Gamification as a tool for enhancing graduate medical education

Teaching geriatric medicine through gamification: a tool for enhancing postgraduate education in geriatric medicine

BACKGROUND

Polypharmacy is becoming increasingly common and all doctors must be prepared to manage it competently.

AIMS

The aim of this project is to evaluate the feasibility and use of a novel gamification-based teaching intervention on polypharmacy among doctors undergoing advanced geriatric training. Among others, one of the learning goals for the students was to be able to describe the adherence to medication.

METHODS

Electronic questionnaire sent to students of the third session "evidence-based medicine in geriatrics" of advanced postgraduate course in geriatrics of the European Academy for Medicine of Ageing.

RESULTS

Most students reported issues with forgetting doses and remembering sufficiently to establish a medication routine due to busy schedules as well as social influences around medication taking. Reflecting on the challenges of the game, most students reported that their own prescribing practice was likely to change.

DISCUSSION AND CONCLUSION

The current model of learning appears to be a feasible approach for postgraduate medical education or in other areas of healthcare such as nursing or physiotherapy. Learning through action and reflection promotes deeper thinking and can lead to behavioral change, in this case thus enhancing the attitudes and understanding regarding pharmacological issues associated with ageing. Recommendations for future research in medical education about medication adherence are outlined.

Gamification in otolaryngology: A narrative review

INTRODUCTION

The medical field has incorporated gamification elements into education platforms over the past decade. The standard definition for gamification that has been adopted by most research studies is the addition of game elements and game mechanics within a platform to enhance user engagement. In this review, seven established, consolidated components, as well as an additional new or novel component, will be evaluated: a point system/leaderboards, question banks or gradable content, social interaction with other participants, leaderboards, progress or levels, immediate feedback, badges/icons or a reward system, and the novel component, a story line.

METHODS

Two reviewers searched MEDLINE, Cochrane, PsycINFO, Web of Knowledge, and the Nursing Registry. This review compares the one identified otolaryngology study with current residency education gamification practices within the medical field.The authors searched "residency AND gamification", "residency AND video games", and "residency AND games". After applying exclusion criteria, the 13 remaining studies included a procedure, questions/scenarios, and at least three gamification elements.

RESULTS

Across the 13 studies, the average number of included gamification elements was higher than the minimum threshold of three (3.84). Ten of the studies incorporated leaderboards, feedback, and social interaction; eight incorporated a question bank; and four incorporated progress bars, rewards, and story lines. The otolaryngology study incorporated four of the gamification components: a point system, instant feedback/solution after a question was answered, player-to-player communication, and a leaderboard.

CONCLUSION

Review of the current literature found that the medical field has limited research regarding the use of gamification in educational platforms. Despite many simulation studies and attempts at gamification, the medical community has not fully embraced gamification within residency education. In closing, the medical education community should establish a definition of "gamification" and survey residency programs to identify desired gamification elements.

Managing Gamified Programming Courses with the FGPE Platform

E-learning tools are gaining increasing relevance as facilitators in the task of learning how to program. This is mainly a result of the pandemic situation and consequent lockdown in several countries, which forced distance learning. Instant and relevant feedback to students, particularly if coupled with gamification, plays a pivotal role in this process and has already been demonstrated as an effective solution in this regard. However, teachers still struggle with the lack of tools that can adequately support the creation and management of online gamified programming courses. Until now, there was no software platform that would be simultaneously open-source and general-purpose (i.e., not integrated with a specific course on a specific programming language) while featuring a meaningful selection of gamification components. Such a solution has been developed as a part of the Framework for Gamified Programming Education (FGPE) project. In this paper, we present its two front-end components: FGPE AuthorKit and FGPE PLE, explain how they can be used by teachers to prepare and manage gamified programming courses, and report the results of the usability evaluation by the teachers using the platform in their classes.

An Interactive, Multimodal Curriculum to Teach Pediatric Cardiology to House Staff

Pediatricians must be able to diagnose, triage, and manage infants and children with congenital heart disease. The pediatric cardiology division at the Medical University of South Carolina updated their curriculum for pediatric residents to a format supported by constructivist learning theory. The purpose of this study is to determine if shorter, interactive learning with fellow and faculty involvement improved pediatric cardiology knowledge demonstrated through test scores and resident satisfaction. A curriculum of short lectures and interactive workshops was delivered over 6 weeks in August and September 2018. Residents answered a 10-question pretest prior to the curriculum, followed by a post-test immediately after the last session and a delayed post-test 8 months later. Residents also provided summative feedback on the educational sessions. Sixty-six residents were eligible to participate in the curriculum with 44 (67%) completing the pretest, 40 (61%) completing the post-test, and 33 (50%) completing the delayed post-test. The mean score increased significantly from 56 to 68% between the pretest and post-test (p = 0.0018). The delayed post-test mean score remained high at 71% without significant change (p = 0.46). Overall feedback was positive highlighting the interactive nature of lectures and the participation of cardiology fellows. Using an interactive, multimodal educational series, pediatric residents had a significant increase in pediatric cardiology test scores and demonstrated good retention.

Measuring and Improving Evidence-Based Patient Care Using a Web-Based Gamified Approach in Primary Care (QualityIQ): Randomized Controlled Trial

BACKGROUND

Unwarranted variability in clinical practice is a challenging problem in practice today, leading to poor outcomes for patients and low-value care for providers, payers, and patients.

OBJECTIVE

In this study, we introduced a novel tool, QualityIQ, and determined the extent to which it helps primary care physicians to align care decisions with the latest best practices included in the Merit-Based Incentive Payment System (MIPS).

METHODS

We developed the fully automated QualityIQ patient simulation platform with real-time evidence-based feedback and gamified peer benchmarking. Each case included workup, diagnosis, and management questions with explicit evidence-based scoring criteria. We recruited practicing primary care physicians across the United States into the study via the web and conducted a cross-sectional study of clinical decisions among a national sample of primary care physicians, randomized to continuing medical education (CME) and non-CME study arms. Physicians "cared" for 8 weekly cases that covered typical primary care scenarios. We measured participation rates, changes in quality scores (including MIPS scores), self-reported practice change, and physician satisfaction with the tool. The primary outcomes for this study were evidence-based care scores within each case, adherence to MIPS measures, and variation in clinical decision-making among the primary care providers caring for the same patient.

RESULTS

We found strong, scalable engagement with the tool, with 75% of participants (61 non-CME and 59 CME) completing at least 6 of 8 total cases. We saw significant improvement in evidence-based clinical decisions across multiple conditions, such as diabetes (+8.3%, P<.001) and osteoarthritis (+7.6%, P=.003) and with MIPS-related quality measures, such as diabetes eye examinations (+22%, P<.001), depression screening (+11%, P<.001), and asthma medications (+33%, P<.001). Although the CME availability did not increase enrollment in the study, participants who were offered CME credits were more likely to complete at least 6 of the 8 cases.

CONCLUSIONS

Although CME availability did not prove to be important, the short, clinically detailed case simulations with real-time feedback and gamified peer benchmarking did lead to significant improvements in evidence-based care decisions among all practicing physicians.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03800901; https://clinicaltrials.gov/ct2/show/NCT03800901.

