Serious Games In Medical Education Research Articles

Analog Serious Games for Medical Education: A Scoping Review.

Serious games are increasingly used in medical education to actively engage learners. Analog serious games are a nondigital subset of serious games with specific purposes that go beyond entertainment. This scoping review describes the literature pertaining to analog serious games and provides recommendations regarding gaps and emerging directions for future research. The authors conducted a scoping review following the Arksey and O'Malley framework, searching 3 databases (MEDLINE, Embase, and CINAHL) for studies of analog serious games designed for physician-track learners published from January 2013 through December 2023. Two authors independently screened the titles and abstracts, whereas 1 of 5 authors screened each full text and extracted data from eligible records. The authors iteratively analyzed the data within numerous categories and coded the findings to examine how the field has evolved during the past decade. The searches retrieved 3,955 records with 865 duplicates. The authors reviewed 3,090 title and abstract records and 202 full-text records. Eighty-eight records met the inclusion criteria, including research reports, conference abstracts, descriptive reports, and short innovation reports. The peak years for publications were 2019 and 2023 (15 publications each). Fewer abstracts and articles were published during the beginning of the COVID-19 pandemic (i.e., 2020-2022). The most common scholarship type was description studies (63 [72%]), whereas the dominant game formats were board games (51 [58%]) and card games (33 [38%]). Most studies tested analog serious games with medical students (60 [68%]) and/or residents and fellows (39 [44%]), with numerous studies including mixed study populations. This scoping review demonstrates moderate growth within the field of analog serious games, along with numerous opportunities for future research. Although analog game-based learning cannot entirely replace traditional pedagogical approaches, analog serious games have potential to meaningfully complement education for physician-track learners in all medical training stages.

Who learns more: the impact of dual-player and single-player modes in a serious game on dental students’ factual knowledge

BackgroundThe use of serious games in medical education provides a bridge between rapidly developing technology and traditional health-care teaching. Building on a promising web-based serious game for reviewing and acquiring factual knowledge in dental education, the present study investigated the benefits of a dual-player mode and various game options for enhancing knowledge gain and study motivation.MethodsBefore the intervention, students’ dental knowledge and game experience were assessed using a pre-knowledge test and questionnaire-based self-assessment. Students in the clinical study phase (n = 57) were stratified based on prior knowledge and gender and then randomly assigned to two groups, with two player modes: single player (SP) and dual player (DP). In the SP group, each participant played alone, whereas in the DP group, the participants played against a previously determined peer. For a period of 4 weeks, the students were able to playfully acquire knowledge from the field of operative dentistry using METIS, a serious game application with three different game options (Marathon, Sprint, and Time). After the intervention phase, both groups completed a post-knowledge test. The usability of the serious game was evaluated with a self-assessment questionnaire.ResultsThe competitive game mode (DP mode; M = 8.92, SD = 1.85) resulted in an increase in the factual knowledge test that was a mean of 2.49 points higher than the SP mode (M = 5.89, SD = 2.19; p < 0.001). The DP group also found the game significantly more helpful for learning (p = 0.04) and engaged more with the teaching content because of the app (p = 0.04). Overall, the usability of METIS was rated as excellent, and students successfully improved their knowledge of dentistry after game play with both game modes (SP, DP, p < 0.001), with the game option “Marathon,” which involves playing the largest number of questions, being the most preferred.ConclusionsThese results suggest that serious games such as METIS are a suitable educational medium for increasing students’ knowledge and interest in the field, and that competition with peers provides even greater motivation to engage with the learning content.

Serious gaming as potential training tool for recognition of adverse drug reactions: side-effect exposure—medical education (SeeMe)

