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Aster A, Laupichler MC, Zimmer S, Raupach T. Game design elements of serious games in the education of medical and healthcare professions: a mixed-methods systematic review of underlying theories and teaching effectiveness. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10327-1. [PMID: 38563873 DOI: 10.1007/s10459-024-10327-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
Serious games, as a learning resource, enhance their game character by embedding game design elements that are typically used in entertainment games. Serious games in its entirety have already proven their teaching effectiveness in different educational contexts including medical education. The embedded game design elements play an essential role for a game's effectiveness and thus they should be selected based on evidence-based theories. For game design elements embedded in serious games used for the education of medical and healthcare professions, an overview of theories for the selection lacks. Additionally, it is still unclear whether and how single game design elements affect the learning effectiveness. Therefore, the main aim of this systematic review is threefold. Firstly, light will be shed on the single game design elements used in serious games in this area. Second, the game design elements' underlying theories will be worked out, and third, the game design elements' effectiveness on student learning outcome will be assessed. Two literature searches were conducted in November 2021 and May 2022 in six literature databases with keywords covering the fields of educational game design, serious game, and medical education. Out of 1006 initial records, 91 were included after applying predefined exclusion criteria. Data analysis revealed that the three most common game design elements were points, storyline, and feedback. Only four underlying theories were mentioned, and no study evaluated specific game design elements. Since game design elements should be based on theories to ensure meaningful evaluations, the conceptual GATE framework is introduced, which facilitates the selection of evidence-based game design elements for serious games.
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Affiliation(s)
- Alexandra Aster
- Institute of Medical Education, University Hospital Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany.
| | - Matthias Carl Laupichler
- Institute of Medical Education, University Hospital Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany
| | - Saskia Zimmer
- Institute of Medical Education, University Hospital Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany
| | - Tobias Raupach
- Institute of Medical Education, University Hospital Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany
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Mohan D, Angus DC, Chang CCH, Elmer J, Fischhoff B, Rak KJ, Barnes JL, Peitzman AB, White DB. Using a theory-based, customized video game as an educational tool to improve physicians' trauma triage decisions: study protocol for a randomized cluster trial. Trials 2024; 25:127. [PMID: 38365758 PMCID: PMC10870723 DOI: 10.1186/s13063-024-07961-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Transfer of severely injured patients to trauma centers, either directly from the field or after evaluation at non-trauma centers, reduces preventable morbidity and mortality. Failure to transfer these patients appropriately (i.e., under-triage) remains common, and occurs in part because physicians at non-trauma centers make diagnostic errors when evaluating the severity of patients' injuries. We developed Night Shift, a theory-based adventure video game, to recalibrate physician heuristics (intuitive judgments) in trauma triage and established its efficacy in the laboratory. We plan a type 1 hybrid effectiveness-implementation trial to determine whether the game changes physician triage decisions in real-life and hypothesize that it will reduce the proportion of patients under-triaged. METHODS We will recruit 800 physicians who work in the emergency departments (EDs) of non-trauma centers in the US and will randomize them to the game (intervention) or to usual education and training (control). We will ask those in the intervention group to play Night Shift for 2 h within 2 weeks of enrollment and again for 20 min at quarterly intervals. Those in the control group will receive only usual education (i.e., nothing supplemental). We will then assess physicians' triage practices for older, severely injured adults in the 1-year following enrollment, using Medicare claims, and will compare under-triage (primary outcome), 30-day mortality and re-admissions, functional independence, and over-triage between the two groups. We will evaluate contextual factors influencing reach, adoption, implementation, and maintenance with interviews of a subset of trial participants (n = 20) and of other key decision makers (e.g., patients, first responders, administrators [n = 100]). DISCUSSION The results of the trial will inform future efforts to improve the implementation of clinical practice guidelines in trauma triage and will provide deeper understanding of effective strategies to reduce diagnostic errors during time-sensitive decision making. TRIAL REGISTRATION ClinicalTrials.gov; NCT06063434 . Registered 26 September 2023.
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Affiliation(s)
- Deepika Mohan
- Department of Surgery, University of Pittsburgh School of Medicine, F1265 PUH, 200 Lothrop St, Pittsburgh, PA, 15213, USA.
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chung-Chou H Chang
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jonathan Elmer
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Baruch Fischhoff
- Department of Engineering and Environmental Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Kim J Rak
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jacqueline L Barnes
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, F1265 PUH, 200 Lothrop St, Pittsburgh, PA, 15213, USA
| | - Douglas B White
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Moon SH, Kim SO. Enhancing triage accuracy in emergency nurses: The impact of a game-based triage educational app. Int Emerg Nurs 2024; 72:101398. [PMID: 38198949 DOI: 10.1016/j.ienj.2023.101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/05/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Digital technology has enabled gamification methods to enhance triage education, reflecting an evolving healthcare landscape. OBJECTIVE To evaluate the effectiveness of a Gamification Triage Education App (GTEA) as a learning tool for emergency nurses, with a focus on creating an engaging and educationally effective platform for triage training. METHOD The GTEA was developed using no-code based software and expanded upon previous iterations, with added features such as points, rankings, instant feedback, and quest-based stories. From December 2021 to March 2022, 27 emergency room nurses from three hospitals in Korea were instructed to use GTEA for 100 min over the course of a week. The effects were measured before and after the intervention. RESULTS The results demonstrated a significant increase in triage accuracy from 4.3 ± 2.00 to 5.33 ± 1.47 (t = -2.18, p = 0.039), along with a substantial reduction in overtriage (t = 3.11, p = 0.004). Additionally, increases in critical thinking disposition, triage competency, and triage knowledge were observed (t = -3.11, p = 0.004; t = -2.72, p = 0.011; t = -3.14, p = 0.004, respectively). CONCLUSIONS The findings provide robust evidence for the effectiveness of gamification in triage training within emergency nursing.