Effects of Gamification on the Benefits of Student Response Systems in Learning of Human Anatomy: Three Experimental Studies

This paper presents three experiments to assess the impact of gamifying an audience response system on the perceptions and educational performance of students. An audience response system called SIDRA (Immediate Audience Response System in Spanish) and two audience response systems with gamification features, R-G-SIDRA (gamified SIDRA with ranking) and RB-G-SIDRA (gamified SIDRA with ranking and badges), were used in a General and Descriptive Human Anatomy course. Students participated in an empirical study. In the academic year 2019–2020, a total of 90 students used RB-G-SIDRA, 90 students employed R-G-SIDRA in the academic year 2018–2019, and 92 students used SIDRA in the academic year 2017–2018. Statistically significant differences were found between final exam grades obtained by using RB-G-SIDRA and SIDRA, U = 39.211 adjusted p = 0.001 and RB-G-SIDRA and R-G-SIDRA U = 31.157 adjusted p = 0.015, thus finding strong evidence with respect to the benefit of the badges used in RB-G-SIDRA. Moreover, in the students’ SIDRA systems scores, statistically significant differences were found between RB-G-SIDRA and SIDRA, U = −90.521 adjusted p < 0.001, and between R-G-SIDRA and SIDRA, U = −87.998 adjusted p < 0.001. Significant correlations between individual and team scores were also found in all of the tests in RB-G-SIDRA and G-SIDRA. The students expressed satisfaction, engagement, and motivation with SIDRA, R-G-SIDRA, and RB-G-SIDRA, thus obtaining a final average assessment of 4.28, 4.61, and 4.47 out of 5, respectively. Students perform better academically with gamified versus non-gamified audience response systems. Findings can be used to build a gamified adaptive learning system.

Gamification and education: A pragmatic approach with two examples of implementation

Leveraging elements of game design and theories of human motivation, gamification provides a variety of techniques to engage learners in novel ways. Our Clinical and Translational Science Award created the software platform (Kaizen-Education©) to deliver gamified educational content in 2012. Here, we explore two novel use cases of this platform to provide practical insights for leveraging these methods in educational settings: (1) national training in rigor, reproducibility, and transparency and (2) attainment of learner competency (n = 7) as a gauge of curricular effectiveness across Master of Public Health degree tracks (n = 5). Data were captured in real time during player interaction with Kaizen-Education© to provide descriptive analyses of player engagement in both implementation examples. We then assessed item analysis to assess knowledge gain and competency attainment. We have just begun to leverage the potential for gamification to engage learners, enhance knowledge acquisition, and document completion of training, across various learning environments. We encourage a systematic approach to gamification applying insights from self-determination theory to learners and learning environments, a methodical approach to game design and rigorous analysis after implementation to generate evidence-based insights to maximize educational return for time invested.

Teaching the technical performance of bronchoscopy to residents in a step-wise simulated approach: factors supporting learning and impacts on clinical work - a qualitative analysis

BACKGROUND

The ability to perform a bronchoscopy is a valuable clinical skill for many medical specialities. Learning this skill is demanding for residents, due to the high cognitive load. Lessons learned from cognitive load theory might provide a way to facilitate this learning. The aim of this study was to investigate residents' perception of factors that support and hinder learning, as well as outcome and acceptance of a workshop on flexible bronchoscopy.

METHODS

Three half-day workshops were designed to teach 12 residents the basics of handling a flexible bronchoscope. They consisted of four phases that alternated between short theoretical aspects and longer practical situations. The practical phases focussed initially on manoeuvring a bronchoscope through holes in panels inside a box, and then on examination and practice using a three-dimensional printed model of the bronchial tree. Afterwards, three audio- and video-recorded focus groups were conducted, transcribed and coded, and underwent reflexive thematic analysis.

RESULTS

Analysis of the focus groups defined two themes: (1) factors that supported a safe and positive learning environment were optimised for intrinsic load, simulated setting, absence of pressure, dyad practice (working in pairs), small group sizes and playful learning; and (2) impacts on clinical work were perceived as high levels of learning and improved patient safety. The residents did not report factors that hindered their learning. Some suggestions were made to improve the set-up of the wooden box.

CONCLUSIONS

The half-day workshop was designed according to several factors, including cognitive load theory in a simulated setting, and creation of a safe and positive learning environment. The residents perceived this as supporting learning and patient safety. Further studies can be designed to confirm these results in a quantitative setting.

TRIAL REGISTRATION

This study was not interventional, therefore was not registered.

Virtual, Augmented, and Alternate Reality in Medical Education: Socially Distanced but Fully Immersed

BACKGROUND

Advancements in technology continue to transform the landscape of medical education. The need for technology-enhanced distance learning has been further accelerated by the coronavirus disease (COVID-19) pandemic. The relatively recent emergence of virtual reality (VR), augmented reality (AR), and alternate reality has expanded the possible applications of simulation-based education (SBE) outside of the traditional simulation laboratory, making SBE accessible asynchronously and in geographically diverse locations.

OBJECTIVE

In this review, we will explore the evidence base for use of emerging technologies in SBE as well as the strengths and limitations of each modality in a variety of settings.

METHODS

PubMed was searched for peer-reviewed articles published between 1995 and 2021 that focused on VR in medical education. The search terms included medical education, VR, simulation, AR, and alternate reality. We also searched reference lists from selected articles to identify additional relevant studies.

RESULTS

VR simulations have been used successfully in resuscitation, communication, and bronchoscopy training. In contrast, AR has demonstrated utility in teaching anatomical correlates with the use of diagnostic imaging, such as point-of-care ultrasound. Alternate reality has been used as a tool for developing clinical reasoning skills, longitudinal patient panel management, and crisis resource management via multiplayer platforms.

CONCLUSION

Although each of these modalities has a variety of educational applications in health profession education, there are benefits and limitations to each that are important to recognize prior to the design and implementation of educational content, including differences in equipment requirements, cost, and scalability.

Poverty Related Education in Pediatrics: Current State, Gaps and Call to Action

Children are the poorest age group in our country, with 1 in 6, or 12 million, living in poverty. This sobering statistic became even more appalling in spring 2020 when COVID-19 magnified existing inequities. These inequities are particularly important to pediatricians, because poverty, along with racism and other interrelated social factors, significantly impact overall child health and well-being. It is imperative that pediatric educators redouble their efforts to train learners to recognize and address health inequities related to poverty and all of its counterparts. In this paper, we describe the current state of poverty-related training in pediatric undergraduate, graduate, and continuing medical education as well as opportunities for growth. We highlight gaps in the current curricula, particularly around the intersectionality between poverty and racism, as well as the need for robust evaluation. Using a logic model framework, we outline content, learning strategies, and outcomes for poverty-related education. We include opportunities for the deployment of best practice learning strategies and the incorporation of newer technologies to deliver the content. We assert that collaboration with community partners is critical to shape the depth and breadth of education. Finally, we emphasize the paramount need for high-quality faculty development and accessible career paths to create the cadre of role models and mentors necessary to lead this work. We conclude with a call for collaboration between institutions, accrediting bodies, and policymakers to promote meaningful, outcome-oriented, poverty-related education, and training throughout the medical education continuum.

