Learning While Having Fun: The Use of Video Gaming to Teach Geriatric House Calls to Medical Students

Integrating a Video Game Recording Into a Qualitative Research Methods Course to Overcome COVID-19 Barriers to Teaching: Qualitative Analysis

BACKGROUND

Because of the COVID-19 pandemic, a doctoral-level public health qualitative research methods course was moved to a web-based format. One module originally required students to conduct in-person observations within the community, but the curriculum was adapted using a web-based video game exercise.

OBJECTIVE

This study sought to evaluate students' perceptions of this adaptation and determine whether the new pilot format successfully met the module's original learning objectives.

METHODS

Recorded footage of a video game session was used for students to observe, take field notes, and compare the results. Qualitative methods were used to evaluate student feedback on the curriculum and determine whether the original learning objectives were met. Data were analyzed using a directed content analysis.

RESULTS

The findings demonstrate that all the learning objectives of this adapted qualitative observational research assignment using a web-based video game exercise were successfully met; namely, the students learned how to compare and contrast the observational notes of peers and to evaluate how personal bias and environmental factors can affect qualitative data collection. The assignment was also positively received by the students.

CONCLUSIONS

The results align with the constructivist learning theory and other successful COVID-19 implementations. Our study demonstrates that the learning objectives of a qualitative observational assignment can be addressed given that there are proper forethought and delivery when the assignment is adapted to a web-based context using a video game exercise.

Evaluating a Dental Public-Health Game across Two Learning Contexts

Serious games have been shown to be effective learning tools in various disciplines, including dental education. Serious-game learning environments allow learners to improve knowledge and skills. GRAPHIC (Games Research Applied to Public Health with Innovative Collaboration), a serious game for dental public health, was designed to simulate a town, enabling students to apply theoretical knowledge to a specific population by selecting health promotion initiatives to improve the oral health of the town population. This study employed a literature-based evaluation framework and a sequential explanatory mixed-methods research design to evaluate the use of GRAPHIC among final-year dental undergraduates across two learning contexts: King’s College London in the United Kingdom and Mahidol University in Thailand. Two hundred and sixty-one students completed all designated tasks, and twelve participated in semi-structured interviews. The findings demonstrated knowledge improvement after game completion based on pre- and post-knowledge assessments, and the students’ perceptions of the game as an interactive and motivational learning experience. The evaluation identified five serious-game dimensions and clear alignment between these dimensions, demonstrating the impact of serious games in dental public health and, more widely, in healthcare education.

Teaching methods fostering enjoyment and creativity in medical education

The journey towards becoming a physician has always been a test of diligence and patience in perfecting the science and art of treating patients. This learning continues well-beyond medical school, requiring a life-long pursuit for acquiring and refining medical knowledge with advances in science and technology. After completing medical school and residency, however, many clinicians report feelings of dissatisfaction and disillusionment with their career path citing lack of autonomy, increased government regulations, and long hours. Although a complex challenge, encouraging creativity and enjoyment during medical education can provide future physicians new skills to advance their medical knowledge while maintaining their personal satisfaction and enjoyment. In this article, we examine examples of how empowering medical education to be enjoyable provides the foundation for producing healthier and more engaged clinicians in the workforce and beyond.

Pharmacy student experience, preference, and perceptions of gaming and game-based learning

INTRODUCTION

The incorporation of serious games in higher education has shown improvement in student engagement and motivation to learn. Research that explores local pharmacy student preferences of gamification aspects of serious games is scarce. Therefore, this study was conducted to investigate local pharmacy student experience, preference, and perceptions of gaming and game-based learning.

METHODS

A cross-sectional study was conducted by distributing self-administered questionnaires among pharmacy students in Malaysia. Descriptive statistics, the Mann-Whitney test, the Kruskal-Wallis test, and the Spearman's correlation test were used for analysis.

RESULTS

A total of 328 pharmacy students enrolled in this study, and 84.1% (n = 276) had video game experience. Students usually played video games using mobile phones (n = 231, 70%). Pharmacy students showed positive perceptions regarding serious games with a mean score of 3.69. However, limited awareness and knowledge of serious games was observed among pharmacy students. The most preferred game genres were role-playing and strategy (n = 174, 53%). Pharmacy students also preferred playing a cooperative game style (n = 113, 34.5%) with scores as a reward system (n = 204, 62.6%). Over three quarters (n = 292, 89.3%) wanted to see the results of the assessment after the game.

