Patient X

developed by:

B.J. Haddad bjhaddad@gmail.com

Jessica Ebel  jebel81@yahoo.com http://www-rohan.sdsu.edu/~ebel/portfolio/
Paulette morgan_wilkinson@yahoo.com
Wilkinson 
Toni Barone  toni_barone@hotmail.com

Instructional Objective

After playing Patient X, students will be able to: 

1. Describe how symptoms, diagnostic tests, and patient history can be used to
diagnose and treat a disease.
2. Define the roles of phagocytes, B-lymphocytes, and T-lymphocytes in the
immune system.
3. Distinguish between bacteria, viruses, and parasites by identifying these root
causes of diseases.
4. Apply science principles to the investigation of individual and community
problems.
5. Apply science principles to local and regional problems and their relationship to
one’s personal health, well-being, and safety.
 6. Apply principles of biology in environmental quality and in personal and
community health.
7. Describe the role of the skin in providing defense against infection.
8. Describe the role of antibodies in the body’s response to infection.
9. Describe the role of vaccination in protecting an individual from an infectious
disease.
10. Identify causes, characteristics, and avoidance strategies of viral, bacterial,
and parasitic diseases.
11. State the interactions of populations, resources, and their environments.
12. Identify why an individual with a compromised immune system may be unable
to fight off and survive infections by microorganisms.
13. List three of the body’s primary defenses against infections that diseases
cause.

Learners and Context of Use

Patient X was designed for high school and college-level health and biology classes,
and pre-med students. It is intended to supplement classroom learning. The game is
designed to for students to play in groups. The game can be played more than once
because the cases are similar, making it difficult for the students to memorize the
outcomes. We are working on a modification that would allow the students to play
against the teacher as an entire class. In addition, Team Alias plans to provide
“booster packs” that would include cards and scenario cases that can be added into
the decks as students gain more knowledge about communicable diseases.  

Competing Products
Pandemic is similar to Patient X in that the topic is diseases and how they spread. It is
also similar in that the game is won or lost depending on how far the disease spreads.
However, Patient X is significantly different because it includes factual content about
diseases, whereas to play Pandemic, the players do not need any knowledge about
diseases to win; Pandemic is all about luck of the draw and rolls of the die.  With
Patient X, players will learn about the symptoms of diseases, how they are
transmitted, as well as how to prevent and cure diseases.

Object of the Game

The object of this game is to gather enough data to correctly identify which disease
Patient X contracted. In order to make a diagnosis, players must land on a FLIGHT
SPACE and have a FLIGHT CARD in his or her possession. Then, after “flying” to the
center of the board, the team must name the disease, and use the Research Booklet
to describe the best PREVENTIONS and CURES.  If the player is right then he or she
wins the game. If the player guesses incorrectly, then he or she must move their pawn
back to start, and the DISEASE infects ten more healthy individuals.  However, if the
DISEASE infects all of the people (by covering up all of the faces on the board with
tokens from the innermost circle to the outermost circle), the RESEARCHERS lose and
the DISEASE wins!
Content Analysis 
 
Content Content Elements Game Elements
Type

Facts  There are three major groups  The players must determine
of microbes: viruses, bacteria, if they are battling a virus,
and protozoa. bacteria, or protozoa.
 Bacteria live almost  By listening to the details
everywhere: in soil and water, presented in the case, players
in plants, and in animals. can determine if the disease
 Adaptable to widely varied was caused by a bacterium.
conditions, bacteria can  By listening to the details
withstand extremely harsh present in the case, players can
environments, such as hot determine if the disease was
springs and tundra.   caused by a bacterium.
 If conditions turn
unfavorable, some bacteria can
remain dormant until things
improve.

Concepts  Pathogen - A bacterium,  The players learn concepts by

virus, or other microorganism answering expertise questions.
that can cause disease.
 Livable microbe habitats -
Each microbe has its own
biological requirements: malaria
needs mosquitoes, hantavirus
lives in rodents, influenza
survives in many animals, and
HIV cannot live outside the
human body for long.
 Endemic Disease - An
infection that is maintained in a
population without the need for
external inputs (think
chickenpox).
 Quarantine - Voluntary or
compulsory isolation, typically
to contain the spread of
something considered
dangerous, often but not always
disease.