PurposeThe recognition of adverse drug reactions (ADRs) is an important part of daily clinical work. However, medical education in this field is mostly drug-based and does not address adequately the complexity of this field regarding individual risk factors and polypharmacy. This study investigates the potential of the web-based serious game SeeMe (side-effect exposure—medical education) in pharmacological education of medical students to improve the recognition of relevant ADRs.MethodsOne hundred fifty-seven medical students were recruited to evaluate the serious game SeeMe. SeeMe was developed to improve knowledge and recognition of ADRs in clinical practice. Players take on the role of a physician trying to understand fictional patients with ADRs. Before and after an 8-week playing period, an evaluation was carried out through a pre- and post-questionnaire and a pre- and post- knowledge test.ResultsThe students achieved significantly better results in the knowledge test, as almost twice as many exam-relevant questions were answered correctly (p < 0.001). The serious game had a positive effect on the students’ perception of the importance of ADRs.ConclusionThis study demonstrates the potential of web- and case-based fictional serious games in medical education. The improved recognition of side effects represents a crucial step for education and training in clinical pharmacology. Future versions of the serious game may take this further and focus on training in the treatment of ADRs and their relevance in various healthcare professions.

Serious Games in Medical Education: What it Adds? How to Go about It?

ABSTRACT Medical educators have adopted a number of teaching–learning methodologies to make their sessions interactive considering the need for active engagement of students to strengthen the process of learning. One among them is the use of serious games, wherein digital applications are used to enable the attainment of the intended learning objectives. A wide range of serious games can be designed to target different areas in healthcare training, which cumulatively provide a holistic and engaging approach for students to acquire knowledge and develop skills. Owing to the extensive areas and domains in medical education wherein we can use serious games, the benefits attributed to them are immense. The successful introduction of serious games into the medical curriculum depends on several factors and we must adopt a systematic approach to optimize the benefits. In conclusion, the introduction of serious games into medical education can benefit medical students by helping them master multiple skills required for successful clinical practice. Acknowledging the changing landscapes in medical education, there is an immense need that teachers and administrators to explore the possibility of integrating these games into medical schools.

Integrating Serious Games into the Medical Curriculum: Recognizing Challenges and Exploring Remedies.

Medical education is complex in nature, acknowledging the fact that the knowledge base is extremely vast and dynamic, and the number of skills that students must acquire during their period of training is also huge. The introduction of serious games in medical education delivery is actually a response to the ever-changing needs of medical education. In fact, the use of serious games in medical education has transformed the learning process and is an eye-catching illustration of a combination of technology and curriculum to strengthen the overall process of attainment of learning outcomes. Owing to the presence of the game factor, students remain motivated and highly engaged. Although medical educators engage themselves in the process of planning and implementation of such games, they are bound to face some challenges. To address these challenges, we must adopt a multipronged approach, including providing required infrastructure, strengthening faculty development programs, and measures to integrate these games into the existing curriculum. In conclusion, serious games are an effective and engaging addition to the teaching-learning methodologies in medical education. Acknowledging the merits of the same, there is an immense need to identify the potential challenges and then work strategically to overcome them and facilitate learning among medical students.

Comparison of Gamification, Game-Based Learning, and Serious Games in Medical Education: A Scientometrics Analysis.

Game in education aims to enhance human motivation and performance in a given activity. Gamification experts and health researchers are still unsure about the status of progress of game for health. So, to fill in this gap, the present study aimed to analyze scientific productions to identify production trends, subject areas, countries, institutes, and authors in these three areas on gamification, game-based learning, and serious games in medical education, as well as to determine co-authorship patterns. The present descriptive quantitative research was conducted through scientometric analysis by using co-authorship networks in gamification, game-based learning, and serious games. First, an advanced search was performed from 1990 to 2020 and the studies were retrieved from Web of sciences, on Aug 17, 2021 The plain text format of data was inputted to Microsoft Excel, CiteSpace and Gephi to analyze scientometric maps for the three domains. Subsequently, the required indicators to review co-authorship networks were obtained: Degree centrality, Betweenness centrality, Closeness centrality, Density, Clustering coefficient, collaboration index and collaboration coefficient. There were 466 documents in gamification, 155 documents in game-based learning, and 295 documents in serious games. The results indicated the rising trend of scientific publications on the three domains. US was a prolific country in all three domains. Author collaboration has remarkably increased, although the number of single-author articles is still high. Due to the increasing growth of publications on these three domains, research can be continued by forming specialized groups and supporting joint publications. Also, research policy-makers should promote author collaborations on the national and international scale.

Gamification vs. Teaching First Aid: What Is Being Produced by Science in The Area?