CONCLUSIONS

This research provided information on serious games preferences of local pharmacy students. Further study should evaluate the acceptance and effectiveness of the implementation of serious games among pharmacy students in Malaysia.

A Game Show-Based Curriculum for Teaching Principles of Reproductive Infectious Disease (GBS PRIDE Trial)

OBJECTIVES

The purpose of this study was to evaluate whether a game show-based curriculum improves obstetrics and gynecology (OBGYN) residents' confidence in and understanding of the principles of reproductive infectious disease (RID), clinical manifestations and sequelae of sexually transmitted infection (STI), and management of serious long-term consequences of STIs.

METHODS

A game show-based curriculum was developed from the basic principles of RID, which include the following: (1) distinguishing between clinical manifestations of STIs and management of long-term sequelae of STIs; (2) evaluation and management of common gynecologic infectious diseases, including chronic vaginitis, pelvic inflammatory disease, and other pelvic infections; (3) diagnosis and management of perinatal infectious diseases, such as parvovirus, varicella-zoster virus, cytomegalovirus, human immunodeficiency virus, toxoplasmosis, and infection-mediated prematurity; (4) evaluation and management of obstetric and gynecologic postoperative infections; and (5) diagnosis and management of acute and chronic human immunodeficiency virus and hepatitis C virus infections in pregnancy. OBGYN residents at a large urban academic training program were randomized to either a Jeopardy-style educational game show intervention plus a traditional didactic-based curriculum or traditional didactic-based curriculum alone. The study team recruited participants by sending out an e-mail to all of the residents, detailing the study and consent process. Participants from both the intervention and control groups completed confidence and knowledge-based pretests. Posttests were administered 4 weeks after completion of the pretests. Statistical methods were applied to analyze the data.

RESULTS

Thirty-eight residents were randomized to a Jeopardy-style game show-based educational intervention (n = 19) or to a traditional didactic-based curriculum (n = 19). All of the participants (100%) completed the pre- and posttests. Pretest median scores were similar between both groups, in which the Jeopardy group had a median score of 48.5 and the traditional group had a median score of 51.4 (P = 0.091). The Jeopardy group median test scores improved between the pretest and posttest (48.5 vs 62.8, P ≤ 0.001). The traditional didactic-based curriculum had a minimal increase in its median posttest scores (51.4 compared with 54.2, P = 0.773). The Jeopardy group had significantly higher posttest median scores and confidence scores than the traditional didactic-based curriculum (Jeopardy = 62.8, traditional = 54.2, P = 0.002).

CONCLUSIONS

A game show-based curriculum improves OBGYN residents' confidence and retention of knowledge regarding RIDs, clinical manifestations and sequelae of STIs, and management of serious long-term consequences of STIs. Additional studies that include longer posttest time intervals are needed to assess the longer-term impact of game show-based curriculum on knowledge retention among OBGYN residents.

The virtual home visit

Previous research has identified the 'unique experience' of home visits for medical students, yet in-training health professionals' exposure to them is limited and there is not a structured method of performing them. It is already recognised that simulation prior to clinical experience improves knowledge and confidence with the additional benefit that the experience can be standardised. We ran a 'Virtual Home Visit' for falls assessment for third year medical students as part of their teaching on multidisciplinary team (MDT) working. Students considered a clinical scenario involving a lady who had fallen at home and fractured the wrist of her dominant hand. They then watched a short video of her home, where each room was filmed in turned. They were then asked to identify both falls risks and possible adaptations. The session was co-facilitated by a GP Educator and an Occupational Therapist. The students enjoyed the session and performed well in a related OSCE assessment. The technology required was minimal to run the session. The facilitators also recognised the potential to use such a session in an interprofessional education environment.

AntibioGame®: A serious game for teaching medical students about antibiotic use

INTRODUCTION

Measures for controlling antimicrobial resistance are urgently required. We describe here AntibioGame®, a serious game for improving the training of medical students in antibiotic use in primary care.

OBJECTIVE

We aimed to design a serious game for antibiotics teaching and to evaluate its usability and playability by medical students.