Principles  If water is left standing, then  The players apply these

mosquitoes will have a place to principles as they try to determine
reproduce. the disease causing the epidemic. 
 If an epidemic reaches  The Fate cards integrate these
 worldwide proportions, then it is principles into the game.
considered a pandemic.
 If there is an especially wet
season, then more (disease-
carrying) rodents are born.
 International travel increases
risk of epidemic.
 Contamination of water and
food supplies increase the level
of risk.
 Environmental Change - If the
environment changes in a way
that is beneficial to pathogens
and/or detrimental to people,
then epidemics are likely to
occur.
 Disease outcomes - If you get
cholera, then it can kill you
within hours
 Disease occurs when an
outside agent capable of causing
the disease meets a host that is
vulnerable to the agent in an
environment that allows the
agent and host to interact.

Procedures To trace an outbreak to its source  Players have the opportunity

and identify the microbe that causes to collect symptom cards.
it:  Players may interview
 Epidemiologists start by Patient X to learn more about
interviewing the people how the disease was
stricken with the disease.  contracted.
 Next they try to find common  Players use the Notebook to
links between these people and gather data about the disease.
the ways the disease has  When players land on a
spread.  Flight space, they can attempt
 Then they take samples from to identify the diagnosis.
anything that might contain
microbes relating to the
outbreak—from blood and local
insects to food and water. 
 To prevent spreading of the
epidemic, contain infected
individuals.

To respond to a newly emerging

epidemic or outbreak:
 Prepare for field work.
 Establish the existence of an
 outbreak.
 Verify the diagnosis.
 Define and identify cases.
 Describe and orient the data
in terms of time, place, and
person.
 Develop hypotheses.
 Evaluate hypotheses.
 Refine hypotheses and carry
out additional studies.
 Implement control and
prevention measures.
 Communicate findings.

Steps to curing a person with the

disease.

Processes  Weather cycles (or wet  The Fate cards integrate these
weather after a drought) can processes into the game.
disrupt the balance of the
species.
 Environmental changes, such
as land-clearings in forests,
irrigation canals, and rice
cultivation, created patches of
stagnant water where
mosquitoes could breed.
 Agricultural lifestyle changes
encouraged people to live in
greater proximity, making it
easy to mosquitoes to transfer
disease-causing microbes from
person to person.
 Pathogen life and
transmission cycles are often
processes. Think malaria and
HIV replication cycles.
 Epidemic waves are cyclical.

Probabilities  Whether a disease-carrier will To increase their chance of

mutate, becoming immune to winning, players will have to
pesticides. consider these probabilities while
 Whether a type of bacteria playing the game.
will become resistant to
antibiotics.
 When a gene will mutate to
cause an epidemic.
 How virulent is the disease?
 How fast is the disease
spreading?
  How well does the disease
respond to treatment?
 How will the state respond to
medical intervention in their
country?

Context The outbreak of a potentially Patient X in the center of the board

virulent disease and a race to stop it represents the disease outbreak,
from spreading. the circles of patients and red
tokens represent the spreading
infection and the pawns represent
the researchers trying to cure the
patients, identify the disease and
stop it from spreading.

Vantage Disease/victim, researcher  Each player in the game

Points has a unique perspective. 
o Player 1 is the
Disease (Patient X)
o Players 2-4 work as a
team of Researchers to try
and figure out the disease
before the Disease takes
over the board.

Game Materials
In the box you will find:  
One large playing board

Six player pawns 

One 6-sided die

One set of 10 different Cases

 Two Research Booklets

One Researcher’s Notepad 

One set of PATIENT HISTORY cards

One set of FATE cards

One set of EXPERTISE cards

A bunch of red tokens (round plastic chips)

                   

Time Required
It takes approximately one minute to set up the board and cards. Players will
probably spend two to three minutes reviewing the rules. An initial roll of the die
determines who is playing the disease. Total set up time is five minutes. How many
players, as well as how informed the players are about the diseases, determine the
length of game play. Therefore, estimated playtime is between 30 and 60 minutes.

The Rules
To begin, shuffle each deck of cards and place them face down in the designated
spots on the board.  Each player chooses a pawn and places it on the start space. In
order to determine roles and to select a starting player, each player must roll the die.
The player that rolls the highest number will play the role of the DISEASE.  The other
players will be RESEARCHERS, working together to try and stop the disease from
taking over.  The disease gets the first turn and play continues clockwise around the
table.  It is also important to note: The DISEASE does not move a pawn around the
board, but does get a turn to roll during each round of play.

