control group (n 6) was asked to refrain from playing any video games for 2 weeks and the game group (n 5) was asked to play any type of video game for 2 weeks. At the end of this time period, members of both the treatment and control groups returned to the lab for assessment of their laparoscopic skills. Surgeons in the gaming group played games for 6.2 hr on average during the 2 weeks and surgeons in the control group reported that they did not play any games. No difference was found in laparoscopic skills between these two groups at follow-up; however, this was not surprising given the small sample size, the low level of intensity of the gaming intervention, and the lack of control over the types of video games played. More recently, another study examined the causal effect of playing games on virtual surgical endoscopy skills with a relatively more scientifically rigorous research design. In this study (Schlickum, Hedman, Enochsson, Kjellin, & Fella¨nder-Tsai, 2009), medical students were randomly assigned to one of three groups. For a total of 5 weeks, one group of participants (n 15) underwent systematic training with the video game Half-Life, a 3-D first-person shooter game; another group underwent training with a 2-D non–first-person shooter game called Chessmaster. These two groups were asked to play between 30 and 60 min a day, 5 days a week, for 5 weeks. The control group participants were asked to refrain from playing any video games at all for 5 weeks. At follow-up, both video game training groups showed significant improvements on the MIST-VR simulator, whereas those in the control group showed none at all. Only the Half-Life group showed improvements on another surgical endoscopy task on the GI Mentor simulator. The enhanced skills shown by the Half-Life group were thought to be due to the high visual spatial skill demands of this game and its visual similarity to endoscopy. This suggests that the content and demands of video games are important for a transfer to surgical skills to occur. Overall, this study is the most scientifically sound study to date that provides evidence that playing certain video games can improve surgical skills. In sum, the research suggests that playing video games certainly does not make surgical skills worse. In some cases, it has no effect at all but, overall, both the correlational studies and the more scientifically grounded controlled study suggest that playing certain video games do improve surgical skill. Tailor-Made Games in Medical Education There are surprisingly few reports in the literature of tailor-made video games used to teach clinical skills. There are even fewer reports of evaluations of these games. In addition, it is often up for debate whether or not the software used in these areas is actually a video game or merely taking advantage of video game technology such as 3-D modeling software and game software engines in simulation scenarios. Cancer care. The Oncology Game was developed for medical students to help them appreciate the multidisciplinary aspects of oncology patient management, increase their knowledge of general principles in cancer care, and promote teamwork skills in solving clinical problems. The PC-based game was designed so that two teams of two students played the game at a time. Sixteen patient scenarios were developed for the game. Treatment plans for the patients required the involvement of two or three of the following cancer specialties: medical oncology, radiation oncology, and surgical oncology. At the start of the game, each student on a team is randomly assigned two patients. Teams work together to advance their patients through the game through surgery and medical and radiation oncology clinics in the best order to obtain the best treatment. Players are presented with questions on general oncology along the way. If they give a correct answer, they can proceed to the next clinic automatically. If they are incorrect, they must rely on the roll of the die to proceed to the clinic. The goal of the game is for each team to complete the treatment of four patients in order. A study was conducted to evaluate the effect of the game on medical student knowledge and their appreciation of the multidisciplinary nature of cancer management (Fukuchi, Offutt, Sacks, & Mann, 2000). Pre- and posttest evaluation of 16 students who played the game over a 3-week period showed that students who played two or more rounds of the game answered significantly more questions correctly on a 16-item true–false questionnaire about 16 different types of cancers represented in the game. 118 KATO Students gave highly favorable subjective ratings of improvements in their understanding of principles in cancer treatment, their knowledge of cancer, and their appreciation of the multidisciplinary nature of cancer through playing the game. Breast health. The same group that developed the interactive, computer-assisted board game for cancer above (the Oncology Game) also created a similar game that simulated the outpatient evaluation and management of patients presenting with breast problems. In this game, each player is responsible for managing four in-game patients. Patients are introduced when players roll a virtual die and drag the patient icon to a specified location so that the patient chart can be reviewed. A history of the patient is