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Affiliation(s)
- Sun-Hee Moon
- College of Nursing, Chonnam National University, Gwangju, South Korea.
| | - Su Ol Kim
- Department of Nursing, Kwangju Women's University, Gwangju, South Korea.
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Bass GA, Chang CWJ, Sorce LR, Subramanian S, Laytin AD, Somodi R, Gray JR, Lane-Fall M, Kaplan LJ. Gamification in Critical Care Education and Practice. Crit Care Explor 2024; 6:e1034. [PMID: 38259864 PMCID: PMC10803028 DOI: 10.1097/cce.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES To explore gamification as an alternative approach to healthcare education and its potential applications to critical care. DATA SOURCES English language manuscripts addressing: 1) gamification theory and application in healthcare and critical care and 2) implementation science focused on the knowledge-to-practice gap were identified in Medline and PubMed databases (inception to 2023). STUDY SELECTION Studies delineating gamification underpinnings, application in education or procedural mentoring, utilization for healthcare or critical care education and practice, and analyses of benefits or pitfalls in comparison to other educational or behavioral modification approaches. DATA EXTRACTION Data indicated the key gamification tenets and the venues within which they were used to enhance knowledge, support continuing medical education, teach procedural skills, enhance decision-making, or modify behavior. DATA SYNTHESIS Gamification engages learners in a visual and cognitive fashion using competitive approaches to enhance acquiring new knowledge or skills. While gamification may be used in a variety of settings, specific design elements may relate to the learning environment or learner styles. Additionally, solo and group gamification approaches demonstrate success and leverage adult learning theory elements in a low-stress and low-risk setting. The potential for gamification-driven behavioral modification to close the knowledge-to-practice gap and enable guideline and protocol compliance remains underutilized. CONCLUSIONS Gamification offers the potential to substantially enhance how critical care professionals acquire and then implement new knowledge in a fashion that is more engaging and rewarding than traditional approaches. Accordingly, educational undertakings from courses to offerings at medical professional meetings may benefit from being gamified.
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Affiliation(s)
- Gary Alan Bass
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Lauren R Sorce
- Department of Pediatrics (Critical Care), Northwestern University, Chicago, IL
| | - Sanjay Subramanian
- Department of Anesthesiology, Critical Care Medicine, Washington University in St. Louis, St. Louis, MO
- Omnicure Inc., St. Louis, MO
| | - Adam D Laytin
- Departments of Anesthesia and Critical Care Medicine and Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Reka Somodi
- Section of Surgical Critical Care, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Jaime R Gray
- Department of Pharmacy, Temple University Health System, Philadelphia, PA
| | - Meghan Lane-Fall
- Departments of Anesthesiology and Critical Care Medicine and Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Kenny R, Fischhoff B, Davis A, Canfield C. Improving Social Bot Detection Through Aid and Training. HUMAN FACTORS 2023:187208231210145. [PMID: 37963198 DOI: 10.1177/00187208231210145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVE We test the effects of three aids on individuals' ability to detect social bots among Twitter personas: a bot indicator score, a training video, and a warning. BACKGROUND Detecting social bots can prevent online deception. We use a simulated social media task to evaluate three aids. METHOD Lay participants judged whether each of 60 Twitter personas was a human or social bot in a simulated online environment, using agreement between three machine learning algorithms to estimate the probability of each persona being a bot. Experiment 1 compared a control group and two intervention groups, one provided a bot indicator score for each tweet; the other provided a warning about social bots. Experiment 2 compared a control group and two intervention groups, one receiving the bot indicator scores and the other a training video, focused on heuristics for identifying social bots. RESULTS The bot indicator score intervention improved predictive performance and reduced overconfidence in both experiments. The training video was also effective, although somewhat less so. The warning had no effect. Participants rarely reported willingness to share content for a persona that they labeled as a bot, even when they agreed with it. CONCLUSIONS Informative interventions improved social bot detection; warning alone did not. APPLICATION We offer an experimental testbed and methodology that can be used to evaluate and refine interventions designed to reduce vulnerability to social bots. We show the value of two interventions that could be applied in many settings.
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Affiliation(s)
- Ryan Kenny
- United States Army, Fayetteville, NC, USA
| | | | - Alex Davis
- Carnegie Mellon University, Pittsburgh, PA, USA
| | - Casey Canfield
- Missouri University of Science and Technology, Rolla, MO, USA
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Mohan D, O'Malley AJ, Chelen J, MacMartin M, Murphy M, Rudolph M, Engel JA, Barnato AE. Using a Video Game Intervention to Increase Hospitalists' Advance Care Planning Conversations with Older Adults: a Stepped Wedge Randomized Clinical Trial. J Gen Intern Med 2023; 38:3224-3234. [PMID: 37429972 PMCID: PMC10651818 DOI: 10.1007/s11606-023-08297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Guidelines recommend Advance Care Planning (ACP) for seriously ill older adults to increase the patient-centeredness of end-of-life care. Few interventions target the inpatient setting. OBJECTIVE To test the effect of a novel physician-directed intervention on ACP conversations in the inpatient setting. DESIGN Stepped wedge cluster-randomized design with five 1-month steps (October 2020-February 2021), and 3-month extensions at each end. SETTING A total of 35/125 hospitals staffed by a nationwide physician practice with an existing quality improvement initiative to increase ACP (enhanced usual care). PARTICIPANTS Physicians employed for ≥ 6 months at these hospitals; patients aged ≥ 65 years they treated between July 2020-May 2021. INTERVENTION Greater than or equal to 2 h of exposure to a theory-based video game designed to increase autonomous motivation for ACP; enhanced usual care. MAIN MEASURE ACP billing (data abstractors blinded to intervention status). RESULTS A total of 163/319 (52%) invited, eligible hospitalists consented to participate, 161 (98%) responded, and 132 (81%) completed all tasks. Physicians' mean age was 40 (SD 7); most were male (76%), Asian (52%), and reported playing the game for ≥ 2 h (81%). These physicians treated 44,235 eligible patients over the entire study period. Most patients (57%) were ≥ 75; 15% had COVID. ACP billing decreased between the pre- and post-intervention periods (26% v. 21%). After adjustment, the homogeneous effect of the game on ACP billing was non-significant (OR 0.96; 95% CI 0.88-1.06; p = 0.42). There was effect modification by step (p < 0.001), with the game associated with increased billing in steps 1-3 (OR 1.03 [step 1]; OR 1.15 [step 2]; OR 1.13 [step 3]) and decreased billing in steps 4-5 (OR 0.66 [step 4]; OR 0.95 [step 5]). CONCLUSIONS When added to enhanced usual care, a novel video game intervention had no clear effect on ACP billing, but variation across steps of the trial raised concerns about confounding from secular trends (i.e., COVID). TRIAL REGISTRATION Clinicaltrials.gov; NCT04557930, 9/21/2020.