Gamification i.e., the incorporation of game design elements into non-game contexts, represents a transformative tool in health education. In this sense, the increasingly intertwined fields of technology, education, and health present opportunities for informed decision-making and the training of educators, health professionals, and policymakers. This need to improve teaching and learning methods is particularly evident in the areas of first aid and basic life support (BLS), with the aim of improving clinical results and health outcomes. Our article carried out a narrative review, focusing on the intersection of gamification, technology and first aid/BLS training with the aim of investigating the application of gamification and serious games in emergency medicine with the aim of improving motivation and theoretical and practical skills. of health professionals. In addition, this review emphasizes the role of simulation-based education in first aid skills training, highlighting its contribution to preparing first aiders for real-world scenarios. Ultimately, this review underscores the transformative potential of serious games in medical education, showcasing their effectiveness across diverse contexts. In summary, it enhances comprehension of gamification's role in healthcare and medical education, particularly in first aid training, by underscoring the adaptability and efficacy of serious games in revolutionizing medical and emergency education and healthcare. Nevertheless, it underscores that this remains a relatively underexplored area of knowledge.

Medical student education simulation competitions.

Sim Wars is a simulation-based competition wherein teams of medical trainees are presented a clinical scenario and provide patient care in front of a live audience. This non-traditional educational offering is a form of serious games in medical education and allows for experiential learning via direct observation. Although a well-described educational modality within graduate medical education, there is a dearth of literature regarding Sim Wars as an educational tool within undergraduate medical education. In this paper, we aim to share student perspectives after participating in Sim Wars. The Sim Wars competition was designed as a double-elimination bracket tournament with arena-style direct observation to maximise student engagement. Teams were provided formative feedback in areas of medical knowledge, clinical management and communication skills. A total of 64 students participated in a regional Sim Wars tournament over the course of 2 years. A total of 36 students completed Likert-based surveys immediately after the Sim Wars competition. Quantitative data and open-ended responses were analysed. Fourteen students participated in focus groups held a few months after Sim Wars regarding their experiences during the competition. Thematic analysis was systematically performed on the qualitative data. Participation in Sim Wars was viewed by students as a high-yield learning experience that increased competence on subsequent clinical rotations. We conclude that this form of serious game can be a highly beneficial educational format for medical students especially if they spend time preparing for the competition and receive structured feedback on their performance.

Use of a Serious Game to Teach Infectious Disease Management in Medical School: Effectiveness and Transfer to a Clinical Examination

PurposePhysicians of all specialties must be familiar with important principles of infectious diseases, but curricular time for this content is limited and clinical teaching requires considerable resources in terms of available patients and teachers. Serious games are scalable interventions that can help standardize teaching. This study assessed whether knowledge and skills acquired in a serious game translate to better performance in a clinical examination.MethodsFifth-year undergraduate medical students (n = 100) at Goettingen Medical School were randomized to three groups receiving different levels of exposure to virtual patients presenting with signs and symptoms of either infective endocarditis or community-acquired pneumonia in a serious game simulating an accident and emergency department. Student performance was assessed based on game logfiles and an objective standardized clinical examination (OSCE).ResultsHigher exposure to virtual patients in the serious game did not result in superior OSCE scores. However, there was good agreement between student performance in the OSCE and in game logfiles (r = 0.477, p = 0.005). An Item Response Theory analysis suggested that items from the serious game covered a wider range of ability, thus better differentiating between students within a given cohort.ConclusionRepeated exposure to virtual patients with infectious diseases in a serious game did not directly impact on exam performance but game logfiles might be good and resource-sparing indicators of student ability. One advantage of using serious games in medical education is standardized content, a lower inhibition threshold to learn, and a need of less staff time compared to small-group clinical teaching.

Reasons to Engage in and Learning Experiences From Different Play Strategies in a Web-Based Serious Game on Delirium for Medical Students: Mixed Methods Design.