Starting The Game

To begin, the DISEASE places a red token on the center circle to represent PATIENT X.
As the disease spreads outward from the center of the circle, it infects more of the
population.  The center circle is one patient (PATIENT X), each face in the next circle
represents two people, those in the next circle represent three people, and each face
in the last ring is worth four people.  At the start of the game, only one patient has
the disease and all of the rest on the board are healthy.  However, as the disease
spreads, different colored tokens will be placed over the healthy individuals to show
that they have become infected.  The number of tokens added and removed will
depend on how many points are earned and lost through game play.    

Now, the DISEASE player chooses a Case Sheet from the set.  It is recommended that
players start with CASE ONE to help later on when keeping track of games that have
been played previously. The RESEARCHERS share one Notepad throughout the game
and copies of the Research Booklets are distributed amongst the team to share.    

After the DISEASE player gets the Case Sheet, he or she reads the “Meet Patient X”
section aloud. During this time, the RESEARCHERS listen carefully and write any
important notes on the notepad. RESEARCHERS must use the Research Booklet as a
reference.  It includes important information about all of the possible diseases, their
symptoms, and how they might be transmitted, tested, and cured.  In this manner,
the RESEARCHERS will be able to collect notes about PATIENT X that will help them to
determine what disease they are up against.

The Second Turn And Beyond

Now the player to the left of the disease gets a turn and rolls the die.  The player
then moves his or her pawn that number of spaces around the board, always going
clockwise.  During the course of play, RESEARCHERS will land on the following spaces.
Some will force the player to draw a card, which will affect what happens on the
board.

Here is a description of each space:

OUTBREAK SPACE:  If a player lands on this space, the DISEASE gets to roll the die
and that number of people become infected.  The disease selects the correct number
of tokens needed to cover up healthy individuals on the board.  Remember that each
red token is worth one. Always cover from the innermost circle outward, and stack
tokens on top of each other as the disease spreads into the outer circles.

PATIENT HISTORY SPACE:  If a player lands on this space he or she must draw a
PATIENT HISTORY CARD.  The card will say one of the following: Interview with
Patient X, Symptom, Transmission, or Test Results. Depending on the card pulled, the
DISEASE reads one clue from that category off of the Case Sheet, starting with number
one.  The RESEARCHERS listen carefully and jot down notes on the team Notepad.
Some of the information given will tell about the disease.  Other information will help
RESEARCHERS to eliminate other diseases from the list of possibilities as they consult
the Research Booklet.  After each card is read, it should be placed in a discard pile
off to the side of the board.  

EXPERTISE SPACE:  If the player lands on this space, the DISEASE draws a EXPERTISE
CARD.  (The disease must draw and read the question aloud because the answer is
provided right there on the card!)  If the team answers the question correctly, they
can “heal” people (by removing tokens). If they answer incorrectly, the disease gets
to infect people (by adding tokens).  The number of individuals affected depends on
how far the disease has spread.  Players would add or remove from the outermost ring
that has tokens on it.  Therefore, if the disease has already spread to the last circle,
the question is worth 4 points (four red tokens).  If the disease is still in the second
circle, question is only worth 2 points (two red tokens).

FATE SPACE:  If the player lands on this space, he or she draws a FATE CARD.  These
cards represent uncontrollable circumstances and relate news regarding the outbreak.
They should not be written down as clues!  Some of the cards are beneficial to the
RESEARCHERS and others help the DISEASE to spread.  The numbers represent the
number of individuals that become diseased (red cards) or healthy (green cards) as a
result.  It is also important to know that some of the FATE CARDS are FLIGHT CARDS in
disguise!  If a player pulls a FLIGHT CARD he or she must hold on to that card for a
later time in the game.

FLIGHT SPACE: Members of the RESEARCH TEAM can only play a flight card when they
land on this space.  Read the FAQs section to learn which players will be allowed to
use this card to win the game!   

Additional Instructions and FAQs

What happens if a player can heal more patients than are sick on the board?
In this case the player who rolled gets to hold onto the number of tokens representing
the number of patients that would have been healed. They can use them on a future
turn if there are enough sick patients.  PATIENT X cannot be healed in this way! This
is not a way to win the game!

What happens if the players run out of PATIENT HISTORY CARDS?