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Affiliation(s)
- Deepika Mohan
- Department of Critical Care Medicine, University of Pittsburgh, Room 638 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
| | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice and Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Julia Chelen
- Advanced Communications Research Group, National Institute of Standards and Technology, U.S. Department of Commerce, Boulder, CO, USA
| | - Meredith MacMartin
- Department of Medicine and The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Megan Murphy
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Jaclyn A Engel
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Amber E Barnato
- The Dartmouth Institute for Health Policy & Clinical Practice and Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Cheng C, Papadakos J, Umakanthan B, Fazelzad R, Martimianakis MA(T, Ugas M, Giuliani ME. On the advantages and disadvantages of virtual continuing medical education: a scoping review. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:41-74. [PMID: 37465741 PMCID: PMC10351643 DOI: 10.36834/cmej.75681] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Introduction With the COVID-19 pandemic, most continuing medical education activities became virtual (VCME). The authors conducted a scoping review to synthesize the advantages and disadvantages of VCME to establish the impact of this approach on inequities that physicians face along the intersections of gender, race, and location of practice. Methods Guided by the methodological framework of Arksey and O'Malley, the search included six databases and was limited to studies published between January 1991 to April 2021. Eligible studies included those related to accredited/non-accredited post-certification medical education, conferences, or meetings in a virtual setting focused on physicians. Numeric and inductive thematic analyses were performed. Results 282 studies were included in the review. Salient advantages identified were convenience, favourable learning formats, collaboration opportunities, effectiveness at improving knowledge and clinical practices, and cost-effectiveness. Prominent disadvantages included technological barriers, poor design, cost, lack of sufficient technological skill, and time. Analysis of the studies showed that VCME was most common in the general/family practice specialty, in suburban settings, and held by countries in the Global North. A minority of studies reported on gender (35%) and race (4%). Discussion Most studies report advantages of VCME, but disadvantages and barriers exist that are contextual to the location of practice and medical subspecialty. VCME events are largely organized by Global North countries with suboptimized accessibility for Global South attendees. A lack of reported data on gender and race reveals a limited understanding of how VCME affects vulnerable populations, prompting potential future considerations as it evolves.
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Affiliation(s)
| | - Janet Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Ontario, Canada
- The Institute for Education Research, University Health Network, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada
| | - Ben Umakanthan
- Cancer Education Program, Princess Margaret Cancer Centre, Ontario, Canada
| | - Rouhi Fazelzad
- Library and Information Sciences, Princess Margaret Cancer Centre, Ontario, Canada
| | | | - Mohamed Ugas
- Cancer Education Program, Princess Margaret Cancer Centre, Ontario, Canada
| | - Meredith Elana Giuliani
- Cancer Education Program, Princess Margaret Cancer Centre, Ontario, Canada
- The Institute for Education Research, University Health Network, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Ontario, Canada
- The Wilson Centre, University Health Network, Ontario, Canada
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Tavares W, Piquette D, Luong D, Chiu M, Dyte C, Fraser K, Clark M. Exploring the Study of Simulation as a Continuing Professional Development Strategy for Physicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 43:188-197. [PMID: 36728972 DOI: 10.1097/ceh.0000000000000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Practicing physicians have the responsibility to engage in lifelong learning. Although simulation is an effective experiential educational strategy, physicians seldom select it for continuing professional development (CPD) for reasons that are poorly understood. The objective of this study was to explore existing evidence on simulation-based CPD and the factors influencing physicians' engagement in simulation-based CPD. METHODS A scoping review of the literature on simulation-based CPD included MEDLINE, Embase, and CINAHL databases. Studies involving the use of simulation for practicing physicians' CPD were included. Information related to motivations for participating in simulation-based CPD, study objectives, research question(s), rationale(s), reasons for using simulation, and simulation features was abstracted. RESULTS The search yielded 8609 articles, with 6906 articles undergoing title and abstract screening after duplicate removal. Six hundred sixty-one articles underwent full-text screening. Two hundred twenty-five studies (1993-2021) were reviewed for data abstraction. Only four studies explored physicians' motivations directly, while 31 studies described incentives or strategies used to enroll physicians in studies on simulation-based CPD. Most studies focused on leveraging or demonstrating the utility of simulation for CPD. Limited evidence suggests that psychological safety, direct relevance to clinical practice, and familiarity with simulation may promote future engagement. DISCUSSION Although simulation is an effective experiential educational method, factors explaining its uptake by physicians as a CPD strategy are unclear. Additional evidence of simulation effectiveness may fail to convince physicians to participate in simulation-based CPD unless personal, social, educational, or contextual factors that shape physicians' motivations and choices to engage in simulation-based CPD are explored.