BackgroundAlthough many studies have recently been published on the value of serious games for medical education, little attention has been given to the role of dark play (choosing unacceptable actions in games).ObjectiveThis study aimed to investigate potential differences in the characteristics of medical students who have the opportunity to choose normal or dark play in a serious game. This study also aimed to compare their reasons for choosing a play strategy and their perceptions of what they learned from their game play.MethodsWe asked undergraduate medical students to play a serious game in which they had to take care of a patient with delirium (The Delirium Experience). After getting acquainted with the game, students could opt for normal or dark play. Student characteristics (age, gender, experience with caring for older or delirious patients, and number of completed clerkships) were collected, and the Delirium Attitude Scale and Learning Motivation and Engagement Questionnaire were administered. Reasons for choosing normal or dark play were evaluated with an open-ended question. Information on lessons they had learned from the game was collected using an open-ended question and self-reported knowledge on delirium.ResultsThis study had 160 participants (89 normal play, 71 dark play). Male students (26/160, 56.5%) chose dark play significantly more often than female students (45/160, 39.5%; P=.049). We did not find significant differences in student characteristics or measurement outcomes between play strategies. Participants’ main reason for choosing normal play was to learn how to provide care to delirious patients, and the main reason for dark play was to gain insight into what a delirious patient has to endure during delirious episodes. All participants learned what to do when taking care of a delirious patient and gained insight into how a patient experiences delirium. We found no differences in self-reported knowledge.ConclusionsWhen medical students have the opportunity to choose dark play in a serious game, half of them will probably choose this play strategy. Male students will more likely opt for dark play than female students. Choice of play strategy is not affected by any other student characteristic or measurement outcome. All students learned the same lessons from playing the game, irrespective of their learning strategy.

Intersection of Serious Games and Learning Motivation for Medical Education

Educational scholars are implementing technologies into the educational process. They use virtual reality, simulations, augmented reality and other immersive technologies that provide entertainment and an interesting, immersive environment as well as engage and motivate students. The aim of this research is to understand the scope and the nature of studies where serious games for medical education are prospective research subjects for the development of learning motivation. There are specific research questions that are of interest to the authors: (1) how many studies are devoted to exploring how serious games and simulations develop learning motivation; (2) how many studies are devoted to medical education, especially continuing professional education; and (3) which professional fields are most reflected in the search results, and is interdisciplinary learning observed? To answer the research questions, a systematic analysis of publications was chosen as the research method. Altogether, 132 articles published from January 1, 2014 to December 31, 2018 were selected for the review.

Diagnostic Markers of User Experience, Play, and Learning for Digital Serious Games: A Conceptual Framework Study

BackgroundSerious games for medical education have seen a resurgence in recent years, partly due to the growth of the video game industry and the ability of such games to support learning achievements. However, there is little consensus on what the serious and game components in a serious game are composed of. As a result, electronic learning (e-learning) and medical simulation modules are sometimes mislabeled as serious games. We hypothesize that one of the main reasons is the difficulty for a medical educator to systematically and accurately evaluate key aspects of serious games.ObjectiveThis study aimed to identify markers that can evaluate serious games and distinguish between serious games, entertainment games, and e-learning.MethodsJabareen’s eight-phase framework-building procedure was used to identify the core markers of a serious game. The procedure was modified slightly to elicit “diagnostic criteria” as opposed to its original purpose of a conceptual framework. Following the identification of purported markers, the newly developed markers were tested on a series of freely available health care serious games—Dr. Game Surgeon Trouble, Staying Alive, and Touch Surgery—and the results were compared to the published test validity for each game.ResultsDiagnostic criteria for serious games were created, comprising the clusters of User Experience (UX), Play, and Learning. Each cluster was formed from six base markers, a minimum of four of which were required for a cluster to be considered present. These criteria were tested on the three games, and Dr. Game Surgeon Trouble and Staying Alive fit the criteria to be considered a serious game. Touch Surgery did not meet the criteria, but fit the definition of an e-learning module.ConclusionsThe diagnostic criteria appear to accurately distinguish between serious games and mediums commonly misidentified as serious games, such as e-learning modules. However, the diagnostic criteria do not determine if a serious game will be efficacious; they only determine if it is a serious game. Future research should include a much larger sample of games designed specifically for health care purposes.