FUN AND GAMES: DESIGNING A GAMIFIED CENTRAL VENOUS CATHETERIZATION TRAINING SIMULATOR

Gamification, or adding elements of games to training systems, has the potential to increase learner engagement and information retention. However, the use of gamification has yet to be explored in Central Venous Catheterization (CVC) trainers which teach a commonly performed medical procedure with high incidence rates. In order to combat these errors, a Dynamic Haptic Robotic Trainer (DHRT) was developed, which focuses on vessel identification and access. A DHRT+ system is currently under development that focuses on whole procedure training (e.g. sterilization and catheter insertion), including a gamified Graphical User Interface. The goal of this paper was to (1) develop a game-like, patient-centered interface to foster personalized learning and (2) understand the perceived utility of gamification for CVC skill development with expert doctors. This paper outlines some of the potential benefits and deficits of the use of gamification in medical trainers that can be used to drive simulation design.

Gamification and Game-Based Strategies for Dermatology Education: Narrative Review

BACKGROUND

Game-based approaches, or gamification, are popular learning strategies in medical education for health care providers and patients alike. Gamification has taken the form of serious educational games and simulations to enable learners to rehearse skills and knowledge in a safe environment. Dermatology learners in particular may benefit from gamification methods, given the visual and procedural nature of the field.

OBJECTIVE

This narrative review surveys current applications of gamification within general medical training, in the education of dermatology students, and in dermatology patient outreach.

METHODS

A literature search was performed using PubMed, Google Scholar, and ResearchGate to access and review relevant medical education- and dermatology-related gamification studies published in peer-reviewed journals. Two independent researchers with education and experience in dermatology screened publications to select studies featuring a diversity of gamification approaches and study subjects for in-depth examination.

RESULTS

A total of 6 general medical education-related and 7 dermatology-specific gamification studies were selected. Gamification generally increased motivation and engagement, improved reinforcement of learning objectives, and contributed to more enjoyable and positive educational experiences compared to traditional modes of instruction. Enhancing examination scores, building confidence, and developing stronger team dynamics were additional benefits for medical trainees. Despite the abundance of gamification studies in general medical education, comparatively few instances were specific to dermatology learning, although large organizations such as the American Academy of Dermatology have begun to implement these strategies nationally. Gamification may also a provide promising alternative means of diversifying patient education and outreach methods, especially for self-identification of malignant melanoma.

CONCLUSIONS

Serious games and simulations in general medical education have successfully increased learner motivation, enjoyment, and performance. In limited preliminary studies, gamified approaches to dermatology-specific medical education enhanced diagnostic accuracy and interest in the field. Game-based interventions in patient-focused educational pilot studies surrounding melanoma detection demonstrated similar efficacy and knowledge benefits. However, small study participant numbers and large variability in outcome measures may indicate decreased generalizability of findings regarding the current impact of gamification approaches, and further investigation in this area is warranted. Additionally, some relevant studies may have been omitted by the simplified literature search strategy of this narrative review. This could be expanded upon in a secondary systematic review of gamified educational platforms.

Development and implementation of a novel Web-based gaming application to enhance emergency medical technician knowledge in low- and middle-income countries

BACKGROUND

Increasing access to high-quality emergency and prehospital care is an important priority in low- and middle-income countries (LMICs). However, ensuring that emergency medical technicians (EMTs) maintain their clinical knowledge and proficiency with procedural skills is challenging, as continuing education requirements are still being introduced, and clinical instructional efforts need strengthening. We describe the development and implementation of an innovative asynchronous learning tool for EMTs in the form of a Web-based trivia game.

METHODS

Over 500 case-based multiple-choice questions (covering 10 essential prehospital content areas) were created by experts in prehospital education, piloted with EMT educators from LMICs, and delivered to EMTs through a Web-based quiz game platform over a 12-week period. We enrolled 252 participants from nine countries.

RESULTS

Thirty-two participants (12.7%) completed the entire 12-week game. Participants who completed the game were administered a survey with a 100% response rate. Ninety-three percent of participants used their mobile phone to access the game. Overall, participants reported that the interface was easy to use (93.8% agreed or strongly agreed), the game improved their knowledge (100% agreed or strongly agreed), and they felt better prepared for their jobs (100% agreed or strongly agreed). The primary motivators for participation were improving patient care (37.5%) and being recognized on the game's leaderboard (31.3%). All participants reported that they would engage in the game again (43.8% agreed and 56.3% strongly agreed) and would recommend the game to their colleagues (34.4% agreed and 65.6% strongly agreed).

CONCLUSIONS

In conclusion, a quiz game targeting EMT learners from LMICs was viewed as accessible and effective by participants. Future efforts should focus on increasing retention and trialing languages in addition to English.

Grant deadline: An escape room to simulate grant submissions

BACKGROUND AND PURPOSE

Previous lectures for graduate trainees did not convey the urgency, complexity, and challenges of a successful grant submission. To increase engagement, instructors applied gamification principles to create an educational escape room. Serious games used in other settings engage participants to solve problems, build teamwork, and improve communication skills. This study was designed to fill a gap in the types of educational training effectively conducted via escape rooms.

EDUCATIONAL ACTIVITY AND SETTING

A college of pharmacy team implemented a game to simulate the grant submission process and familiarize trainees to internal processes and resources. Participants searched for grant opportunities, identified proposal errors, solved research-related clues to open locks, contacted a difficult collaborator, physically located resources, and requested permission for late submission. The activity was implemented during an introductory class for first-year graduate students (n = 19). Learning objectives targeted the technical and relational aspects of proposals within a realistic, timed setting. Student perceptions of the escape room experience were gathered via individual interviews (n = 8) and evaluated by thematic analysis.

FINDINGS

Analysis of participant emotions, thoughts, and attitudes identified common themes of excitement (63%), fun (50%), stress (38%), and frustration (25%). Compared to didactic instruction, many interviewed students preferred the escape room (63%) and found it conducive to learning (63%). A subset thought it might not work for everyone (13%) or would be improved by adding a didactic component (13%).

SUMMARY

This escape room served as an engaging method to introduce graduate students to the grant submission process.

Efficacy of Serious Games in Healthcare Professions Education: A Systematic Review and Meta-analysis

SUMMARY STATEMENT

Serious games (SGs) are interactive and entertaining software designed primarily with an educational purpose. This systematic review synthesizes evidence from experimental studies regarding the efficacy of SGs for supporting engagement and improving learning outcomes in healthcare professions education. Randomized controlled trials (RCTs) published between January 2005 and April 2019 were included. Reference selection and data extraction were performed in duplicate, independently. Thirty-seven RCTs were found and 29 were included in random-effect meta-analyses. Compared with other educational interventions, SGs did not lead to more time spent with the intervention {mean difference 23.21 minutes [95% confidence interval (CI) = -1.25 to 47.66]}, higher knowledge acquisition [standardized mean difference (SMD) = 0.16 (95% CI = -0.20 to 0.52)], cognitive [SMD 0.08 (95% CI = -0.73 to 0.89)], and procedural skills development [SMD 0.05 (95% CI = -0.78 to 0.87)], attitude change [SMD = -0.09 (95% CI = -0.38 to 0.20)], nor behavior change [SMD = 0.2 (95% CI = -0.11 to 0.51)]. Only a small SMD of 0.27 (95% CI = 0.01 to 0.53) was found in favor of SGs for improving confidence in skills.