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Affiliation(s)
- Walter Tavares
- Dr. Tavares: Assistant Professor and Scientist, Wilson Centre for Health Professions Education, Temerty Faculty of Medicine, Institute for Health Policy Management and Evaluation, University Health Network, University of Toronto, Toronto, Ontario, Canada, and York Region Paramedic and Senior Services, Community Health Services Department, Regional Municipality of York, Newmarket Ontario, Canada. Dr. Piquette: Assistant Professor, Inter-Department Division of Critical Care Medicine, University of Toronto, Staff Physician, Sunnybrook Health Sciences Centre, Centre Researcher, The Wilson Centre, Toronto, Ontario, Canada. Ms. Luong: Research Associate II, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. Dr. Chiu: Associate Professor, Department of Anesthesiology and Pain Medicine, Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Dyte: Clinical Lecturer and Anesthesiologist, Department of Anesthesia, Perioperative and Pain Medicine, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Fraser: Clinical Professor of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Clark: Clinical Associate Professor of Surgery, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
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Mohan D, Elmer J, Arnold RM, Forsythe RM, Fischhoff B, Rak K, Barnes JL, White DB. Testing the feasibility, acceptability, and preliminary effect of a novel deliberate practice intervention to reduce diagnostic error in trauma triage: a study protocol for a randomized pilot trial. Pilot Feasibility Stud 2022; 8:253. [PMID: 36510328 PMCID: PMC9743730 DOI: 10.1186/s40814-022-01212-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Non-compliance with clinical practice guidelines in trauma remains common, in part because physicians make diagnostic errors when triaging injured patients. Deliberate practice, purposeful participation in a training task under the oversight of a coach, effectively changes behavior in procedural domains of medicine but has rarely been used to improve diagnostic skill. We plan a pilot parallel randomized trial to test the feasibility, acceptability, and preliminary effect of a novel deliberate practice intervention to reduce physician diagnostic errors in trauma triage. METHODS We will randomize a national convenience sample of physicians who work at non-trauma centers (n = 60) in a 1:1 ratio to a deliberate practice intervention or to a passive control. We will use a customized, theory-based serious video game as the basis of our training task, selected based on its behavior change techniques and game mechanics, along with a coaching manual to standardize the fidelity of the intervention delivery. The intervention consists of three 30-min sessions with content experts (coaches), conducted remotely, during which physicians (trainees) play the game and receive feedback on their diagnostic processes. We will assess (a) the fidelity with which the intervention is delivered by reviewing video recordings of the coaching sessions; (b) the acceptability of the intervention through surveys and semi-structured interviews, and (c) the effect of the intervention by comparing the performance of trainees and a control group of physicians on a validated virtual simulation. We hypothesize that trainees will make ≥ 25% fewer diagnostic errors on the simulation than control physicians, a large effect size. We additionally hypothesize that ≥ 90% of trainees will receive their intervention as planned. CONCLUSIONS The results of the trial will inform the decision to proceed with a future hybrid effectiveness-implementation trial of the intervention. It will also provide a deeper understanding of the challenges of using deliberate practice to modify the diagnostic skill of physicians. TRIAL REGISTRATION Clinical trials.gov ( NCT05168579 ); 23 December 2021.
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Affiliation(s)
- Deepika Mohan
- grid.21925.3d0000 0004 1936 9000Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Jonathan Elmer
- grid.21925.3d0000 0004 1936 9000Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Robert M. Arnold
- grid.21925.3d0000 0004 1936 9000Department of Medicine, Division of Palliative Care, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Raquel M. Forsythe
- grid.21925.3d0000 0004 1936 9000Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Baruch Fischhoff
- grid.147455.60000 0001 2097 0344Department of Engineering and Environmental Policy, Carnegie Mellon University, Pittsburgh, PA USA
| | - Kimberly Rak
- grid.21925.3d0000 0004 1936 9000Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Jacqueline L. Barnes
- grid.21925.3d0000 0004 1936 9000Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Douglas B. White
- grid.21925.3d0000 0004 1936 9000Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
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Levy AR, Khalil E, Chandramohan M, Whitfill TM, Cicero MX. Efficacy of Computer-Based Simulation as a Modality for Learning Pediatric Disaster Triage for Pediatric Emergency Nurses. Simul Healthc 2022; 17:329-335. [PMID: 34652326 DOI: 10.1097/sih.0000000000000616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY STATEMENT Pediatric disaster triage (PDT) is challenging for healthcare personnel. Mistriage can lead to poor resource utilization. In contrast to live simulation, screen-based simulation is more reproducible and less costly. We hypothesized that the screen-based simulation "60 Seconds to Survival" (60S) to learning PDT will be associated with improved triage accuracy for pediatric emergency nursing personnel.During this prospective observational study, 138 nurse participants at 2 tertiary care emergency departments were required to play 60S at least 5 times over 13 weeks. Efficacy was assessed by measuring the learners' triage accuracy, mistriage, and simulated patient outcomes using JumpStart.Triage accuracy improved from a median of 61.1 [interquartile range (IQR) = 48.5-72.0] to 91.7 (IQR = 60.4-95.8, P < 0.0001), whereas mistriage decreased from 38.9 (IQR = 28.0-51.5) to 8.3 (IQR = 4.2-39.6, P < 0.0001), demonstrating a significant improvement in accuracy and decrease in mistriage. Screen-based simulation 60S is an effective modality for learning PDT by pediatric emergency nurses.