METHODS

We used various gamification techniques (e.g. use of mascots, avatars, rewards, leader board) and cartoon graphics in the design of AntibioGame®. This game implements clinical case templates built from a list of learning goals defined by a medical team through an analysis of clinical practice guidelines. The game was evaluated by asking medical students to rate their satisfaction and the usability and playability of the game on an electronic form and through group discussions. The electronic form was derived from the MEEGA + scale, a five-point Likert scale including 32 items for assessing both usability and playability.

RESULTS

AntibioGame® is a case-based game in which students play the role of a doctor meeting patients in consultation and helping other health professionals to solve their problems, as in real life. The scenarios are realistic and cover situations frequently encountered in primary care. The 57 medical students enrolled found the game attractive, usable, fun, and appropriate for learning. Game quality was considered "good" (score = 60 on the MEEGA + scale). All the students said they would recommend the game, 96 % liked it and 81 % would use it for revision.

CONCLUSION

AntibioGame® is a promising tool for improving knowledge in antibiotic prescription that could easily be included in multifaceted programs for training medical students.

Impact of Using a 3D Visual Metaphor Serious Game to Teach History-Taking Content to Medical Students: Longitudinal Mixed Methods Pilot Study

Background

History taking is a key component of clinical practice; however, this skill is often poorly performed by students and doctors.

Objective

The study aimed to determine whether Metaphoria, a 3D serious game (SG), is superior to another electronic medium (PDF text file) in learning the history-taking content of a single organ system (cardiac).

Methods

In 2015, a longitudinal mixed methods (quantitative and qualitative) pilot study was conducted over multiple sampling time points (10 weeks) on a group of undergraduate medical students at The University of Auckland Medical School, New Zealand. Assessors involved in the study were blinded to group allocation. From an initial sample of 83, a total of 46 medical students were recruited. Participants were assigned to either a PDF group (n=19) or a game group (n=27). In total, 1 participant left the PDF group after allocation was revealed and was excluded. A total of 24 students in the game group and 14 students in the PDF group completed follow-up 7 weeks later. Using an iterative design process for over a year, with input from a variety of clinical disciplines, a cardiac history-taking game and PDF file were designed and informed by Cognitive Load Theory. Each group completed its intervention in 40 min. A total of 3 levels of Kirkpatrick training evaluation model were examined using validated questionnaires: affective (perception and satisfaction), cognitive (knowledge gains and cognitive load), and behavioral attitudes (Objective Structured Clinical Exam) as well as qualitative assessment. A priori hypotheses were formulated before data collection.

Results

Compared with baseline, both groups showed significant improvement in knowledge and self-efficacy longitudinally (P<.001). Apart from the game group having a statistically significant difference in terms of satisfaction (P<.001), there were no significant differences between groups in knowledge gain, self-efficacy, cognitive load, ease of use, acceptability, or objective structured clinical examination scores. However, qualitative findings indicated that the game was more engaging and enjoyable, and it served as a visual aid compared with the PDF file.

Conclusions

Students favored learning through utilization of an SG with regard to cardiac history taking. This may be relevant to other areas of medicine, and this highlights the importance of innovative methods of teaching the next generation of medical students.

High-fidelity is not superior to low-fidelity simulation but leads to overconfidence in medical students

BACKGROUND

Simulation has become integral to the training of both undergraduate medical students and medical professionals. Due to the increasing degree of realism and range of features, the latest mannequins are referred to as high-fidelity simulators. Whether increased realism leads to a general improvement in trainees' outcomes is currently controversial and there are few data on the effects of these simulators on participants' personal confidence and self-assessment.

METHODS

One-hundred-and-thirty-five fourth-year medical students were randomly allocated to participate in either a high- or a low-fidelity simulated Advanced Life Support training session. Theoretical knowledge and self-assessment pre- and post-tests were completed. Students' performance in simulated scenarios was recorded and rated by experts.

RESULTS

Participants in both groups showed a significant improvement in theoretical knowledge in the post-test as compared to the pre-test, without significant intergroup differences. Performance, as assessed by video analysis, was comparable between groups, but, unexpectedly, the low-fidelity group had significantly better results in several sub-items. Irrespective of the findings, participants of the high-fidelity group considered themselves to be advantaged, solely based on their group allocation, compared with those in the low-fidelity group, at both pre- and post-self-assessments. Self-rated confidence regarding their individual performance was also significantly overrated.

