Game on: The gamification of the pharmacy classroom

Effect of Choose-Your-Own-Adventure (CYOA) Activities on Pharmacy Student Knowledge

OBJECTIVE

Many strategies are used in pharmacy education to maintain student engagement through active learning. Gamification, such as the choose-your-own-adventure activity (CYOAA), is one such method. The purpose of this study was to assess improvement in clinical knowledge and retention after the implementation of CYOAA.

METHODS

Two CYOAAs were designed and implemented within second-year pharmacy courses. One activity was on venous thromboembolism (VTE) and the other on chronic obstructive pulmonary disease (COPD). Students completed a six question prequiz and postquiz for both activities mapped to core learning objectives and four similar but more difficult questions on corresponding exams. After the CYOAAs, the students completed a reflection and perceptions survey.

RESULTS

Seventy-five students completed the VTE CYOAA and 77 completed COPD CYOAA. Over the three time points, there was a significant decrease in the mean assessment scores on the VTE activity (68% to 65% to 40%) versus a significant and sustained increase in mean assessment scores on COPD (62% to 83% to 85%). Of the 36 and 33 students who completed the postsurvey, the majority agreed or strongly agreed that they preferred CYOAA to traditional cases and that the activities improved their knowledge, critical thinking skills, and confidence in clinical decision-making.

CONCLUSION

There was a mixed result in the mean assessment scores, with an increase seen with the COPD CYOAA and a decrease with VTE, as well as positive perceptions for VTE and COPD, indicating that this classroom innovation is well-liked and may improve knowledge outcomes.

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

PURPOSE

The 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.

METHODS

One 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.

RESULTS

The 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.

CONCLUSION

This 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.

Enhancing the Management of Non-Specific Neck Pain through Gamification: Design and Efficacy of a Health Application

Chronic non-specific neck pain (CNNP) poses a substantial health and economic burden in China. This study introduces a gamified motion-sensing health application framework to address the limitations of existing health applications. The gamified cervical spine somatic exercise application employs motion capture technology alongside the smartphone's built-in sensors to simulate accurate somatic interactions. Controlled experiments and data analyses demonstrated that the application significantly outperformed traditional text and video interventions in relieving participants' neck pain by increasing their average daily activity and compliance with the cervical spine exercise routine. The neck pain level of the participants is quantified by the Neck Disability Index (NDI). The results from the controlled experiments demonstrate that this gamified approach significantly decreases the Neck Disability Index (NDI) score from 1.54 to 1.24, highlighting its ability to alleviate neck pain and increase user compliance.

A meta-narrative review of choose-your-own-adventure style patient case activities in pharmacy education

BACKGROUND

The objective of this review was to characterize the methods of delivery and assessment of Choose Your Own Adventure (CYOA)-style activities in pharmacy education. A secondary objective was to utilize available data to determine best practices for educators interested in developing similar activities.

METHODS

A meta-narrative approach according to the guidance of the RAMESES standards was used for this review. A broad literature search was conducted using PubMed and Embase. Studies published on the use of a CYOA-style patient case format in pharmacy education were identified and appraised individually for their relevance.

RESULTS

Thirteen studies from the pharmacy education literature were included in the review. Activities were delivered for 25 unique topics, largely in small groups during class via patient simulation or interactive data collection software. Overall, students have a positive perception of CYOA-style activities, with positive results regarding knowledge development and student engagement. The most commonly reported challenge to implementing CYOA-style patient case activities was the up-front time commitment to develop activities.

IMPLICATIONS

This review provides a snapshot of the small but expanding body of literature on CYOA-style patient case activities in pharmacy education. CYOA-style activities are recommended for expanded use in pharmacy education as the preponderance of studies that assessed knowledge development showed significant improvement in knowledge after participation in CYOA-style activities. Additionally, students have a positive perception of CYOA-style activities and reported that they were enjoyable, improved their confidence, and helped them learn course material.