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Affiliation(s)
- Arielle R Levy
- From the Departments of Pediatrics and Emergency Medicine (A.R.L.), Sainte-Justine Hospital University Center, University of Montreal; Department of Pediatrics (E.K., M.C.), McGill University, Montreal, Canada; and Section of Pediatric Emergency Medicine (T.M.W., M.X.C.), Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT
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Krishnamurthy K, Selvaraj N, Gupta P, Cyriac B, Dhurairaj P, Abdullah A, Krishnapillai A, Lugova H, Haque M, Xie S, Ang ET. Benefits of gamification in medical education. Clin Anat 2022; 35:795-807. [PMID: 35637557 DOI: 10.1002/ca.23916] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022]
Abstract
Medical education is changing at a fast pace. Students attend medical school with a high degree of technological literacy and a desire for a diverse educational experience. As a result, a growing number of medical schools are incorporating technology-enhanced active learning and multimedia education tools into their curriculum. Gamified training platforms include educational games, mobile medical apps, and virtual patient scenarios. We provide a systematic review of what is meant by gamification in this era. Specific educational games, mobile apps, and virtual simulations that may be used for preclinical and clinical training have been discovered and classified. The available data were presented in terms of the recognized platforms for medical education's possible benefits. Virtual patient simulations have been shown to enhance learning results in general. Gamification could improve learning, engagement, and cooperation by allowing for real-world application. They may also help with promoting risk-free healthcare decision-making, remote learning, learning analytics, and quick feedback. We account for Preclinical training which included 5 electronic games and 4 mobile apps, while clinical training included 5 electronic games, 10 mobile applications, and 12 virtual patient simulation tools. There were additionally nine more gamified virtual environment training products that were not commercially accessible. Many of these studies have shown that utilizing gamified media in medical education may confer advantages. This collection of hyperlinked resources may be utilized by medical students, practitioners, and instructors at all levels.
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Affiliation(s)
| | - Nikil Selvaraj
- American University of Barbados, Wildey, St Michael, Barbados
| | - Palak Gupta
- American University of Barbados, Wildey, St Michael, Barbados
| | - Benitta Cyriac
- American University of Barbados, Wildey, St Michael, Barbados
| | | | - Adnan Abdullah
- Unit of Occupational Medicine, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Ambigga Krishnapillai
- Unit of Family Medicine, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Halyna Lugova
- Unit of Community Medicine, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Sophie Xie
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eng-Tat Ang
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Chittaro L, Buttussi F. Learning Safety Through Public Serious Games: A Study of "Prepare for Impact" on a Very Large, International Sample of Players. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2022; 28:1573-1584. [PMID: 32894716 DOI: 10.1109/tvcg.2020.3022340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recent years have witnessed a growing interest in serious games (SGs), i.e., digital games for education and training. However, although the potential scalability of SGs to large player populations is often praised in the literature, available SG evaluations did not provide evidence of it because they did not study learning on large, varied, international samples in naturalistic conditions. This article considers a SG that educates players about aircraft cabin safety. It presents the first study of learning in a SG intervention conducted in naturalistic conditions with a very large, worldwide sample, which includes 45,000 players who accepted to answer a knowledge questionnaire before and after playing the game, and more than 400,000 players whose in-game behavior was analyzed. Results show that the SG led to improvement in players' knowledge, assessed with different metrics. Moreover, analysis of repeated play shows that participants improved their in-game safety behavior over time. We also focus on the role of making errors in the game, showing how they led to improvement in knowledge. Finally, we highlight the theoretical models, such as error-based learning and Protection Motivation Theory, that oriented the game design, and can be reused to create SGs for other domains.
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Mohan D, Chang CC, Fischhoff B, Rosengart MR, Angus DC, Yealy DM, Barnato AE. Outcomes after a Digital Behavior Change Intervention to Improve Trauma Triage: An Analysis of Medicare Claims. J Surg Res 2021; 268:532-539. [PMID: 34464890 PMCID: PMC8678167 DOI: 10.1016/j.jss.2021.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/20/2021] [Accepted: 07/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Under-triage in trauma remains prevalent, in part because of decisions made by physicians at non-trauma centers. We developed two digital behavior change interventions to recalibrate physician heuristics (pattern recognition), and randomized 688 emergency medicine physicians to use the interventions or to a control. In this observational follow-up, we evaluated whether exposure to the interventions changed physician performance in practice. METHODS We obtained 2016 - 2018 Medicare claims for severely injured patients, linked the names of trial participants to National Provider Identifiers (NPIs), and identified claims filed by trial participants for injured patients presenting to non-trauma centers in the year before and after their trial. The primary outcome measure was the triage status of severely injured patients. RESULTS We linked 670 (97%) participants to NPIs, identified claims filed for severely injured patients by 520 (76%) participants, and claims filed at non-trauma centers by 228 (33%). Most participants were white (64%), male (67%), and had more than three years of experience (91%). Patients had a median Injury Severity Score of 16 (IQR 16 - 17), and primarily sustained neuro-trauma. After adjustment, patients treated by physicians randomized to the interventions experienced less under-triage in the year after the trial than before (41% versus 58% [-17%], P = 0.015); patients treated by physicians randomized to the control experienced no difference in under-triage (49% versus 56% [-7%], P = 0.35). The difference-in-the-difference was non-significant (10%, P = 0.18). CONCLUSIONS It was feasible to track trial participants' performance in national claims. Sample size limitations constrained causal inference about the effect of the interventions.
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Affiliation(s)
- Deepika Mohan
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,.