CONCLUSION

The use of high-fidelity simulation led to equal or even worse performance and growth in knowledge as compared to low-fidelity simulation, while also inducing undesirable effects such as overconfidence. Hence, in this study, it was not beneficial compared to low-fidelity, but rather proved to be an adverse learning tool.

Serious Gaming in Medical Education: A Proposed Structured Framework for Game Development

STATEMENT

Serious games are increasingly being used for medical education. However, the design and development of serious games for the education of health professionals is highly variable, and very few articles report the development process used for game development. There are many established processes for software development that can improve and streamline development, and incorporating the best practices from educational pedagogy and software development may enhance teamwork and communication, decrease development costs, and improve the quality of serious games. In this article, we review and summarize the literature for serious game development for medical education, and combining the best practices, we propose a structured three-phase iterative development framework for serious game development.

Medical Student Evaluation With a Serious Game Compared to Multiple Choice Questions Assessment

Background

The gold standard for evaluating medical students’ knowledge is by multiple choice question (MCQs) tests: an objective and effective means of restituting book-based knowledge. However, concerns have been raised regarding their effectiveness to evaluate global medical skills. Furthermore, MCQs of unequal difficulty can generate frustration and may also lead to a sizable proportion of close results with low score variability. Serious games (SG) have recently been introduced to better evaluate students’ medical skills.

Objectives

The study aimed to compare MCQs with SG for medical student evaluation.

Methods

We designed a cross-over randomized study including volunteer medical students from two medical schools in Paris (France) from January to September 2016. The students were randomized into two groups and evaluated either by the SG first and then the MCQs, or vice-versa, for a cardiology clinical case. The primary endpoint was score variability evaluated by variance comparison. Secondary endpoints were differences in and correlation between the MCQ and SG results, and student satisfaction.

Results

A total of 68 medical students were included. The score variability was significantly higher in the SG group (σ² =265.4) than the MCQs group (σ²=140.2; P=.009). The mean score was significantly lower for the SG than the MCQs at 66.1 (SD 16.3) and 75.7 (SD 11.8) points out of 100, respectively (P<.001). No correlation was found between the two test results (R²=0.04, P=.58). The self-reported satisfaction was significantly higher for SG (P<.001).

Conclusions

Our study suggests that SGs are more effective in terms of score variability than MCQs. In addition, they are associated with a higher student satisfaction rate. SGs could represent a new evaluation modality for medical students.

Simulation in Undergraduate Psychiatry: Exploring the Depth of Learner Engagement

OBJECTIVES

Simulation-based methodologies are increasingly used in undergraduate medical education to expand students' exposure to complex clinical scenarios. Engagement of students in these simulation-based methodologies is a key determinant of their success in learning. Thus, the authors conducted a systematic review to (1) identify simulation methods in use within the undergraduate psychiatry curriculum and (2) assess learner engagement using these methods.

METHODS

Following a PRISMA methodology, the authors searched MEDLINE, ERIC, and PsychINFO databases from 1977 to 2015. Studies applying simulation in undergraduate psychiatric education were reviewed. The depth of learner engagement was assessed using Kolb's four-stage learning cycle.

RESULTS

Of 371 publications identified, 63 met all the inclusion criteria: 48 used standardized patients and 16 used online or virtual learning case modules. Only one study used high fidelity mannequins. Three studies satisfied multiple stages in Kolb's Learning Cycle, including a single study that addressed all four domains.

CONCLUSIONS

Despite the varied uses of simulation across other health disciplines, there were few novel or innovative uses of simulation in undergraduate psychiatric education since the last review in 2008. Expanding on the use of simulation to improve communication, build empathy, and decrease stigma in psychiatry is essential given the relevance to all facets of medical practice. Given the complexity of psychiatry, simulation interventions should extend beyond communication scenarios. Medical students need more opportunities to reflect and debrief on simulation experiences and integrate learning into new contexts. Faculty development should focus on these novel approaches to simulation to deeply engage learners and enhance outcomes.

Game on: The gamification of the pharmacy classroom

BACKGROUND

Gamification is the use of game mechanics to promote engagement and enjoyment of problem-solving in non-game situations. Gamification has been used widely in recent years in industry and academia as a tool for training and education.