Gamification of health professions education: a systematic review

Gamification refers to using game attributes in a non-gaming context. Health professions educators increasingly turn to gamification to optimize students' learning outcomes. However, little is known about the concept of gamification and its possible working mechanisms. This review focused on empirical evidence for the effectiveness of gamification approaches and theoretical rationales for applying the chosen game attributes. We systematically searched multiple databases, and included all empirical studies evaluating the use of game attributes in health professions education. Of 5044 articles initially identified, 44 met the inclusion criteria. Negative outcomes for using gamification were not reported. Almost all studies included assessment attributes (n = 40), mostly in combination with conflict/challenge attributes (n = 27). Eight studies revealed that this specific combination had increased the use of the learning material, sometimes leading to improved learning outcomes. A relatively small number of studies was performed to explain mechanisms underlying the use of game attributes (n = 7). Our findings suggest that it is possible to improve learning outcomes in health professions education by using gamification, especially when employing game attributes that improve learning behaviours and attitudes towards learning. However, most studies lacked well-defined control groups and did not apply and/or report theory to understand underlying processes. Future research should clarify mechanisms underlying gamified educational interventions and explore theories that could explain the effects of these interventions on learning outcomes, using well-defined control groups, in a longitudinal way. In doing so, we can build on existing theories and gain a practical and comprehensive understanding of how to select the right game elements for the right educational context and the right type of student.

Outcomes of the implementation of game-based anatomy teaching approaches: An overview

OBJECTIVE

We aimed to investigate to what extent the literature supports that game-based learning (gamification) could play a significant role in anatomy education.

MATERIALS AND METHODS

PubMed, Education Resources Information Center and Cochrane Databases were searched for papers with purpose to investigate the educational outcomes of game-based anatomy learning. We extracted from each paper the number of participants, type of study (comparative or not), level of evidence according to Kirkpatrick hierarchy, possible evaluation of statistical significance, method which was implemented, academic performance of participants after the educational intervention, perceptions about the effectiveness of game-based approach and its impact on motivation to learn.

RESULTS

Eight papers were included. Six of them were comparative, comprised assessment of students' examinations results and showed that those results were generally improved after exposure to game-based methods, in comparison with non-game-based ones. There is lack of evidence that the intensity of competition is correlated with the educational outcomes and that game-based approaches motivate students to a greater extent in comparison with other teaching methods.

CONCLUSION

Game-based methods could obtain a remarkable supplemental role in the blended learning approach, which is applied by anatomy educators. Further research is needed to shed light on the characteristics of game-based methods which are more useful and should be adopted.

Developing a Resident-led First-year Radiology Resident Lecture Series

The first year of radiology residency presents many unique challenges, from transitioning into a completely new, specialized field to preparing for call. Implementation of a longitudinal lecture series dedicated towards the clinical demands of being a first-year radiology resident may improve their knowledge and comfort level, as well as benefit the entire program. In this article, we outline our experience with the development of a resident-led dedicated first-year radiology resident lecture series providing targeted, high-yield instruction on rotation logistics, basic physics and artifacts, examination protocolling, and common and "don't miss" pathology.

Game-Based Learning in Virtual Worlds: A Multiuser Online Game for Medical Undergraduate Radiology Education within Second Life

Game-based learning can have a positive impact on medical education, and virtual worlds have great potential for supporting immersive online games. It is necessary to reinforce current medical students' knowledge about radiological anatomy and radiological signs. To meet this need, the objectives of this study were: to design a competition-based game in the virtual world, Second Life and to analyze the students' perceptions of Second Life and the game, as well as to analyze the medium-term retention of knowledge and the potential impact on the final grades. Ninety out of 197 (45.6%) third-year medical students voluntarily participated in an online game based on self-guided presentations and multiple-choice tests over six 6-day stages. Participants and non-participants were invited to perform an evaluation questionnaire about the experience and a post-exposure knowledge test. Participants rated the experience with mean scores equal to or higher than 8.1 on a 10-point scale, highlighting the professor (9.5 ± 1.1; mean ± SD) and the virtual environment (8.9 ± 1.1). Participants had better results in the post-exposure test than non-participants (59.0 ± 13.5 versus 45.3 ± 11.5; P < 0.001) and a lower percentage of answers left blank (6.7 ± 8.4 versus 13.1 ± 12.9; P = 0.014). Competitive game-based learning within Second Life is an effective and well-accepted means of teaching core radiological anatomy and radiological signs content to medical students. The higher medium-term outcomes obtained by participants may indicate effective learning with the game. Additionally, valuable positive perceptions about the game, the educational contents, and the potential benefit for their education were discovered among non-participants.

Gamification and Its Application in the Social Environment

This study sets out to conduct a systematic review of the emergence and evolution of gamification in the social environment, its main components, and its application as a learning tool through the motivation and engagement it generates in people. The results were obtained by consulting two major scientific databases, namely, Scopus and the Web of Science, which provided 136 articles published on the social environment from 2011 through to mid-2016 using the term gamification. The results of this study reveal how over time gamification has been gaining importance in the social environment through the use of its components. The highest number of scientific publications come from the United States and Spain. In addition, the use of gaming components increases motivation and engagement. It shows how gamification uses (individual or group) rewards according to the context to achieve the proposed objectives, being successfully implemented in education, health, services, and social learning.

A systematic review of digital badges in health care education

OBJECTIVES

A challenge to competency-based medical education is the verification of skill acquisition. Digital badges represent an innovative instruction strategy involving the credentialing of competencies to provide evidence for achievement. Despite increasing interest in digital badges, there has been no synthesis of the health care education literature regarding this credentialing strategy. The present authors proposed to address this gap by conducting the first systematic review of digital badges in health care education, to reveal pedagogical and research limitations, and to provide an evidence-based foundation for the design and implementation of digital badges.

METHODS

A systematic search of the medical education literature from January 2008 to March 2019 was conducted using MEDLINE, Web of Science, CAB Abstracts and ScienceDirect. Included studies described digital badges in academic or professional medical education programmes in any health care profession. Included studies were appraised and quality assessment, methodological scoring, quantitative analysis and thematic extraction were conducted.

RESULTS

A total of 1050 relevant records were screened for inclusion; 201 full text articles were then assessed for eligibility, which resulted in the identification of 30 independent papers for analysis. All records had been published since 2013; 77% were journal articles, and 83% involved academic health care education programmes. Scores for quality were relatively moderate. Thematic analyses revealed implications for the design and implementation of digital badges: learner characteristics may moderate student outcomes; the novelty effect can negate the value of digital badges, and educators may overcome instruction-related challenges with digital badges using design and implementation strategies such as the creation of badging ecosystems.