| | - Chung-Chou Chang
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Baruch Fischhoff
- Department of Engineering and Environmental Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Matthew R Rosengart
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Amber E Barnato
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Maheu-Cadotte MA, Dubé V, Cossette S, Lapierre A, Fontaine G, Deschênes MF, Lavoie P. Involvement of End Users in the Development of Serious Games for Health Care Professions Education: Systematic Descriptive Review. JMIR Serious Games 2021; 9:e28650. [PMID: 34129514 PMCID: PMC8414295 DOI: 10.2196/28650] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND On the basis of ethical and methodological arguments, numerous calls have been made to increase the involvement of end users in the development of serious games (SGs). Involving end users in the development process is considered a way to give them power and control over educational software that is designed for them. It can also help identify areas for improvement in the design of SGs and improve their efficacy in targeted learning outcomes. However, no recognized guidelines or frameworks exist to guide end users' involvement in SG development. OBJECTIVE The aim of this study is to describe how end users are involved in the development of SGs for health care professions education. METHODS We examined the literature presenting the development of 45 SGs that had reached the stage of efficacy evaluation in randomized trials. One author performed data extraction using an ad hoc form based on a design and development framework for SGs. Data were then coded and synthesized on the basis of similarities. The coding scheme was refined iteratively with the involvement of a second author. Results are presented using frequencies and percentages. RESULTS End users' involvement was mentioned in the development of 21 of 45 SGs. The number of end users involved ranged from 12 to 36. End users were often involved in answering specific concerns that arose during the SG design (n=6) or in testing a prototype (n=12). In many cases, researchers solicited input from end users regarding the goals to reach (n=10) or the functional esthetics of the SGs (n=7). Most researchers used self-reported questionnaires (n=7). CONCLUSIONS Researchers mentioned end users' involvement in the development of less than half of the identified SGs, and this involvement was also poorly described. These findings represent significant limitations to evaluating the impact of the involvement of end users on the efficacy of SGs and in making recommendations regarding their involvement.
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Affiliation(s)
- Marc-André Maheu-Cadotte
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Research Center, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Research Center, Montreal Heart Institute, Montreal, QC, Canada
| | - Véronique Dubé
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Research Center, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Sylvie Cossette
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Research Center, Montreal Heart Institute, Montreal, QC, Canada
| | | | - Guillaume Fontaine
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Research Center, Montreal Heart Institute, Montreal, QC, Canada
| | | | - Patrick Lavoie
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Research Center, Montreal Heart Institute, Montreal, QC, Canada
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Lindquist B, Gaiha SM, Vasudevan A, Dooher S, Leggio W, Mulkerin W, Zozula A, Strehlow M, Sebok‐Syer SS, Mahadevan SV. Development and implementation of a novel Web-based gaming application to enhance emergency medical technician knowledge in low- and middle-income countries. AEM EDUCATION AND TRAINING 2021; 5:e10602. [PMID: 34124530 PMCID: PMC8171777 DOI: 10.1002/aet2.10602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Benjamin Lindquist
- Department of Emergency MedicineStanford UniversityStanfordCaliforniaUSA
| | - Shivani M. Gaiha
- Department of PediatricsStanford UniversityStanfordCaliforniaUSA
| | | | - Sean Dooher
- University of CaliforniaBerkeleyCaliforniaUSA
| | - William Leggio
- Department of EMS EducationCreighton UniversityOmahaNebraskaUSA
| | - William Mulkerin
- Department of Emergency MedicineStanford UniversityStanfordCaliforniaUSA
| | - Alexander Zozula
- Department of Emergency MedicineUniversity of Massachusetts Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Matthew Strehlow
- Department of Emergency MedicineStanford UniversityStanfordCaliforniaUSA
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Taba JV, Cortez VS, Moraes WA, Iuamoto LR, Hsing WT, Suzuki MO, do Nascimento FS, Pipek LZ, de Mattos VC, D’Albuquerque EC, Carneiro-D’Albuquerque LA, Meyer A, Andraus W. The development of laparoscopic skills using virtual reality simulations: A systematic review. PLoS One 2021; 16:e0252609. [PMID: 34138901 PMCID: PMC8211221 DOI: 10.1371/journal.pone.0252609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Teaching based on virtual reality simulators in medicine has expanded in recent years due to the limitations of more traditional methods, especially for surgical procedures such as laparoscopy. Purpose of review To analyze the effects of using virtual reality simulations on the development of laparoscopic skills in medical students and physicians. Data sources The literature screening was done in April 2020 through Medline (PubMed), EMBASE and Database of the National Institute of Health. Eligibility criteria Randomized clinical trials that subjected medical students and physicians to training in laparoscopic skills in virtual reality simulators. Study appraisal Paired reviewers independently identified 1529 articles and included 7 trials that met the eligibility criteria. Findings In all studies, participants that trained in virtual simulators showed improvements in laparoscopic skills, although the articles that also had a physical model training group did not show better performance of one model compared to the other. Limitations No article beyond 2015 met the eligibility criteria, and the analyzed simulators have different versions and models, which might impact the results. Conclusion Virtual reality simulators are useful educational tools, but do not show proven significant advantages over traditional models. The lack of standardization and a scarcity of articles makes comparative analysis between simulators difficult, requiring more research in the area, according to the model suggested in this review. Systematic review registration number Registered by the Prospective Register of Systematic Reviews (PROSPERO), identification code CRD42020176479.
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Affiliation(s)
- João Victor Taba
- Faculty of Medicine FMUSP, University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Leandro Ryuchi Iuamoto
- Center of Acupuncture, Department of Orthopaedics and Traumatology, University of São Paulo, São Paulo, SP, Brazil
| | - Wu Tu Hsing
- Center of Acupuncture, Department of Orthopaedics and Traumatology, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | - Alberto Meyer
- Department of Gastroenterology, Hospital das Clínicas, HCFMUSP, São Paulo, SP, Brazil
- * E-mail:
| | - Wellington Andraus
- Department of Gastroenterology, Hospital das Clínicas, HCFMUSP, São Paulo, SP, Brazil
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Maheu-Cadotte MA, Cossette S, Dubé V, Fontaine G, Lavallée A, Lavoie P, Mailhot T, Deschênes MF. Efficacy of Serious Games in Healthcare Professions Education: A Systematic Review and Meta-analysis. Simul Healthc 2021; 16:199-212. [PMID: 33196609 DOI: 10.1097/sih.0000000000000512] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
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.