Impact of Serious Games on Body Composition, Physical Activity, and Dietary Change in Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Over the past four decades, obesity in children of all ages has increased worldwide, which has intensified the search for innovative intervention strategies. Serious games, a youth-friendly form of intervention designed with educational or behavioral goals, are emerging as a potential solution to this health challenge. To analyze the effectiveness of serious games in improving body composition, physical activity, and dietary change, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Web of Science, EMBASE, and Scopus databases. Pooled standardized mean differences (SMD) were calculated for 20 studies (n = 2238 the intervention group; n = 1983 in the control group) using random-effect models. The intervention group demonstrated a slightly better, although non-significant, body composition score, with a pooled SMD of -0.26 (95% CI: -0.61 to 0.09). The pooled effect tends to be stronger with longer duration of intervention (-0.40 [95% CI: -0.96, 0.16] for >3 months vs. -0.02 [95% CI: -0.33, 0.30] for ≤3 months), although the difference was not statistically significant (p-difference = 0.24). As for the specific pathways leading to better weight control, improvements in dietary habits due to serious game interventions were not significant, while a direct positive effect of serious games on increasing physical activity was observed (pooled SMD = 0.61 [95% CI: 0.04 to 1.19]). While the impact of serious game interventions on body composition and dietary changes is limited, their effectiveness in increasing physical activity is notable. Serious games show potential as tools for overweight/obesity control among children and adolescents but may require longer intervention to sustain its effect.

"Pharmacotrophy": a playful tournament for game- and team-based learning in pharmacology education - assessing its impact on students' performance

BACKGROUND

At the Faculty of Pharmacy of Paris, we conducted a pharmacology tournament in 2021 and 2022, named "Pharmacotrophy", to offer a game-, team- and competitive-based learning innovation based on fun and challenge. This article aims to (1) provide a detailed overview of the organisation of "Pharmacotrophy," (2) present and compare feedback from both students and teachers, and (3) assess the impact of student participation on their exam marks.

METHODS

"Pharmacotrophy" took place in 2021 and 2022 over a two-week period at the beginning of the exam revision phase. It involved a combination of remote matches using the online quiz creation tool Kahoot!® and in-person matches. Teams, consisting of three students from the 4th or 5th year, participated in several selection rounds leading up to the final match. The questions covered various topics from the pharmacology curriculum. Using an anonymous online survey, we collected the feedback from students and teacher regarding the organisation of the tournament and the interest and difficulty of the different type of questions. We retrospectively compared the exam marks of 4th year students who took part in "Pharmacotrophy" (n2021 = 19 and n2022 = 20) with those of the rest of the 4th year (n2021 = 315-320 and n2022 = 279-281), both in the year before "Pharmacotrophy" and just after the tournament.

RESULTS

Students highlighted the educational benefits of team-based and game-based learning. This novel approach positively and constructively motivated students to review pharmacology. Additionally, students appreciated the establishment of a trust-based relationship with their teachers. All students had a similar pharmacology level based on their exam results in the year before "Pharmacotrophy." After the tournament, participants had marks 20.1% higher in pharmacology questions compared to non-participants (p = 0.02), while they had comparable overall levels, as evidenced by their final grade averages and marks in non-pharmacology questions. Moreover, participants who advanced further in the competition achieved higher marks in pharmacology questions compared to those who were eliminated early in the tournament.

CONCLUSION

The implementation of "Pharmacotrophy" provided students with an enjoyable way to review pharmacology coursework and revived the interest in pharmacology for some. Specifically, participating in "Pharmacotrophy" led to an increase in pharmacology marks for students who were not among the top performers in the class or did not excel in pharmacology in the previous year. This study quantified the pedagogical value of this innovative curriculum in terms of knowledge acquisition.

Educational game improves systems thinking, socialization, and teamwork among students of 13 health professions programs

Systems thinking and interprofessional collaborative practice competencies are critical to inculcate in students of health professions programs. The purpose of this study was to evaluate the impact that an interprofessional education (IPE) experience consisting of an educational game, Friday Night at the ER (FNER), and structured debriefing had on students' systems thinking and self-assessed interprofessional socialization and teamwork skills. Systems thinking was evaluated using the Systems Thinking Scale (STS), and interprofessional socialization and teamwork were evaluated using a modified Interprofessional Socialization and Valuing Scale-9 (ISVS-9) and Interprofessional Collaboration Competency Attainment Scale (ICCAS) question #21. This single-center study targeted students in 13 health professions programs. In the cohort (N of 626), Systems thinking increased significantly. Interprofessional socialization increased significantly, with a large effect size, and 485 (78%) students indicated their interprofessional collaborative practice competencies improved. Program evaluation data revealed students highly valued the experience and would recommend it to their peers. Based on our findings, an IPE experience consisting of FNER gameplay and structured debriefing can improve systems thinking and interprofessional socialization and teamwork in a large, diverse group of students of health professions programs.