Innovative Means of Medical Students Teaching through Graphical Methods for Cardiac Data Estimating and Serious Games

Now-a-days non-traditional methods and tools are introduced in the training of medical students which are mediated by the rapid development of information technologies: software training systems, Serious Games, and video materials. The paper presents a software system for the processing and analysis of physiological data, which is suitable for use in the medical students’ training process and a study has been made of the use of serious games in medical education. For optimal work with a software system, a database of cardiac data has been created for healthy individuals and individuals with various cardiac diseases. The established system and the cardiology database can be used by medical doctors to study statistical parameters and graphical cardiac data representation in various diseases. The results obtained from the analysis of the data through graphical methods can be used as an effective visual means for increasing the success of medical students' training. The paper presents the results of a survey of the interest of medical students in higher education Universities in Bulgaria to the inclusion of Serious Games in their medical training. The results show a high interest in game-based learning: by including serious games such as innovative training, it will be possible to build on theoretical education and to increase the efficiency of the education process.

P073: The GridlockED board game: using serious games for medical education

Introduction: The management of patient flow in the emergency department (ED) is crucial for the practice of emergency medicine (EM). However, this skill is difficult to teach didactically and is learned implicitly in the latter half of residency training. To help expedite the learning process, we developed the GridlockED board game as an educational tool to simulate ED patient flow. By having junior medical trainees play this game, we believe that they will develop a greater understanding of patient flow and resource management in the ED. Additionally, since GridlockED is a cooperative game, players may also benefit by improving their communication and teamwork skills. Methods: GridlockED was developed over twenty months of iterative gameplay and review. Feedback from attending emergency physicians, residents, and medical students was integrated into the game through a Plan-Do-Study-Act (PDSA) model. Emergency medicine nurses, physicians and residents at McMaster University were recruited to play GridlockED. Each player completed a pre-survey to collect demographic data and to assess their prior experience with playing board games. All play sessions were recorded for data collection purposes. Following each game session, a member of the research team conducted an exit interview with the players to gather information about their play experience and the educational value of the game. A post-survey was also sent to each participant for further feedback. Results: Eighteen gameplay sessions were conducted from June to August 2017. A total of thirty-two participants played the game (13 emergency physicians, 15 residents, and four nurses). Overall responses to the post-gameplay survey showed that players endorsed GridlockED as a useful potential teaching tool (75%, n=24/32) and the majority felt that it had the potential to improve patient flow in the ED (56%, n=18/32). Most participants found that the game was easy to play (91%, n=27/29), and that the instructions were clear (87.5%, n=28/32). Respondents also felt that the game reflected real life scenarios (56%, n=18) and that cases reflected the types of patients that they saw in the ED (78%, n=25). Conclusion: Our results have shown an overall positive response to GridlockED, with most participants supporting it as both an engaging board game and potential teaching tool. We believe that future studies with larger sample sizes and medical students will further validate the use of serious games in medical education.

Learning decision making through serious games.

In Serious Games (SGs), educational content is integrated into a game so that learning is intrinsic to play, thereby motivating players and improving engagement. SGs enable learning by developing situated understanding in users and by enabling players to practise safe clinical decision making; however, the use of SGs in medical education is not well established. We aimed to design a game-based resource to teach clinical decision making to medical students, and to assess user perceptions of educational value, usability and the role for SGs in undergraduate training. An SG focusing on the acute management of tachyarrhythmias was developed. Third- and fourth-year medical students at the medical school were invited to use and evaluate the game using questionnaires and focus groups. We invited 479 students, and 281 accessed the game. Only 47 students completed the questionnaire and 31 students participated in the focus groups. The data suggest that SGs: (1) can allow students to rehearse taking responsibility for decision making; (2) are fun and motivational; (3) have a role in revising and consolidating knowledge; and (4) could be formative assessment tools. Serious Games enable learning by developing situated understanding in users SGs could be employed as adjuvant learning resources to develop students' skills and knowledge. Further empirical research is required to assess the added value of games in medical education.

A Virtual Emergency Telemedicine Serious Game in Medical Training: A Quantitative, Professional Feedback-Informed Evaluation Study.