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Affiliation(s)
- Marc-André Maheu-Cadotte
- From the Faculty of Nursing of the Université de Montréal (S.C., V.D., G.F., A.L., P.L., M.-F.D.); Montreal Heart Institute Research Center (S.C., P.L., T.M.); Research Center of the Université de Montréal Hospital Center (V.D.); CHU Ste-Justine Research Center (AL), Montreal, Quebec, Canada; Department of Pharmacy and Health Systems Sciences, Bouvé College of Health Sciences (T.M.), Boston, MA; and Center for Innovation in Nursing Education (M.-F.D.), Montreal, Quebec, Canada
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Lateef F, Lim RE, Loh MWY, Pang KYC, Wong M, Lew KX, Madhavi S. Taking Serious Games Forward in Curriculum and Assessment: Starting Infusions Right Every Time. J Emerg Trauma Shock 2021; 14:232-239. [PMID: 35125790 PMCID: PMC8780635 DOI: 10.4103/jets.jets_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/15/2021] [Indexed: 11/04/2022] Open
Abstract
Technology-driven educational modalities are increasingly utilized today in a variety of forms. Different combinations of the spectrum of simulation-based learning, the use of virtual reality, augmented reality, mixed reality, and serious gaming continue to gain traction on various educational platforms. In this paper, we share the formation of our project team to plan and execute a serious game on starting infusions and the use of infusion pump for nursing and health-care staff. The incorporation of element of assessment is also discussed. The various phases we went through included: Learning needs assessment and conceptualizationAssembly of project teamTransfer of medical conceptsStoryboard and content productionLearners' experiential mappingTesting of the prototypeBeta testing and release of the final product The collaborative work and coordination between the subject-matter experts together with the technical production team is critical. Issues such as assessment and debriefing in serious gaming were also addressed, not forgetting the need to ensure that, above all, learning must take place.
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Affiliation(s)
- Fatimah Lateef
- Department of Emergency Medicine, Singapore General Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Lee Kong Chian Medical School, Nanyang Technological University and Duke NUS Graduate Medical School, Singapore,SingHealth Duke NUS Institute of Medical Simulation, Singapore,Address for correspondence: Prof. Fatimah Lateef, Department of Emergency Medicine, Singapore General Hospital, 1 Hospital Drive, Outram Road, 169608 Singapore. E-mail:
| | - Rong Ee Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | | | - Mark Wong
- MSC Computer-aided Graphical Technology Application
| | - Kai Xiong Lew
- SingHealth Duke NUS Institute of Medical Simulation, Singapore
| | - Suppiah Madhavi
- SingHealth Duke NUS Institute of Medical Simulation, Singapore
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Teaching Disaster Medicine With a Novel Game-Based Computer Application: A Case Study at Sichuan University. Disaster Med Public Health Prep 2020; 16:548-554. [PMID: 33191895 DOI: 10.1017/dmp.2020.309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study evaluates the effectiveness of our game-based pedagogical technique by comparing the learning, enjoyment, interest, and motivation of medical students who learned about best practices for patient surge in a natural disaster with a novel game-based computer application, with those of medical students who learned about it with a traditional lecture. METHODS We conducted our study by modifying an existing optional course in disaster medicine that we taught at Sichuan University. More specifically, in 2017, while our application was still in development, we taught this course by lecture. In this iteration, 63 third-grade medical students voluntarily joined our course as our 'lecture group.' Once our application was complete in 2018, 68 third-grade medical students voluntarily joined this course as the 'game group.' We examined the different effects of these learning methods on student achievement using pre -, post -, and final tests. RESULTS Both teaching methods significantly increased short-term knowledge and there was no statistical difference between the 2 methods (p > 0.05). However, the game group demonstrated significantly higher knowledge retention than the traditional lecture group (p < 0.05). CONCLUSION Our game-based computer application proved to be an effective tool for teaching medical students best practices for caring for patient surge in a natural disaster.
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Gamborg ML, Mehlsen M, Paltved C, Tramm G, Musaeus P. Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine. BMC Emerg Med 2020; 20:73. [PMID: 32928158 PMCID: PMC7489001 DOI: 10.1186/s12873-020-00367-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/31/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by vague conceptualizations of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalizations in studies on GEM. OBJECTIVE A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. METHODS A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. RESULTS Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. CONCLUSIONS This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.
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Affiliation(s)
- Maria Louise Gamborg
- Centre for Health Sciences Education, Faculty of Health, Aarhus University, Aarhus, Denmark.
- Corporate HR MidtSim, Central Region of Denmark & Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Mimi Mehlsen
- Department of Psychology, Faculty of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Charlotte Paltved
- Corporate HR MidtSim, Central Region of Denmark & Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Gitte Tramm
- Department of Psychology, Faculty of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Peter Musaeus
- Centre for Health Sciences Education, Faculty of Health, Aarhus University, Aarhus, Denmark
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21
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Comparing fast thinking and slow thinking: The relative benefits of interventions, individual differences, and inferential rules. JUDGMENT AND DECISION MAKING 2020. [DOI: 10.1017/s1930297500007865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractResearch on judgment and decision making has suggested that the System 2 process of slow thinking can help people to improve their decision making by reducing well-established statistical decision biases (including base rate neglect, probability matching, and the conjunction fallacy). In a large pre-registered study with 1,706 participants and 23,292 unique observations, we compare the effects of individual differences and behavioral interventions to test the relative benefits of slow thinking on performance in canonical judgment and decision-making problems, compared to a control condition, a fast thinking condition, an incentive condition, and a condition that combines fast and slow thinking. We also draw on the rule-based reasoning literature to examine the benefits of having access to a simple form of the rule needed to solve a specific focal problem. Overall, we find equivocal evidence of a small benefit from slow thinking, evidence for a small benefit to accuracy incentives, and clear evidence of a larger cost from fast thinking. The difference in performance between fast-thinking and slow-thinking interventions is comparable to a one-scale point difference on the 4-point Cognitive Reflection Test (CRT). Inferential rules contribute unique explanatory power and interact with individual differences to support the idea that System 2 benefits from a combination of slower processes and knowledge appropriate to the problem.