CONCLUSIONS

The results indicate a growing momentum for the use of digital badges as an innovative instruction and credentialing strategy within higher education and provide evidence for outcomes within a learner-centred, competency-based model of medical education. There is a paucity of research to support the design and implementation of this credentialing system in health care education. The potential benefits necessitate future high-quality analyses reporting institutional, patient and workplace-based outcomes to evaluate the effectiveness and moderating conditions of digital badges.

Gamification in Physical Education: Evaluation of Impact on Motivation and Academic Performance within Higher Education

Gamification is an innovative pedagogical approach to addressing problems related to social behaviour, student motivation and academic performance at different educational stages. Therefore, this research aimed to analyse its impact on the motivations and academic performances of university students. The research was carried out in the training of future teachers specialising in physical education during two academic courses. In total, 127 students participated in the study, divided into a gamified experimental group (n = 62) and a control group (n = 65). The participants completed a questionnaire to assess motivation in physical education before and after the intervention and performed a final exam to assess academic performance. The results indicated an increase in external regulation in the experimental group only. Furthermore, this group achieved significantly better academic performance. The findings of this study suggest that gamified implementation is beneficial for academic performance at the university stage, even though intrinsic motivation does not change. Furthermore, the nature of rewards or punishments, as characteristic of this pedagogical approach, could play an important role in the expected results, since external regulation increased significantly after the intervention.

A comparative case study of 2D, 3D and immersive-virtual-reality applications for healthcare education

BACKGROUND AND OBJECTIVE

The workings of medical educational tools are implemented using a myriad of approaches ranging from presenting static content to immersing students in gamified virtual-reality environments. The objective of this paper is to explore whether and how different approaches for designing medical educational tools affect students' learning performance.

MATERIALS AND METHODS

Four versions of an educational tool for the study of clinical cases were implemented: a 2D version, a gamified 2D version, a gamified 3D version, and a gamified immersive-virtual-reality version. All complying with the same functional requirements. Each version was used and evaluated by an independent group of students. The participants (n = 78) evaluated the applications regarding usefulness, usability, and gamification. Afterward, the students took an exam to assess the retention of information on the clinical cases presented.

RESULTS

One-sample Wilcoxon signed-rank tests confirmed that the participants perceived that it was at least quite likely that gamification helped improved their learning. In addition, based on the participants' perception, the gamification of the immersive-virtual-reality version helped the most to improve their learning performance in comparison with the gamified 2D and 3D versions.

CONCLUSIONS

Regardless of whether different versions of a medical educational tool (complying with the same functional requirements) are perceived as equally useful and usable, the design approach (either 2D, 3D, or immersive-virtual-reality with or without gamification) affects students' retention of information on clinical cases.

Spielerische Ansätze in Prävention und Gesundheitsförderung: Serious Games und Gamification

Digitale Spieleanwendungen können im Bereich Prävention und Gesundheitsförderung eingesetzt werden, um etwa gesundheitsrelevante Informationen zu vermitteln oder Verhaltensänderungen zu evozieren. Dabei sind die beiden relevantesten spielerischen Ansätze Serious Games (Spiele mit ernsthaftem Hintergrund) und Gamification (Anwendung spieltypischer Elemente in spielfremden Kontexten). Der Begriff Serious Games umschreibt Spiele, die eingesetzt werden, um ernsthafte Inhalte, wie zum Beispiel gesundheitliche Themen, zu vermitteln. Bei Gamification werden Spieldesignelemente, wie beispielsweise Punkte, Bestenlisten, Auszeichnungen, Profilgestaltung und Teamevents, eingesetzt, um eine Motivations- und Leistungssteigerung etwa in Lernumgebungen zu bewirken. Der vorliegende narrative Beitrag beleuchtet die Wirkungsweise und Studienlage sowie die Vor- und Nachteile spielerischer Anwendungen in der Prävention und Gesundheitsförderung und führt einige dieser Anwendungen exemplarisch auf.

Serious Games und Gamification zeigen in der Prävention und Gesundheitsförderung ein großes Potenzial. Insbesondere bei schwer erreichbaren und desinteressierten Zielgruppen kann ein direkter Bezug zu deren Lebenswelt hergestellt werden. Grundlagen für den wirkungsvollen Einsatz spielerischer Ansätze in der Arbeit und Ausbildung von Gesundheitsberufen sind die bereits hohe Vertrautheit mit dem Medium Spiel sowie die direkte Adressierung der psychologischen Grundbedürfnisse zur Steigerung der Motivation.

The effects of gamification on antimicrobial resistance knowledge and its relationship to dentistry in Saudi Arabia: a randomized controlled trial

Background

Antimicrobial resistance (AMR) has reached alarming levels and is considered to be a worldwide public health problem. One of the most significant factors contributing to the spread of AMR is the lack of proper knowledge about the use of antibiotics, which are being used more frequently in dentistry. Recent studies have found that gamification shows promising results for helping the average person improve their knowledge about health and may also be used to boost knowledge about AMR among the public. This study aimed to assess the effects of gamification on AMR awareness, using a board game to promote knowledge about AMR among the public in Saudi Arabia.

Methods

Using a single-blinded parallel group randomized controlled trial design, 94 volunteers were recruited and randomized into two groups. The study group received information about AMR by playing a board game, while the control group received the same information given in a conventional lecture. The participants were evaluated three times: (T1) before the intervention, (T2) immediately after the intervention, and (T3) one month after the intervention for follow-up to evaluate their retention of the information.

Results

Results showed that there were significant improvements (p <  0.05) in knowledge scores for T2 and T3 in comparison to the T1 baseline scores in both groups. However, the knowledge scores also relapsed significantly from T2 to T3 in both groups. Nevertheless, the difference in knowledge score T1 to T3 was significantly higher in the study group in comparison to the control group, and the participants had higher mean scores to use the game as health promotion method.

Conclusions

Gamification using a board game can significantly improve AMR knowledge, with better retention than conventional lecture. It is a promising method for boosting public knowledge about AMR and its relationship to dentistry.

Trial registration

ISRCTN registry: ISRCTN15884410 (retrospectively registered 26-October-2019).

Exploring Pediatric Resident Attitudes and Preferences for Board Exam Preparation

Objective The American Board of Pediatrics Certifying Exam (ABP CE) is a high stakes exam and is important for employment and fellowship opportunities in pediatrics. Although research has suggested interventions which may improve scores, little research has focused on resident perception of preparation for the ABP CE. In this study, we aimed to better define pediatric residents' attitudes and preferences regarding preparation for the ABP CE. Methods Pediatric residents from one residency program were invited to participate in focus groups to discuss their attitudes and preferences on board exam preparation for the ABP CE. Focus groups were audio recorded and transcribed. Conventional content analysis was used to analyze qualitative data. From the transcripts, authors developed codes through an iterative process, which were then organized into categories. These categories were then grouped into themes. Results Nineteen residents participated in three focus groups. Focus group transcription analysis resulted in 49 codes, which were sorted into 26 categories. The categories were then grouped into four key themes: 1) the ABP CE is not immediately important early in residency; 2) more personalized guidance is preferred; 3) consistent board preparation focus from the residency program is valued; 4) learning format is important. Conclusions Residents believe preparation for the ABP CE increases in importance as they progress through residency, and they desire more personalized, consistent, and structured focus from their training program related to ABP CE preparation. Attention to these perceptions can help guide pediatric residency program leadership in developing effective board exam preparation strategies and curricula for their residents.