Interprofessional Simulation Learning Game Increases Socialization and Teamwork Among Students of Health Professions Programs

BACKGROUND

Interprofessional (IP) socialization is important to develop early in the training of health professions students.

PURPOSE

This study compared changes in health professions students' IP socialization and readiness to function in IP teams and sought to understand students' participation experiences using a simulation learning game ( Friday Night at the ER [FNER]).

METHODS

The single-center study targeted students in 13 health professions programs using a mixed-methods design. Student teams engaged in open discussion, played the game, and participated in team debriefing.

RESULTS

IP socialization increased from fairly great to great extent among all students. Qualitative analyses revealed 3 overarching themes supporting the development of IP communication and systems-based thinking. Program evaluation data revealed that students highly valued this experience as being effective and important to their professional development.

CONCLUSIONS

An IP experience consisting of FNER gameplay and structured debriefing can improve IP socialization and lay the foundation for the development of IP skills among early health professions students.

Analysis of different gamification-based teaching resources for physiotherapy students: a comparative study

BACKGROUND

For health professionals, gamification is a new teaching method that has achieved an important role in recent years, with excellent results in learning and knowledge acquisition. Thus, the objective of this study was to analyze the gaming experience through different gamification resources in the classroom with physiotherapy students.

METHODS

A comparative study on gamification-based teaching resources was carried out during the first semester of the 2021-2022 academic year. A total of 33 physiotherapy students participated in this study. After the theoretical topics were taught, the participants were invited to participate in different gamification resources such as Kahoot!, Physiotherapy Party and Escape Room. The gaming experience with the different gamification resources was measured with the GAMEX scale.

RESULTS

The Physiotherapy Party showed a higher score in relation to the enjoyment dimension compared to the Kahoot! and Escape Room (p = 0.004). The Escape Room presented higher scores in absorption, creative thinking, activation and dominance compared to Kahoot! and Physiotherapy Party (p < 0.005).

CONCLUSIONS

Gamification resources promote enjoyment and creativity in the students in the classroom. The use of new teaching methods based on gamification, such as Escape Room as Physiotherapy Party should be considered as first choice in the use of gamification resources due to the benefits they bring to students.

Implementation of longitudinal thematic course design across four institutions

INTRODUCTION

The objective of this study was to describe thematic course design utilized in pharmacy courses at four different institutions. Best practices and lessons learned are shared.

METHODS

Four institutions independently incorporated a longitudinal Harry Potter (HP) theme into their courses. Faculty collaborated to share course experiences and determine similar concepts present at all four institutions. A mixed-methods approach was used to analyze available data. Thematic analysis was used for qualitative course evaluation comments. Quantitative course evaluation data from two institutions was also analyzed.

RESULTS

Similar concepts identified as important elements of longitudinal thematic course design included creation of new groups, incorporation of thematic activities (e.g., adding HP characters to patient cases), and gamification. Qualitative analysis of student course evaluation comments found three emerging themes: increased student engagement, enjoyment of thematic course design, and appreciation for the gaming aspect. Quantitative course evaluation data demonstrated that students liked the HP theme to facilitate learning and it increased student engagement in the course.

CONCLUSIONS

A thematic course design at four institutions was well received by students and potentially increased student engagement with the course material longitudinally.

A preceptor development program using an interactive board game

BACKGROUND AND PURPOSE

Colleges and schools of pharmacy and residency programs must be engaged in the purposeful development of their preceptors. Preceptor development needs vary widely from a new preceptor needing foundational preceptor skills to a more experienced preceptor who may wish to incorporate more sophisticated precepting methods such as layered learning or interprofessional precepting. It can be challenging to create preceptor development activities that meet these varied needs and keep preceptors of all levels engaged.