OBJECTIVE

The aims of this paper are to provide an overview of gamification and digital game-based learning (DGBL), review the use of digital games in health professional education, and provide suggestions for future use in pharmacy curricula.

DISCUSSION

Many examples of game-based learning in pharmacy and other health professional curricula have been published, however the body of literature on DGBL is less developed. Overall, evaluations of these techniques show that students find them engaging and enjoyable. A recent meta-analysis of studies comparing DGBL to non-game based learning in primary, secondary, post-secondary education found that DGBL significantly enhances learning. Challenges to implementing game-based learning are financial, cultural, and technological.

CONCLUSION

Many areas of the pharmacy curriculum could be appropriate for digital gamification. With more students entering pharmacy school familiar with video games and game-based living the time has come for pharmacy educators to explore how these instructional technologies could benefit a new generation of pharmacy students. As serious games are developed and researched in pharmacy curricula, test scores, student confidence in knowledge and skills, and retention of knowledge and skills are all outcomes that, if published, will help advance the adoption of DGBL into the pharmacy school classroom.

A Systematic Review of Serious Games in Training Health Care Professionals

STATEMENT

Serious games are computer-based games designed for training purposes. They are poised to expand their role in medical education. This systematic review, conducted in accordance with PRISMA guidelines, aimed to synthesize current serious gaming trends in health care training, especially those pertaining to developmental methodologies and game evaluation. PubMed, EMBASE, and Cochrane databases were queried for relevant documents published through December 2014. Of the 3737 publications identified, 48 of them, covering 42 serious games, were included. From 2007 to 2014, they demonstrate a growth from 2 games and 2 genres to 42 games and 8 genres. Overall, study design was heterogeneous and methodological quality by MERQSI score averaged 10.5/18, which is modest. Seventy-nine percent of serious games were evaluated for training outcomes. As the number of serious games for health care training continues to grow, having schemas that organize how educators approach their development and evaluation is essential for their success.

The Conversations About Cancer (CAC) Project-Phase II: National findings from viewing When Cancer Calls…and implications for Entertainment-Education (E-E)

OBJECTIVE

We address cancer communication by creating and assessing the impacts of a theatrical production, When Cancer Calls…(WCC…), anchored in conversations from the first natural history of a patient and family members talking through cancer on the telephone.

METHODS

A national study was conducted using a multi-site and randomized controlled trial. An 80-minute video was produced to assess viewing impacts across cancer patients, survivors, and family members. Comparisons were made with a control video on cancer nutrition and diet. Pretest-posttest sample size was 1006, and 669 participants completed a 30-day follow-up impacts assessment.

RESULTS

All five family and communication indices increased significantly for WCC…. When compared to the placebo, average pretest-posttest change scores were higher for self-efficacy (775%), family fabric (665%), outside support (189%), and family communication (97%). One month following viewings, WCC…participants reported 30% more conversations about cancer among patients and family members about cancer.

CONCLUSION

A new genre of Entertainment-Education (E-E) was created that triggers positive reactions from audience members. Managing delicate and often complex communication about the trials, tribulations, hopes, and triumphs of cancer journeys is fundamentally important for everyday living.

PRACTICE IMPLICATIONS

Unique opportunities exist to make WCC… available to national and global audiences, create tailored curricula, and integrate these viewings into educational programs for patients, family members, and care-provider teams across diverse health, corporate, and governmental systems.

Gaming Preferences, Motivations, and Experiences of Pharmacy Students in Asia

OBJECTIVE

Serious games are becoming popular in various healthcare domains. However, they should be designed to cater toward learners' perspectives, needs, and specifications in order to be used to their full potential in education. This study investigated the gaming experiences, motivations, and preferences of pharmacy students.

MATERIALS AND METHODS

An anonymous self-administered survey obtained participant demographics, gaming experiences (enjoyment level of different game genres, years of experience, gaming frequency and duration, and motivations), and gaming preferences (on in-game rewards, settings, storylines, perspectives, and styles). Descriptive statistics, t tests, analysis of variance, chi-squared tests, and Fisher's exact tests were used for analysis.