Players do not receive additional clues.  At this point, if a player lands on a PATIENT
HISTORY SPACE and there are no more clues corresponding to the card they’ve drawn,
the disease gets to spread to 4 more people.

Who is allowed to use a FLIGHT CARD?

When playing with three players or less, any RESEARCHER can use the FLIGHT CARD,
regardless of who drew the card.  However, when playing with four or more players,
the player who drew the card must be the one to land on a FLIGHT SPACE and take
the flight.

Alternate Rules

Classroom/Group Play
1. Use only the Patient History cards to quiz students as a whole group on their
Epidemic knowledge.

2. Divide students into the groups of Researchers (6 groups maximum), Patient X

(1 group/player only) and the Disease (1 group/player only). The Patient X
Group chooses a Case and reads the introduction aloud to the rest of the class.
The Research Groups then take turns rolling and moving their pawns around the
board with the Disease Group taking turns and rolling once each round as with
 normal gameplay. All cards are drawn and read by the Disease Group and all
Patient Histories are read by the Patient X Group. The Research Group whose
pawn diagnoses the Disease first becomes Patient X Group for the next round.
If the Disease Group wins by infecting all the Patients on the board then they
become the Patient X Group for the next round. 

3. A variation of the above: The teacher plays the role of the Disease and
facilitates a whole group learning experience as the class is divided into groups
of Researchers.

Make it More or Less Challenging

1. Have students play the game without the referencing the Research Booklet.
Students will need to rely on their own knowledge of Epidemics to identify the
disease.

2. Use blank cards and have students generate additional Patient History cards.

3. The teacher can generate new scenarios based on additional diseases. To

differentiate, the teacher can create scenarios of obscure diseases that are
more difficult to diagnose or more common diseases that are more easily
identifiable. 

Motivational Issues
Jess Schell’s book The Art of Game Design was relied upon heavily in the creation of
this game. 
Experience: Patient X enables players in the Researcher role to experience fighting
(and perhaps defeating) a disease by using the knowledge they’ve gained in their
studies as well as the knowledge they’ve gained during gameplay. 
Goals: The goal of the game for researchers is to determine what disease Patient X
has and therefore stop the spread of the disease. Sub-goals are to determine if the
disease is caused by a bactertium, virus, or protozoa; how the disease is transmitted,
and so on. The goal of the disease is to spread faster than the researchers can heal or
diagonse the disease.
Problem Solving: The above goals and sub-goals are problems that must be solved. 
Curiosity: The unusual design of the game, mysterious title, and silhouette will
arouse player curiosity. They will want to know more about Patient X. Players will
want to gather enough information to diagnose the disease.
Challenge: Players are challenged to “save the world.” Players will want to show
their teammates that they are able to contribute to solving the mystery. The person
playing the disease can choose what information to give those playing Researcher,
challenging the Disease to select the information that will be most likely to confuse or
delay the researchers from discovering what disease it is.
Fantasy: While Patient X dies in some cases, no one actually dies as a result of this
game. The case studies describe the victim (Patient X) in a way that encourages the
players to feel empathy. The victims are male and female, young and old, and of
various nationalities. Players can fantasize about being a researcher who is able to
stop the spread of disease and possibly save the world.
Empathy: Schell states that empathy is an integral part of gameplay (Schell, page
123). As mentioned above under Fantasy, players in the Researcher role will
empathize with the characters described in the cases. Therefore, they will be
motivated to play because they can heal the infected, diagnose the disease, and stop
its spread--perhaps saving Patient X and possibly saving others.
Competition: Players in the role of researcher work to defeat the Disease. Disease
tries to infect enough people to defeat the researchers.
Cooperation/Collaboration: Players in the role of researcher work together as a
team, sharing information, knowledge, and strategies to defeat the Disease.
According to Schell, players will be motivated so as to “enjoy the deep pleasures that
come from group problem solving and being part of a successful team” (Schell, page
355).
Surprise: All players will be surprised by the Fate cards, which can heal patients or
infect more patients.
Chance: All players experience chance through rolls of the die, which spaces they
land on, and what cards they draw.
Interest: The players are immediately hooked by the Case study. Throughout the
game there are peaks of interest as the players learn more about Patient X, followed
by periods of rest.
Visible Progress: All players see their progress in the game by the number of (or lack
of) tokens on the board. Researchers are motivated to reduce the number of tokens
while the Disease is motivated to increase the number of tokens.
Fun: The playtesters were observed to be having fun while playing this game. (They
were smiling, laughing, and didn’t want to stop playing.) When asked what was fun,
they said they especially liked the Patient History cards as well as working together to
solve a problem.