Creating and testing a GCP game in an asynchronous course environment: The game and future plans

Introduction:

The National Institute of Health has mandated good clinical practice (GCP) training for all clinical research investigators and professionals. We developed a GCP game using the Kaizen-Education platform. The GCP Kaizen game was designed to help clinical research professionals immerse themselves into applying International Conference on Harmonization GCP (R2) guidelines in the clinical research setting through case-based questions.

Methods:

Students were invited to participate in the GCP Kaizen game as part of their 100% online academic Masters during the Spring 2019 semester. The structure of the game consisted of 75 original multiple choice and 25 repeated questions stemming from fictitious vignettes that were distributed across 10 weeks. Each question presented a teachable rationale after the answers were submitted. At the end of the game, a satisfaction survey was issued to collect player satisfaction data on the game platform, content, experience as well as perceptions of GCP learning and future GCP concept application.

Results:

There were 71 total players who participated and answered at least one question. Of those, 53 (75%) answered all 100 questions. The game had a high Cronbach’s alpha, and item analyses provided information on question quality, thus assisting us in future quality edits before re-testing and wider dissemination.

Conclusions:

The GCP Kaizen game provides an alternative method for mandated GCP training using principles of gamification. It proved to be a reliable and an effective educational method with high player satisfaction.

Development and Implementation of Interprofessional Relations Between a College of Pharmacy and Osteopathic Residency Programs in a Community Teaching Hospital

Background: Team-based health care optimizes patient outcomes, and therefore, both interprofessional education (IPE) and interprofessional relations (IPR) are required in health professions education, postgraduate training, and real-world clinical practice. Existing literature describes progressive developments and assessments of IPE in colleges of pharmacy and medicine; however, there are fewer reports describing processes or projects that foster physician-pharmacist IPR in clinical practices without established interprofessional collaborations. Objectives: The primary objective was to establish IPR between pharmacists and osteopathic residents in a community teaching hospital. The secondary objective was to innovate the delivery of pharmacotherapeutic content delivered to the residents during their didactic lecture series by providing active learning strategies. Methods: This report describes a project wherein college of pharmacy faculty developed IPR with osteopathic residents in a community teaching hospital that previously did not have any established physician-pharmacist IPR. Osteopathic medical residents completed a post-implementation survey after they attended a 12-month series of didactic lectures that incorporated active learning delivered by pharmacist faculty. Results: Sixty-six residents were eligible to complete the survey; 20 residents completed the survey. Eighteen residents believed that both physicians and pharmacists should be educated to establish IPR and that it should be included in professional, graduate, and continuing education settings for both professions. Sixteen residents believed that the active learning techniques employed by college of pharmacy faculty were useful for IPR. Conclusions: Physician-pharmacist IPR may be achievable in settings where IPR was previously sparse. Shared interests, adherence, and innovations in IPR frameworks are essential for developing physician-pharmacist IPR.

Theories of learning and teaching methods used in postgraduate education in the health sciences: a scoping review

OBJECTIVE

The objective of this scoping review was to determine the theories of learning and methods used in teaching in postgraduate education in the health sciences. The longer-term objective was to use the information gathered to design a workshop for teachers of postgraduate students.

INTRODUCTION

Whilst undergraduate teaching in the health sciences has received considerable attention in the literature in terms of methods used, innovative ideas and outcomes, the same cannot be said of postgraduate education. A considerable amount of postgraduate teaching takes place in the workplace and often in the form of informal teaching. The increasing complexity of health problems calls for innovative teaching.

INCLUSION CRITERIA

Papers included in this review were those that considered postgraduate education in the health science disciplines, including but not limited to medicine, nursing, occupational therapy, physiotherapy, pharmacy and dentistry, and that described theories of learning and/or teaching methods used in teaching.

METHODS

Five databases were searched for the period 2001 through 2016. PubMed yielded the most records (3142). No relevant papers were identified through hand searching of the references of the included papers. A data extraction table was developed and used to extract relevant information from included papers.

RESULTS

Sixty-one papers were included in the review. Most of the included papers were from the USA, with 17 published in 2015. Descriptive study designs were the most frequently identified study design. Most of the papers were from the medical disciplines. Twenty-seven papers did not refer to a teaching and learning theory, a further group referred to a theory but often towards the end of the paper, and seven papers had as their focus the importance of theories in medical education. The theories named were of a wide variety. Likewise, a wide range of teaching methods were identified.

CONCLUSIONS

It is clear that a range of theories and teaching methods are used in postgraduate health science education, with educators feeling the need to explore more innovative methods.

Kaizen: Interactive Gaming for Diabetes Patient Education

Objective: An estimated 100 million Americans have diabetes, undiagnosed diabetes, a high risk of being diagnosed with diabetes, or prediabetes. Many complications can arise if diabetes is poorly managed. Hence, the need for adequate knowledge, skills, and ability to care for oneself, known as diabetes self-care management, is needed to reduce complication rates. We used an interactive platform that incorporates principles of gamification to enhance user engagement to enhance diabetes knowledge. The purpose of this descriptive pilot study was to discover what adult patients with diabetes thought about this novel educational approach to diabetes education. Materials and Methods: We collected focus group data from participants at a diabetes clinic after they played an interactive diabetes trivia game, on our software platform (Kaizen Education). Transcripts were coded and common themes were identified. Results: We conducted 9 focus groups that included 33 adult (age >18) participants who had diabetes. An overarching theme of play/gaming as a form of learning was apparent, and after analyzing the coding several themes emerged, including preferences and desired environments (clinic and home) for learning, desired players (including family, significant others), and a good balance of question difficulty. Conclusions: Participants were overwhelmingly positive about gamified education and felt empowered to lead discussions with their health care providers about diabetes self-care education, in a sense "flipping" the traditional clinic patient education paradigm. These results suggested that a flipped clinic approach could be beneficial, empowering, and engaging for patients.

Feasibility and efficacy of gamification in general surgery residency: Preliminary outcomes of residency teams

BACKGROUND

Comprehensive studies evaluating the efficacy of team-based competition ("Gamification") in surgery have not been performed. Board pass rates and resident satisfaction may improve if surgical residents are involved in competition.

METHODS

Residents at Montefiore Medical Center (Bronx, New York) were surveyed and separated into teams during a draft. Each resident's performance was converted into a point system. Resident scores were combined into a team score and presented as a leaderboard. Awards were given. ABSITE, ACGME residency satisfaction, and ABS qualifying exam pass rates were compared.

RESULTS

Sixty percent of residents are inspired to improve their performance during gamification. ABSITE average percentile score improved from 28 to 43. ABS qualifying exam pass rates improved from 73% to 100%. Resident satisfaction improved from 65% to 88%. The point system allowed for establishing "growth curves" for each resident enabling enhanced assessment of residents.