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Ghoman SK, Patel SD, Cutumisu M, von Hauff P, Jeffery T, Brown MRG, Schmölzer GM. Serious games, a game changer in teaching neonatal resuscitation? A review. Arch Dis Child Fetal Neonatal Ed 2020; 105:98-107. [PMID: 31256010 PMCID: PMC6951231 DOI: 10.1136/archdischild-2019-317011] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/22/2019] [Accepted: 05/31/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Neonatal healthcare professionals require frequent simulation-based education (SBE) to improve their cognitive, psychomotor and communication skills during neonatal resuscitation. However, current SBE approaches are resource-intensive and not routinely offered in all healthcare facilities. Serious games (board and computer based) may be effective and more accessible alternatives. OBJECTIVE To review the current literature about serious games, and how these games might improve knowledge retention and skills in neonatal healthcare professionals. METHOD Literature searches of PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science and EMBASE databases were performed to identify studies examining serious games in neonatology. All games, such as board games, tabletop games, video games, screen-based simulators, tabletop simulators and virtual reality games were included. RESULTS Twelve serious games were included in this review (four board games, five video games and three virtual reality games). Overall, knowledge improvement was reported for the RETAIN (REsuscitationTrAINing for healthcare professionals) board game (10% increase in knowledge retention) and The Neonatology Game (4.15 points higher test score compared with control). Serious games are increasingly incorporated into Nursing and Medical School Curriculums to reinforce theoretical and practical learning. CONCLUSIONS Serious games have the potential to improve healthcare professionals' knowledge, skills and adherence to the resuscitation algorithm and could enhance access to SBE in resource-intensive and resource-limited areas. Future research should examine important clinical outcomes in newborn infants.
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Affiliation(s)
- Simran K Ghoman
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonoton, Alberta, Canada
| | - Siddhi D Patel
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Faculty of Science, University of Alberta, Edmonoton, Alberta, Canada
| | - Maria Cutumisu
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Centre for Research in Applied Measurement and Evaluation, University of Alberta, Edmonton, Alberta, Canada
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick von Hauff
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Academic Technology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Jeffery
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Academic Technology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew R G Brown
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonoton, Alberta, Canada
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Zhou C, Occa A, Kim S, Morgan S. A Meta-analysis of Narrative Game-based Interventions for Promoting Healthy Behaviors. JOURNAL OF HEALTH COMMUNICATION 2019; 25:54-65. [PMID: 31829829 DOI: 10.1080/10810730.2019.1701586] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Health interventions that use serious games have become increasingly popular. However, many of these games have been designed with few immersive game features which would improve users' engagement with the persuasive messages. To address this issue, researchers have incorporated narrative elements in games to facilitate message processing and enhance behavioral change. There have been theoretical debates about whether narratives benefit these interventions; empirical evidences for their effects are slightly mixed. This meta-analysis provides a deeper understanding of the overall impact of narrative game-based interventions on health-related behaviors and their psychological determinants. Combining the results from 22 studies, this meta-analysis found that narrative game-based interventions were effective in changing behaviors, knowledge, self-efficacy, and enjoyment. These effects were moderated by factors such as the genre of the game, the genre of the story, group play, and participant age. Implications of the findings and suggestions for future design of narrative game-based interventions were discussed.
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Affiliation(s)
- Chun Zhou
- Department of Communication, College of Communication, Architecture + The Arts, Florida International University, Miami, Florida, USA
| | - Aurora Occa
- Department of Communication, College of Communication and Information, University of Kentucky, Lexington, Kentucky, USA
| | - Soyoon Kim
- Department of Communication Studies, School of Communication, University of Miami, Coral Gables, Florida, USA
| | - Susan Morgan
- Department of Communication Studies, School of Communication, University of Miami, Coral Gables, Florida, USA
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24
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Abstract
This article was migrated. The article was marked as recommended. Gamification incorporates elements of gameplay into real-word activities and behaviours. These elements include progress mechanics, player development and narrative structure. Gamification is being increasingly used in an educational context as it has the ability to make learning fun, memorable and more effective. We recommend ways in which gamification can be effectively implemented in medical education, including common pitfalls and hurdles to avoid.
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25
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Does Preexisting Practice Modify How Video Games Recalibrate Physician Heuristics in Trauma Triage? J Surg Res 2019; 242:55-61. [PMID: 31071605 PMCID: PMC6913034 DOI: 10.1016/j.jss.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/07/2019] [Accepted: 04/04/2019] [Indexed: 11/20/2022]
Abstract
Background: A majority of severely injured patients fail to receive care at trauma centers (undertriage), in part, because of physician judgment. We previously developed two educational video games that reduced physicians’ undertriage compared with control in two clinical trials. In this secondary analysis, we investigated heterogeneity of treatment effect of the interventions by assessing physicians’ preexisting practice patterns in claims data. We hypothesized that physicians with high preexisting undertriage would benefit most from game-based training. Methods: Using Medicare claims records from 2010 to 2015, we measured physicians’ preexisting triage practices before their participation in one of two trials conducted in 2016 and 2017. We categorized physicians as having received game-based training versus control and noted their postintervention simulation triage performance in the trials. We used multivariable linear regression models to assess the heterogeneity of game-based training effect among physicians with high and low preexisting undertriage. Results: Of the 394 eligible physicians from our trials, we identified 275 (70%) with claims for Medicare fee-for-service beneficiaries suffering severe injury between 2010 and 2015. On average, the physicians were 44 y old (SD 8.4) with 12 y (SD 8.2) of experience. We found significant interaction between preexisting practice and intervention efficacy (P = 0.04). Physicians with high undertriage before enrollment improved significantly with game-based training compared with the control (46% versus 63%, P < 0.001). Those with low preexisting undertriage did not (58% versus 56%, P = 0.76). Conclusions: Using claims-based data, we found heterogeneity of treatment effect of interventions designed to recalibrate physician heuristics. Physicians with high preexisting undertriage benefited most from game-based training.
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