RESULTS

The response rate was 69.1 percent (465/673 undergraduates). Role-playing games (RPGs) (4.12 ± 1.07) and massively multiplayer online RPGs (MMORPGs) (3.81 ± 1.26) had the highest enjoyment ratings. Males enjoyed imagination games (e.g., RPGs, MMORPGs) more than females, whereas females enjoyed simulation games more. Top motivating factors for respondents were progressing to the next level (3.63 ± 1.19), excitement (3.33 ± 1.33), and a feeling of efficacy when playing (3.02 ± 1.16). Unlocking mechanisms (25.2 percent) and experience points (17.6 percent) were the most popular in-game reward systems. Most respondents preferred a fantasy/medieval/mythic setting (59.8 percent) and an adventurer storyline (41.3 percent), with similar proportions preferring competitive (35.3 percent), cooperative (33.3 percent), and collaborative (30.8 percent) game styles.

CONCLUSIONS

Different groups of pharmacy students differ in their gaming experiences, motivating factors, and preferences. There is no "one size fits all" game that is suitable for all pharmacy education. Such differences should be considered when developing a pharmacy game in order to cater to the diverse student population.

Utilizing a Meals on Wheels program to teach falls risk assessment to medical students

Falls are a critical public health issue for older adults, and falls risk assessment is an expected competency for medical students. The aim of this study was to design an innovative method to teach falls risk assessment using community-based resources and limited geriatrics faculty. The authors developed a Fall Prevention Program through a partnership with Meals-on-Wheels (MOW). A 3rd-year medical student accompanies a MOW client services associate to a client's home and performs a falls risk assessment including history of falls, fear of falling, medication review, visual acuity, a Get Up and Go test, a Mini-Cog, and a home safety evaluation, reviewed in a small group session with a faculty member. During the 2010 academic year, 110 students completed the in-home falls risk assessment, rating it highly. One year later, 63 students voluntarily completed a retrospective pre/postsurvey, and the proportion of students reporting moderate to very high confidence in performing falls risk assessments increased from 30.6% to 87.3% (p < .001). Students also reported using most of the skills learned in subsequent clerkships. A single educational intervention in the MOW program effectively addressed geriatrics competencies with minimal faculty effort and could be adopted by many medical schools.

Equipping tomorrow's doctors for the patients of today

As the proportion of older patients with frailty presenting to health services increases, so does the need for doctors to be adequately trained to meet their needs. The presentations seen in such patients, the evidence-based models of care and skillsets required to deliver them are different than for younger patient groups-so specific training is required. Several research programmes have used detailed and explicit methods to establish evidence-based expert-validated curricula outlining learning outcomes for undergraduates in geriatric medicine-there is now broad-consensus on what newly qualified doctors need to know. There are, despite this, shortcomings in the teaching of undergraduates about geriatric medicine. National and international surveys from the UK, EU, USA, Canada, Austria and the Netherlands have all shown shortcomings in the content and amount of undergraduate teaching. Mechanisms to improve this situation, aside from specifying curricula, include developing academic departments and professorships in geriatric medicine, providing grants to develop teaching in geriatric medicine and developing novel teaching interventions to make the best of existing resources. Under the last of these headings, innovations have been shown to improve outcomes by: using technology to ensure the most effective allocation of teaching time and resources; using inter-professional education as a means of improving attitudes towards care of older patients; focusing teaching specifically on attitudes towards older patients and those who work with them; and trying to engage patients in teaching. Research areas going forward include how to incentivise medical schools to deliver specified curricula, how to choose from an ever-expanding array of teaching technologies, how to implement interprofessional education in a sustainable way and how to design teaching interventions using a qualitative understanding of attitudes towards older patients and the teams that care for them.

The Conversations About Cancer (CAC) project: assessing feasibility and audience impacts from viewing The Cancer Play