BackgroundSerious games involving virtual patients in medical education can provide a controlled setting within which players can learn in an engaging way, while avoiding the risks associated with real patients. Moreover, serious games align with medical students’ preferred learning styles. The Virtual Emergency TeleMedicine (VETM) game is a simulation-based game that was developed in collaboration with the mEducator Best Practice network in response to calls to integrate serious games in medical education and training. The VETM game makes use of data from an electrocardiogram to train practicing doctors, nurses, or medical students for problem-solving in real-life clinical scenarios through a telemedicine system and virtual patients. The study responds to two gaps: the limited number of games in emergency cardiology and the lack of evaluations by professionals.ObjectiveThe objective of this study is a quantitative, professional feedback-informed evaluation of one scenario of VETM, involving cardiovascular complications. The study has the following research question: “What are professionals’ perceptions of the potential of the Virtual Emergency Telemedicine game for training people involved in the assessment and management of emergency cases?”MethodsThe evaluation of the VETM game was conducted with 90 professional ambulance crew nursing personnel specializing in the assessment and management of emergency cases. After collaboratively trying out one VETM scenario, participants individually completed an evaluation of the game (36 questions on a 5-point Likert scale) and provided written and verbal comments. The instrument assessed six dimensions of the game: (1) user interface, (2) difficulty level, (3) feedback, (4) educational value, (5) user engagement, and (6) terminology. Data sources of the study were 90 questionnaires, including written comments from 51 participants, 24 interviews with 55 participants, and 379 log files of their interaction with the game.ResultsOverall, the results were positive in all dimensions of the game that were assessed as means ranged from 3.2 to 3.99 out of 5, with user engagement receiving the highest score (mean 3.99, SD 0.87). Users’ perceived difficulty level received the lowest score (mean 3.20, SD 0.65), a finding which agrees with the analysis of log files that showed a rather low success rate (20.6%). Even though professionals saw the educational value and usefulness of the tool for pre-hospital emergency training (mean 3.83, SD 1.05), they identified confusing features and provided input for improving them.ConclusionsOverall, the results of the professional feedback-informed evaluation of the game provide a strong indication of its potential as an educational tool for emergency training. Professionals’ input will serve to improve the game. Further research will aim to validate VETM, in a randomized pre-test, post-test control group study to examine possible learning gains in participants’ problem-solving skills in treating a patient’s symptoms in an emergency situation.

Systematic review of serious games for medical education and surgical skills training

The application of digital games for training medical professionals is on the rise. So-called 'serious' games form training tools that provide a challenging simulated environment, ideal for future surgical training. Ultimately, serious games are directed at reducing medical error and subsequent healthcare costs. The aim was to review current serious games for training medical professionals and to evaluate the validity testing of such games. PubMed, Embase, the Cochrane Database of Systematic Reviews, PsychInfo and CINAHL were searched using predefined inclusion criteria for available studies up to April 2012. The primary endpoint was validation according to current criteria. A total of 25 articles were identified, describing a total of 30 serious games. The games were divided into two categories: those developed for specific educational purposes (17) and commercial games also useful for developing skills relevant to medical personnel (13). Pooling of data was not performed owing to the heterogeneity of study designs and serious games. Six serious games were identified that had a process of validation. Of these six, three games were developed for team training in critical care and triage, and three were commercially available games applied to train laparoscopic psychomotor skills. None of the serious games had completed a full validation process for the purpose of use. Blended and interactive learning by means of serious games may be applied to train both technical and non-technical skills relevant to the surgical field. Games developed or used for this purpose need validation before integration into surgical teaching curricula.

Immersive Virtual Environments for Medical Training

Advances in simulation technology are fueling a paradigmatic shift in how medicine will be taught and practiced in the future. Current simulators range from simplified part task trainers to fully immersive virtual environments. We are on the verge of training platforms that provide realistic representations of medical and surgical scenarios that engage learners in a manner that approximates reality. This article reviews the rationale for developing advanced virtual environments and details the technologies that are currently available. Immersive environments using virtual reality, herein reviewed, include Cave Automated Virtual Environments, Distributive Virtual Environments for collaborative learning over the internet (Project TOUCH), Serious Games for medical education (PULSE and 3DiTeams), and a Wide Area Virtual Environment. The ultimate role of these technologies in surgical education remains to be determined but will undoubtedly play an important part in the future.