CONCLUSIONS

A comprehensive team-based competition inspires performance, is feasible, and seems to improve ABSITE scores, ABS pass rates, and satisfaction while being a tool for assessment of performance.

A meta-analysis for comparing effective teaching in clinical education

Aim: Many factors affect learning outcomes, however studies comparing the effectiveness of different clinical teaching methods are limited. We utilize the list of influences on educational achievement compiled by John Hattie to inform a meta-analysis of learning effect sizes (ESs) associated with teaching-learning factors (TLFs) in clinical education. Methods: A literature search was conducted in PubMed to identify articles examining clinically relevant TLFs. Selection criteria were applied to identify learner-focused studies, with subsequent categorization by study design (pretest-posttest or controlled group). The Cohen's ES (d) for each TLF was extracted and a pooled ES determined. Results: From 3454 studies, 132 suitable articles enabled analysis of 16 TLFs' ESs. In general, ESs derived from pretest-posttest data were larger than those from controlled group designs, probably due to learner maturation effect. The TLFs of mastery learning, small group learning and goal settings possessed the largest ESs (d ≥ 0.8), while worked examples, play programs, questioning, concept mapping, meta-cognitive strategies, visual-perception programs and teaching strategies demonstrated ESs between 0.4 and 0.8. Conclusions: This is the first study to provide a rigorous and comprehensive overview of the effectiveness of TLFs in clinical education. We discuss the practical traits shared by effective TLFs which may assist teaching design.

Gamification: An Innovative Approach to Reinforce Clinical Knowledge for MD-PhD Students During Their PhD Research Years

A longstanding challenge facing MD-PhD students and other dual-degree medical trainees is the loss of clinical knowledge that occurs during the non medical phases of training. Academic medical institutions nationwide have developed continued clinical training and exposure to maintain clinical competence; however, quantitative assessment of their usefulness remains largely unexplored. The current study therefore sought to both implement and optimize an online game platform to support MD-PhD students throughout their research training. Sixty three current MD-PhD students completing the PhD research phase of training were enrolled in an institutionally-developed online game platform for 2 preliminary and 4 competition rounds of 3-4 weeks each. During preliminary game rounds, we found that participation, though initially high, declined precipitously throughout the duration of each round, with 37 students participating to some extent. Daily reminders were implemented in subsequent rounds, which markedly improved player participation. Average participation in competition rounds exceeded 35% (23/63) active participants each round, with trending improvement in scores throughout the duration of PhD training. Both player participation and progress through the research phase of the MD-PhD program correlated positively with game performance and therefore knowledge retention and/or acquisition. Coupled with positive survey-based feedback from participants, our data therefore suggest that gamification is an effective tool for MD-PhD programs to combat loss of clinical knowledge during research training.

Developing the Evidence Base for M-Learning in Undergraduate Radiology Education: Identifying Learner Preferences for Mobile Apps

PURPOSE

There is a lack of evidence for developing radiology mobile apps for medical students. This study identifies the characteristics which students perceive as most valuable to teaching radiology with mobile apps (m-learning).

METHODS

An online anonymous survey was administered to second- to fourth-year medical students at a single institution. The survey, which was based on established theoretical framework, collected students' preferred content organization, content presentation, and delivery strategies. The Copeland method was used to rank student preferences and a 2-tailed t test was used to determine if student responses were related to their clinical experience, with statistical significance at P < .05.

RESULTS

The response rate was 25.6% (163/635). For content organization, image interpretation (66.9%), imaging anatomy (61.3%), and common pathological conditions (50.3%) were selected as the most important. For content presentation, quizzes (49.1%) and case presentations (46.0%) were selected as the most useful. Students with clinical experience rated algorithms as more important (P < .01) and quizzes as less important (P = .03). For delivery strategies, ease of use (92.6%), navigation (90.8%), and gestural design (74.8%) were deemed the most applicable.

CONCLUSION

This study documents medical students' preferences for m-learning in radiology. Although learner preferences are not the only feature to consider in the development of educational technology, these provide the initial framework for radiologists wishing to develop and incorporate mobile apps into their teaching.

"Playing for Bragging Rights": A Qualitative Study of Students' Perceptions of Gamification

BACKGROUND

Nursing faculty sought to promote students' engagement with course material and their peers by using Kaizen, an online educational game. The purpose of this qualitative study was to learn more about nursing students' perceptions of team competition in an educational game and whether the game promoted their engagement with educational material in one fundamental nursing course.

METHOD

Qualitative data collection included focus groups, observations of students, documents showing leaderboards and game participation, and "status of competition" e-mails. Data were transcribed and coded to determine emerging themes.

RESULTS

Four themes emerged from data analysis: learning in teams, motivators to play, learning course content, and suggestions for game improvement.

CONCLUSION

Students were overwhelmingly positive about using a gamified platform for its educational rewards. They perceived that playing the game increased their knowledge retention, and they believed it helped them improve their test-taking skills. [J Nurs Educ. 2019;58(2):79-85.].

Innovative strategies: Increased engagement and synthesis in online advanced practice nursing education

INTRODUCTION

The struggle to maintain quality education in the online environment has brought about the redesign for the family nurse practitioner courses.

BACKGROUND

The family nurse practitioner program uses graduate Health Education Systems Incorporated examination as a quality indicator and program benchmark. A downward trend in Health Education Systems Incorporated examination scores stimulated a need for change. Two strategies were implemented to enhance engagement and improve synthesis of clinical information. Case-based learning and gamification involves the use of game thinking and game mechanics in non-game contexts to engage users in solving problems while the case-based discussions act as formative assessment tool, providing information on student's progress and development.

OBJECTIVES

To assess the implementation of innovative strategies on the Health Education Systems Incorporated examination scores and to enhance students engagement and synthesis of clinical information.

METHOD

Case presentations were created in the Learning Management System an online program, for every module. Interwoven throughout the module are various game elements. The game elements include voluntary participation with immediate feedback that can be both positive and negative and provides a social connection. The student has the freedom to fail and the freedom to choose without significant repercussions.

RESULTS

The results showed examination scores increased significantly. Using a one-way analysis of variance to compare Health Education Systems Incorporated examination scores between semester cohorts of students, followed by a post hoc pairwise comparison a statistically significant difference (p < .001) between previous semesters was identified.

CONCLUSION

Although there are many approaches for online learning, using case presentations can mirror different social and cultural situations to challenge the learner. Case-based discussion and gamification strategies are effective in engaging students in a challenging environment. Student responded positively to case-base presentation with game elements. Using this approach is designed to challenge and add value to the learning experience.

The effect of an International competitive leaderboard on self-motivated simulation-based CPR practice among healthcare professionals: A randomized control trial

BACKGROUND

Little is known about how best to motivate healthcare professionals to engage in frequent cardiopulmonary resuscitation (CPR) refresher skills practice. A competitive leaderboard for simulated CPR can encourage self-directed practice on a small scale. The study aimed to determine if a large-scale, multi-center leaderboard improved simulated CPR practice frequency and CPR performance among healthcare professionals.

