahl, 2009), their intended users give them high ratings of acceptability and find them engaging (Kato & Beale, 2006; Lieberman, 1997). Commercially Available Video Games in Medical Education Video games and video game technology have long been used to improve patient safety and patient care through their use as tools to teach doctors. Commercial games have been explored as a means to improve surgical skills, and tailor-made games for medical students have been used to teach clinical skills. Research on these games is reviewed below. Surgical skills. The relationship between video game play and surgical skills has been a focus of attention in particular because skills in playing certain video games are also crucial in performing surgery (e.g., visual spatial performance, eye– hand coordination, fine motor control, and reaction time). Studies have focused on how video game play may enhance some of these skills in a normal population. There is evidence that individuals who are avid video game players show enhanced visual attention skills (Green & Bavelier, 2003) and visual memory (Ferguson, Cruz, & Rueda, 2008). There is also causal evidence that nonplayers trained on video games show improved visual skills (Green & Bavelier, 2003, 2007). Other research has shown, however, that avid video game players do not differ from nonplayers in their visual processing strategies but merely have faster response times to visual attention tasks (Castel, Pratt, & Drummond, 2005). SPECIAL ISSUE: VIDEO GAMES IN HEALTH CARE 117 Studies with physicians that have examined the relationship of video game play to actual surgical skills such as targeting and grasping objects and suturing have also shown a great deal of evidence of a positive association. One study that compared the surgical skills of avid video game players (3 hr/week) with their less avid counterparts found that the avid players made 37% fewer errors and were 27% faster in completing a simulated laparoscopic procedure and suturing (Rosser et al., 2007). Physicians in this study were also asked to play three video games in the lab: Super Monkey Ball 2, Star Wars Racer Revenge, and Silent Scope. The physicians’ skill in playing these video games and their past experience playing games explained a significant amount of variance in their performance on the simulated laparoscopic procedure. A number of similar studies have been carried out that also show that physicians who play video games or are skilful at playing games make fewer errors in performing laparoscopy (Grantcharov, Bardram, Funch-Jensen, & Rosenberg, 2003), are faster at achieving proficiency on certain tasks in a laparoscopic simulator (Shane, Pettitt, Morgenthal, & Smith, 2008), and are more efficient in screening and faster in examining during simulated gastroscopy (Enochsson et al., 2004). One study with mixed findings showed that medical students with previous video game experience had enhanced skills in maneuvering safely in a sinus surgery simulator. Their advantage, however, did not hold as the demands and realism of the sinus surgery simulator increased at higher levels (Glaser, Hall, Uribe, & Fried, 2005). There are also studies that did not find an association between video gameplay experience or skills and robotic surgical performance (Hagen, Wagner, Inan, & Morel, 2009; Harper et al., 2007) or endoscopy (Westman et al., 2006). Taken together, the above studies are compelling, yet they merely show a correlation between video game experience or skill and surgical skills. They do not demonstrate the causal relationship that playing games will lead one to be more skillful in surgery. A handful of studies have more recently tested this causal claim. One study that found that video game skills were indeed associated with laparoscopic skill among novice surgeons also examined more closely the causal role of playing games on laparoscopic surgery skills (Rosenberg, Landsittel, & Averch, 2005). In this small study, participants were randomly assigned to a control group or a gaming group. The