Basic communication research has identified a major social problem: communicating about cancer from diagnosis through death of a loved one. Over the past decade, an award-winning investigation into how family members talk through cancer on the telephone, based on a corpus of 61 phone calls over a period of 13 months, has been transformed into a theatrical production entitled The Cancer Play. All dialogue in the play is drawn from naturally occurring (transcribed) interactions between family members as they navigate their way through the trials, tribulations, hopes, and triumphs of a cancer journey. This dramatic performance explicitly acknowledges the power of the arts as an exceptional learning tool for extending empirical research, exploring ordinary family life, and exposing the often taken-for-granted conceptions of health and illness. In this study, a Phase I STTR project funded by the National Cancer Institute (NCI), we assess the feasibility of educating and impacting cancer patients, family members, and medical professionals who viewed the play as a live performance and through DVD screenings. Pre- and postperformance questionnaires were administered to solicit audience feedback. Pre-post change scores demonstrate overwhelming and positive impacts for changing opinions about the perceived importance, and attributed significance, of family communication in the midst of cancer. Paired-sample t-tests were conducted on five factor-analyzed indices/indicators-two indices of opinions about cancer and family communication, two indices measuring the importance of key communication activities, and the self-efficacy indicator-and all factors improved significantly (<.001). Informal talkback sessions were also held following the viewings, and selected audience members participated in focus groups. Talkback and focus-group sessions generated equally strong, support responses. Implications of the Phase I study are being applied in Phase II, a currently funded effort to disseminate the play nationally and to more rigorously test its impact on diverse audiences. Future directions for advancing research, education, and training across diverse academic and health care professions are discussed.

Developing the Serious Games potential in nursing education

Shortened hospital stays, high patient acuity and technological advances demand that nurses increasingly make decisions under conditions of uncertainty and risk (Ebright et al., 2003). With rising trends towards out-patient care, nurses will need to perform complex problem-solving within a dynamic and changing environment for which there is not one clear solution (Schofield et al., 2010; Wolff et al., 2009). The development of sharp clinical reasoning skills, as well as skills in detection, monitoring, investigation and evaluation are therefore essential (Aitken et al., 2002). Yet few nursing students have long-term exposure to home-care and community situations. This is primarily due to scarce human resources and the time-consuming requirements of student supervision (Duque et al., 2008). When students are given the opportunity to experience home-care or community visits these tend to be unstructured leading to wide variations in their competencies. New pedagogical tools are needed to adequately and consistently prepare nurses for the skills they will need to care for patients outside acute care settings. Advances in Information and Communications Technologies (ICT) offer an opportunity to explore innovative pedagogical solutions that could help students develop these skills in a safe environment. A three-phased project is underway that aims to create and test a Serious Game to improve nurses' clinical reasoning and detection skills in home-care and community settings. The first phase of this project involves the development of a scenario, the game engine and the graphic design and will be the focus of this paper. The second and third phases will test the Serious Game as an educational intervention and will be reported in subsequent papers.

Musical mnemonics in health science: a first look

Song, with its memory enhancement potential and ability to engage, has been employed as a learning tool in some academic settings. Of the countless learning environments, health science may seem the most atypical setting for the musical mnemonic, and yet it may be the most suitable for its application. With medicine's robust history of student-made mnemonics, it only seems natural that learners and instructors alike have begun to experiment with song meant to educate and entertain, primarily imparting them through popular media-sharing sites. This initial assessment of song in health science is meant to highlight notions of efficacy, audience, and use through an informal survey of 10 user-made YouTube musical mnemonics. Two of these mnemonics were co-created by the author, while the remaining eight were identified via select search terms and significant viewer numbers. Resulting YouTube data infers that instructors play a major role in the use of musical mnemonics in health science education. User comments indicate that some students have found value in mnemonic songs, helping them recall information during assessments. More robust research methods, like Q-method, meta-analysis, and opinion mining, can further confirm the value and role of musical mnemonics as they pertain to medicine and healthcare.

Evaluation of a blended learning model in geriatric medicine: a successful learning experience for medical students

BACKGROUND

Despite the increasingly ageing population, teaching geriatric medicine at medical schools is a challenge due to the particularities of this subspecialty and the lack of student interest in this subject.

METHODS

We assessed a blended system that combines e-learning and person-to-person interaction. Our program offered the students a hands-on learning experience based on self-reflection, access to technology, interactive learning, frequent interaction with the multidisciplinary team, more exposure to patients, and regular feedback.

RESULTS

Our results indicate that the students appreciate this system as a rich and effective learning experience demonstrated by their positive feedback and by their significant improvement in knowledge assessed at the end of their rotation.

CONCLUSION

Implementing an interactive blended system is a beneficial approach to teaching geriatric medicine in medical schools and to motivating medical students' interest in this important medical subspecialty.

Gaming used as an informal instructional technique: effects on learner knowledge and satisfaction

BACKGROUND

Jeopardy!, Concentration, quiz bowls, and other gaming formats have been incorporated into health sciences classroom and online education. However, there is limited information about the impact of these strategies on learner engagement and outcomes. To address this gap, we hypothesized that gaming would lead to a significant increase in retained short- and long-term medical knowledge with high learner session satisfaction.