METHODS

This was a multi-national, randomized cross-over study among 17 sites using a competitive online leaderboard to improve simulated practice frequency and CPR performance. All sites placed a Laerdal® ResusciAnne or ResusciBaby QCPR manikin in 1 or more clinical units - emergency department, ICU, etc. - in easy reach for 8 months. These simulators provide visual feedback during 2-minute compressions-only CPR and a performance score. Sites were randomly assigned to the intervention for the first 4-months or the second 4-months. Following any CPR practice by a healthcare professional, participants uploaded scores and an optional 'selfie' photo to the leaderboard. During the intervention phase, the leaderboard displayed ranked scores and high scores earned digital badges. The leaderboard did not display control phase participants. Outcomes included CPR practice frequency and mean compression score, using non-parametric statistics for analyses.

RESULTS

Nine-hundred nineteen participants completed 1850 simulated CPR episodes. Exposure to the leaderboard yielded 1.94 episodes per person compared to 2.14 during the control phase (p = 0.99). Mean CPR performance participants did not differ between phases: 90.7 vs. 89.3 (p = 0.19).

CONCLUSION

A competitive leaderboard was not associated with an increase in self-directed simulated CPR practice or improved performance.

Escape into patient safety: bringing human factors to life for medical students

Background

Patient safety is at the core of the General Medical Council (GMC) standards for undergraduate medical education. It is recognised that patient safety and human factors' education is necessary for doctors to practice safely. Teaching patient safety to medical students is difficult. Institutions must develop expertise and build curricula while students must also be able to see the subject as relevant to future practice. Consequently graduates may lack confidence in this area.

Method

We used gamification (the application of game design principles to education) to create a patient safety simulation for medical students using game elements. Gamification builds motivation and engagement, whilst developing teamwork and communication. We designed an escape room-a team-based game where learners solve a series of clinical and communication-based tasks in order to treat a fictional patient while avoiding 'clinician error'. This is followed up with an after action review where students reflect on their experience and identify learning points.

Outcome

Students praised the session's interactivity and rated it highly for gaining new knowledge and skills and for increasing confidence to apply patient safety concepts to future work.

Conclusion

Our findings are in line with existing evidence demonstrating the success of experiential learning interventions for teaching patient safety to medical students. Where the escape room has potential to add value is the use of game elements to engage learners with the experience being recreated despite its simplicity as a simulation. More thorough evaluation of larger pilots is recommended to continue exploring the effectiveness of escape rooms as a teaching method.

Gamification vs. Privacy: Identifying and Analysing the Major Concerns

Gamification, the use of game design elements in applications that are not games, has been developed to provide attractive environments and maintain user interest in several domains. In domains such as education, marketing and health, where gamification techniques are applied, user engagement in applications has increased. In these applications the protection of users’ privacy is an important aspect to consider, due to the applications obtaining a record of the personal information of their users. Thus, the purpose of this paper is to identify if applications where gamification is applied do respect users’ privacy. For the accomplishment of this aim, two main steps have been implemented. Since the main principle of gamification is the existence of game elements, the first step was to identify the set of game elements recorded in the literature that are commonly applied in various applications. Afterwards, an examination of the relationship between these elements and privacy requirements was implemented in order to identify which elements conflict with the privacy requirements leading to potential privacy violations and which elements do not. Α conceptual model according to the results of this examination was designed, which presents how elements conflict with requirements. Based on the results, there are indeed game elements which can lead to privacy violations. The results of this work provide valuable guidance to software developers, especially during the design stages of gamified applications since it helps them to consider the protection of users’ privacy in parallel from the early stages of the application development onwards.

A systematic review of serious games in medical education: quality of evidence and pedagogical strategy

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.

Simulation-based ultrasound-guided regional anesthesia curriculum for anesthesiology residents

Proficiency in ultrasound-guided regional anesthesia (UGRA) requires the practitioner to acquire cognitive and technical skills. For anesthesiology residents, an assortment of challenges has been identified in learning UGRA skills. Currently, a validated UGRA curriculum for residents does not exist, and the level of UGRA proficiency achieved during residency training can vary considerably. Simulated practice has been shown to enhance proficiency in UGRA, and a competency-based education with simulation training has been endorsed for anesthesiology residents. The objective of this review is to outline simulation-based training that can be implemented in a UGRA curriculum and to explore educational tools like gamification to facilitate competency in regional anesthesiology.

Gamifying anatomy education

The objective of our research is to find out if gamification increases motivation for self-directed learning (SDL) of human anatomy among year 1 medical students, and more importantly, their academic grades (n = 120). At the NUS Yong Loo Lin School of Medicine, anatomy teaching has traditionally been delivered via didactic means. To encourage more active learning, suitable games (non-digital) and the script concordance test were utilized to enhance the process. The flipped classroom approach was also introduced to further trigger active learning. In addition, the use of mobile apps (digital) was also initiated as supplements for SDL. Feedback was collected based on the previously validated PRO-SDL scale. Results from the research yielded inconclusive evidence to support enhanced motivation among our students due to gamification (P > 0.05). However, it did help to encourage active participation for a "fun learning" experience supported by numerous positive comments. More importantly, the participant's continuous assessment (CA1, CA2, and CA3) and objective specific practical exam results were better than the cohort's average (P < 0.05), suggesting that enhanced meta-cognition, and factual recall had taken place. While it is positive, there are some caveats to note with gamification, first and foremost, that it is tutor dependent. Taken together, gamification could represent a new paradigm for anatomy education, and also an opportune time to change the prevailing culture in the healthcare and education industry. Clin. Anat. 31:997-1005, 2018. © 2018 Wiley Periodicals, Inc.

SonoGames: Effect of an Innovative Competitive Game on the Education, Perception, and Use of Point-of-Care Ultrasound

OBJECTIVES

Gamification is a powerful tool in medical education. SonoGames is a competitive games-based event designed to educate and inspire emergency medicine (EM) residents about point-of-care ultrasound. We sought to describe: (1) the perceived effectiveness of a competitive event on both immediate learning and long-term education; and (2) the resultant attitudes of participants and program directors regarding ultrasound training.

METHODS

The SonoGames Organizational Committee designed 2 surveys: 1 for SonoGames V EM resident participants and a second for EM program directors. Survey questions used a 5-point Likert scale to assess overall perceptions and attitudes about ultrasound, changes in self-reported content knowledge and competency, effects on clinical use, and perceived impacts of a competitive game format on education.

RESULTS

Seventy-three resident participants and 42 program directors responded to the survey. Ninety-four percent of participants thought that the competitive gaming format of SonoGames was effective in making the event an educational experience. Participants reported that their ultrasound knowledge increased (81%), their enthusiasm for ultrasound increased (87%), and their clinical use of ultrasound increased (61%). Residency program directors reported similar increases to a lesser degree. Greater advancement through the event was associated with more positive responses. Residencies that participated in the event saw greater increases in the use of ultrasound by residents than those that did not.

CONCLUSIONS

A competitive games-based educational event focused on point-of-care ultrasound is an effective educational tool. SonoGames increases EM residents' knowledge, enthusiasm, and clinical use of ultrasound both during and after the event.