EDUCATIONAL ACTIVITY AND SETTING

The Preceptor's Game of Life was developed to incorporate serious gaming into preceptor development to increase engagement and promote learning across all precepting levels. This game was designed to review precepting fundamentals and focused heavily on the application of these principles to authentic precepting scenarios. An element of friendly competition, collaboration, and storytelling created a safe and fun environment where participants could discuss solutions to scenario-based problems.

FINDINGS

The Preceptor's Game of Life has been well received by state and national audiences. Audience members were engaged and invested as they discussed the scenarios presented. Individual, informal feedback following the session and formal session evaluations were positive.

SUMMARY

Though the Preceptor's Game of Life required careful logistical planning, the outcome was positive. High levels of engagement amongst the participants were noted in the form of note taking and audience participation. Audience members appreciated activating their prior knowledge and experiences and applying that to future scenarios. This manuscript serves as a tool for others interested in novel preceptor development methods.

Implementation of a hepatitis-themed virtual escape room in pharmacy education: A pilot study

As we enter a world of blended learning in higher education, an increased need for adaptation of teaching strategies to enhance engagement has been recognised to amplify learning outcomes online. Gamification has been identified as a creative tool to engage the current cohort of learners who are also characteristically tech-savvy. To this end, escape room games have gained considerable traction in medical and pharmacy education to promote learning, critical thinking and teamwork. In this pilot study we describe the implementation of a 60-minute, web-based hepatitis-themed escape room game within a Year 3 Pharmacotherapy unit at Monash University. A total of 418 students participated in this activity. Students' knowledge gain on the topic was assessed through a pre- and post-intervention assessment, whereby a statistically significant improvement was seen in the knowledge score following implementation of the gaming activity (58.66% pre-intervention vs. 72.05% post-intervention, p < 0.05). The innovative learning activity was also well perceived by the students. Virtual escape room game is a viable pedagogical approach to teach and reinforce clinical concepts among pharmacy students. With the evolving landscape of education and learner demographics, investment in technology- enhanced game-based learning is a promising trajectory to support students' growth in a learner-centered environment. A comparison between virtual escape room game and traditional teaching will further inform effectiveness of the gamification on long term knowledge retention.

Gamification in pharmacy education: a systematic quantitative literature review

OBJECTIVES

Gamification involves applying game attributes to non-game contexts and its educational use is increasing. It is essential to review the outcomes and the efficacy of gamification to identify evidence to support its use in pharmacy education.

THIS ARTICLE

systematically and quantitatively reviews and evaluates the alignment of learning outcomes and the quality of peer-reviewed literature reporting gamification in pharmacy education.

KEY FINDINGS

A literature search was undertaken in February 2022 using CINAHL Complete, MEDLINE, Science Direct, Scopus and ERIC databases, via keywords (game* OR gaming OR gamif*) AND pharmac* AND education. Google Scholar was searched using 'gamification of pharmacy education' and 'serious games in pharmacy education'. Data extracted included type of gamified intervention, mode of delivery, game fidelity, intended learning outcomes and outcomes reported. Quality assessments aligned with key aspects of the SQUIRE-EDU Reporting Guidelines. Of 759 abstracts and 95 full-text papers assessed, 66 articles met the inclusion criteria. They described gamification from 12 countries in the education of 8272 pharmacy and health professional students. Gamified interventions ranged from board games to immersive simulations, with escape rooms most frequently reported. Reporting quality was inconsistent, with observed misalignment between intended learning outcomes and outcomes reported, an apparent overreliance on student perceptions as primary data and a lack of reference to reporting guidelines.

SUMMARY

Gamification is included in the curricula of many pharmacy degrees, across multiple subject areas. This review identified evidence gaps and reinforces the need for improved quality of gamification research, critical alignment of learning outcomes with evaluation, and use of reporting guidelines.

Microlearning activities improve student comprehension of difficult concepts and performance in a biochemistry course

INTRODUCTION

Students must rapidly learn and retain fundamental basic science knowledge in a doctor of pharmacy curriculum. Active learning stimulates engagement, reinforces concept understanding, and promotes retention of knowledge. The purpose this study was to determine if introducing game-based active recall and critical thinking microlearning activities improved student comprehension of challenging concepts, exam performance, and successful completion of a biochemistry course.