The ARCS model (Keller) was also used.

Attention: The players are presented with a game board that is visually stimulating.
They are curious about the circular shapes, symbols, and silhouettes, which are
unusual for a board game. They see a large silhouette of a person that is labeled:
Patient X. They want to know more about Patient X.
Relevance: The players find Patient X relevant because it gives them an opportunity
to show the others players what they know and have learned about diseases. The
game is geared toward students who will find it relevant because it covers what they
have been studying.
Confidence: Players recognize aspects of the game, giving them confidence that they
can play (and possibly win). They see the game’s rules, a die, and pawns, which are
quite familiar. The players who are researchers team up to share information, giving
them confidence that together, they can use to beat the disease.
Satisfaction: The game is entertaining, providing players satisfaction. Players are
rewarded by giving their best effort to win the game. Researchers who win the game
feel especially satisfied, having achieved a victory that prevents the spread of
disease. All players will also feel satisfaction at having gained more information about
diseases, preparing them for a test, or perhaps for use in their jobs or everyday lives.

Design Process
Our choice of “epidemics” as a game topic came out of our initial conversation about
the game. Our team was most interested in pursuing this topic as we saw the most
potential for interesting content. We began our design process by brainstorming and
researching epidemics in order to learn as much as possible about the subject matter.
The Centers for Disease Control website provided the necessary information for the
content of the game. We then reviewed the game Pandemic for ideas on how to
structure a game about epidemics. Unlike Pandemic, which requires little if any
knowledge of epidemics, we wanted Patient X to be not only fun, but also a learning
experience for the players.

Initially, we planned to have geography and historical perspective play a large role in
the game. We also contemplated including only water borne diseases. But as we
began designing the game, we realized that we needed to focus on the science of the
epidemics and simplifying the gameplay. Each member of our team focused on
specific elements of the game. 

Two rounds of playtesting were conducted in order to gather feedback about the
game. Each member of our group playtested the game with various groups of two to
four players.  Feedback from our playtesting that we incorporated in our game
revisions included: 
1. Building stories into the scenarios.
2. Simplifying the game by removing scoring system and focusing specifically on
the cards.
3. Adding more opportunities for expertise cards to be drawn as they were
popular with the playtesters as well as an excellent vehicle for students
(players) to learn content.
4. Add more challenge to the game by having the disease spread more quickly.

There are many lessons learned from this design process. The most important is to
have a clear objective for how to win the game. Once that goal was clear, the rest of
the game design centered around keeping gameplay interesting and well balanced.
While it was interesting learning about the diseases, an more thorough understanding
of the game’s content at the start of the design process would be helpful in the
future. It was a challenge trying to learn about game design and apply it to content
that we were unfamiliar with. 

References

Centers for Disease Control and Prevention. Web. 10 Oct. 2010.

<http://www.cdc.gov>.

"Great Dorm & Grown-Up Party Games: Pandemic." About.com. Web. 9 Oct. 2010.
<http://youngadults.about.com/od/dormlife/gr/pandemic.htm>.

"Pandemic." BoardGameGeek. Web. 8 Oct. 2010.

<http://boardgamegeek.com/boardgame/30549/pandemic>.

Schell, J. (2010). The Art of Game Design. Burlington, MA: Morgan Kaufmann
Publishers. (Original work published 2008).

"Science Standards." California Educational Standards for Grades 9-12. Web. 10 Oct.
2010. <http://www.cde.ca.gov/be/st/ss/documents/sciencestnd.pdf>.
"Standards for Science Teacher Preparation." National Science Teachers Association.
Web. 8 Oct. 2010. <http://www.nsta.org/pdfs/nstastandards2003.pdf>.

"What is motivational design?." ARCS Model. Web. 15 Oct. 2010.

<http://www.arcsmodel.com/Mot%20dsgn%20Mot%20dsgn.htm>.

"Why is everyone so crazy over Pandemic? A 2-player game Review." BoardGameGeek.

Web. 8 Oct. 2010. <http://boardgamegeek.com/boardgame/30549/pandemic>.