METHODS

Using the Jeopardy! game show model as a primary instructional technique to teach geriatrics, 8 PGY2 General Surgery residents were divided into 2 teams and competed to provide the "question" to each stated "answer" during 5 protected block curriculum units (1-h/U). A surgical faculty facilitator acted as the game host and provided feedback and brief elaboration of quiz answers/questions as necessary. Each quiz session contained two 25-question rounds. Paper-based pretests and posttests contained questions related to all core curriculum unit topics with 5 geriatric gaming questions per test. Residents completed the pretests 3 days before the session and a delayed posttest of geriatric topics on average 9.2 weeks (range, 5-12 weeks) after the instructional session. The cumulative average percent correct was compared between pretests and posttests using the Student t test. The residents completed session evaluation forms using Likert scale ratings after each gaming session and each protected curriculum block to assess educational value.

RESULTS

A total of 25 identical geriatric preunit and delayed postunit questions were administered across the instructional sessions. The combined pretest average score across all 8 residents was 51.5% for geriatric topics compared with 59.5% (p = 0.12) for all other unit topics. Delayed posttest geriatric scores demonstrated a statistically significant increase in retained medical knowledge with an average of 82.6% (p = 0.02). The difference between delayed posttest geriatric scores and posttest scores of all other unit topics was not significant. Residents reported a high level of satisfaction with the gaming sessions: The average session content rating was 4.9 compared with the overall block content rating of 4.6 (scale, 1-5, 5 = Outstanding).

CONCLUSIONS

The quiz type and competitive gaming sessions can be used as a primary instructional technique leading to significant improvements in delayed posttests of medical knowledge and high resident satisfaction of educational value. Knowledge gains seem to be sustained based on the intervals between the interventions and recorded gains.

Final-year medical students' perceptions regarding the curriculum in public health

BACKGROUND

The Faculty of Medicine, University of Colombo, has an integrated curriculum in which teaching of public health takes place through a series of modules which span the full five-year study programme.

AIM

To assess final year medical student perceptions regarding the public health curriculum and to identify factors which influence this.

MATERIALS AND METHODS

The study was cross sectional. Convenience sampling was utilized on final-year students of the Faculty of Medicine, University of Colombo, Sri Lanka. A self-administered 4-point Likert scale questionnaire covered general opinion on public healthcare and perceptions about the curriculum. Data were analyzed using descriptive statistics and Chi-square tests.

RESULTS

One hundred and eighty four students (94%) participated in the study. Eighty-two percent (148) viewed public health as an important field. Only 9% (16) were interested in a career in public health. A significant association was found between choosing public health as career and the following: perception of public health as an important field; holding a good opinion about public health prior to commencement of the course; having found the field-based experience enjoyable and beneficial to the community; and feeling competent to work in the community at the end of the course (P < 0.01). With regard to teaching methods, group activities and discussion-centered activities were identified positively (153, 83% and 125, 68% respectively). The majority of students indicated that they were not stimulated to read more on the subject or regularly revise what they have learnt, both during the introductory public health programme and during the final year.

CONCLUSIONS

The curriculum has been able to create a positive opinion about public health. However, students lack enthusiasm to learn independently. Experiential, group-centered teaching activities and a constructivist approach may be more effective in promoting independent learning. Perceptions are important and should aid in structuring the curricula.

Workforce development in geriatric home care

With the rapidly aging population, it is anticipated that within two decades several million more individuals in the United States with functional impairment and serious ill health will need home health care. This article discusses workforce development, which is a critical issue for future planning, as recently highlighted by the Institute of Medicine (IOM). Key aspects of recruitment, training, and retention of home care workers are discussed, including those who provide basic support for activities of daily living as well as a variety of skilled professionals: therapists, nurses, pharmacists, and physicians. Although the geriatric workforce shortage affects all care settings, it is especially critical in home health care, in part because we are starting with far too few clinicians to meet the medical needs of homebound elderly. A combination of actions is needed, including educational programs, such as those developed by the American Academy of Home Care Physicians (AAHCP), changes in financial incentives, and changes in the culture and practice of health care, to make the home the primary focus of care for these vulnerable, underserved individuals rather than an afterthought.