METHODS

Microlearning activities were generated using Articulate Storyline software. Questions and problems were embedded in gamification-type activities to reinforce challenging biochemistry concepts and improve critical thinking. Activities were published on Blackboard and student performance was recorded. Students were divided into performance groups using their first exam scores. Student's exam scores were related to results from corresponding microlearning. Statistical analysis of results was performed to compare exam results with outcomes of microlearning activities.

RESULTS

Student performance on exams and final scores positively correlated with successful completion of microlearning activities. Students who successfully completed more microlearning activities performed significantly better on all exams in comparison with students who completed few microlearning activities. Students who initially struggled with the material but completed more microlearning improved their performance on exams and passed the course with a higher score. In contrast, students who struggled and completed fewer activities failed to improve their exam and course performance.

CONCLUSIONS

Active recall and critical thinking microlearning activities enhanced knowledge retention and comprehension of challenging biochemical concepts. Microlearning scores positively correlated with student exam performance in a biochemistry course, especially amongst students struggling with the material.

A novel game to review pharmacoeconomic content in a pharmacy program

BACKGROUND AND PURPOSE

This study reports on the development of a new game designed specifically for a pharmacoeconomics course to meet three objectives: (1) identify four main types of pharmacoeconomic analyses, (2) understand different outcomes for each analysis, and (3) interpret findings of pharmacoeconomic analyses.

EDUCATIONAL ACTIVITY AND SETTING

The game simulated real-world applicability of pharmacoeconomic analyses in a classroom setting using a candy theme. Groups of pharmacy students (N = 62) competed by building formularies that incorporated a minimum number of medications (candies) from each outcome category and at least two specialty services. Each medication and service were assigned a cost and rating according to the outcome associated with each analysis type. The following class session served as a debriefing to assess student perceptions using a written survey. Survey responses ranged from a score of 1 (strongly agree) to 5 (strongly disagree). A separate open-ended question collected feedback on the strengths and weaknesses of the game and analyzed into themes.

FINDINGS

Student responses averaged 1.96 (SD = 1.1) for all questions. The highest rated question, "I attained the stated goals/objectives of this activity," scored 1.81 (SD = 1.1). Four overall themes emerged: engaging (n = 10), valuable (n = 19), confusing (n = 17), and disconnected (n = 8). Students highlighted the value of the gaming activity for providing practical, real-life examples to increase their understanding.

SUMMARY

The design and application of gaming in a pharmacoeconomics course proved practical and valuable for student learning.

The Role of Game-Based Learning in Experiential Education: Tool Validation, Motivation Assessment, and Outcomes Evaluation among a Sample of Pharmacy Students

(1) Background: There is a scarcity of data regarding game-based learning (GBL) in experiential pharmacy education; in addition, the impact of educational games on the attainment of intended learning outcomes and students’ motivation to actively learn and practice through non-traditional pedagogical tools are yet to be explored. (2) Methods: This was a prospective quasi-experimental study that introduced GBL into the Pharmacy Practice Experience course of the Bachelor of Pharmacy (BPharm) program at the Lebanese International University in Lebanon. Data collection took place between July and September 2021. The study objectives were to assess the impact of GBL on attaining intended learning outcomes, determine students’ motivation to engage in GBL, and assess the impact of this motivation on the attainment of learning outcomes. (3) Results: GBL was associated with a significantly higher exam average (mean difference = 7.152, p < 0.001). Moreover, an active learning motivation assessment scale (ALMAS) was constructed and validated; it was found to have good reliability as well as high sensitivity and specificity, and it determined a good level of motivation to engage in GBL. Game-based learners with higher motivation scores had significantly higher exam averages compared to those with lower scores (Beta = 0.296, 95% CI 0.110–0.545, p = 0.004). (4) Conclusion: GBL was associated with better attainment of intended learning outcomes. Students appear to be motivated to learn by this style of active learning, and motivation is prognostic of the attainment of learning outcomes.

Twelve tips to enhance student engagement in synchronous online teaching and learning

Synchronous learning is a component of online learning for engaging students in real-time. It is the nearest we can get to a live feeling in the e-environment. These sessions must be designed in a way to keep students continuously involved. This paper aims to provide health professional educators with tips for increasing student engagement in the online synchronous environment. The relevant literature regarding student engagement and synchronous online learning was reviewed and collated with the authors' own experiences, to formulate these tips. Health professional educators can use these tips to enhance student engagement in online synchronous classes.Increased student engagement in online sessions, means better learning. These tips have been tried and tested by the authors as being satisfactory for increasing student interest in synchronous sessions and hence providing an optimal learning experience online.

Crossword puzzle as a learning tool to enhance learning about anticoagulant therapeutics

BACKGROUND

Educational games make the learning process more enjoyable, fun, and create a competitive classroom environment that can positively affect learning. The purpose of this study was to evaluate pharmacy students' perceptions of crossword puzzles (CWPs) as a learning tool in the pharmacotherapy cardiovascular module focusing on anticoagulants' therapeutics and assessing if students' preference of learning style influenced their perception.

METHODS

Clues for the puzzle were developed, validated, and piloted by course faculty. A free internet puzzle generator was used to create puzzles with 10 to 20 clues. Students were given 30 min to solve the puzzle following six hours of didactic lectures about the topic. An 8-item survey instrument and Pharmacists' Inventory of Learning Styles (PILS) questionnaire were administered to examine students' perceptions of the game and their learning style preference, respectively.

RESULTS

Two hundred sixty-seven students participated in the activity from both undergraduate programs (BPharm and PharmD) over three consecutive course offerings. Most students expressed favorable perceptions of the puzzle. Female and BPharm students had significantly more favorable perceptions than male and PharmD students on several perception items. The dominant preferred learning style (PLS) was converger (35.6%), followed by assimilator (25.3%), while 15.1% had mixed learning styles. The study did not find a significant association between PLS and students' perceptions toward the CWP.

CONCLUSIONS

The CWP game presented an innovative, creative, and easy active learning tool to enhance information recall, retention, and class engagement while accommodating all learning style preferences.

Creation and implementation of a drug discovery and development game

BACKGROUND AND PURPOSE

Gamification is a commonly employed active-learning technique to increase student engagement and learning. Few games teaching the drug discovery and development process exist.

EDUCATIONAL ACTIVITY AND SETTING

A six hour component of the elective course Non-traditional Pharmacy Career Routes focused on drug development. Four of the six hours were devoted to a game designed to mimic the drug discovery and development process. The 17 enrolled students were split into smaller groups designated to represent large pharmaceutical, start-up, or generic companies. The number of resources each group began with varied depending on the type of company they were assigned. Students worked to develop and bring to market the most drugs and gain the most money. To reinforce the reflective and innovative learning process, students created "failure" cards before the game started that had reasons for failures during the drug development process.

FINDINGS

Two questions about the drug discovery and development process were on a pre-/post-assessment. The first question was answered correctly by 12 of 16 students on the pre-assessment, while 15 of 17 students answered correctly on the post-assessment. The second question was answered correctly by 13 of 16 students on the pre-assessment and all students on the post-assessment. The students enjoyed playing the game and felt that it helped them to understand the drug development process.

SUMMARY

A novel, role-play game that allows students to learn the drug discovery and development process has the potential to be implemented in similar courses.

Game-Based Learning in Pharmacy Education

Game-based learning (GBL) involves adding game elements to non-game activities to encourage engagement. Pharmacy curricula are required to incorporate active learning to meet accreditation standards. The literature supports that well-designed GBL holds the attention of students and improves knowledge in some instances. Furthermore, these adaptable experiences can be leveraged for a variety of content areas in pharmacy education. Some activities utilized by educators require large amounts of technological expertise, while others involve minimal use of technology. The incorporation of technology can create highly immersive experiences for learners; however, there are barriers (e.g., financial and technology prowess) to implementation compared to simpler designs. One area of GBL that is not well defined in the literature is how to adequately assess student learning outcomes. Most current studies describe subjective attitudes and confidence or assess content knowledge through objective pre- and post-tests. In the future, more defined and connected methods for assessment—such as active demonstrations within the game—will be needed to better incorporate GBL into pharmacy curricula. Based on the collective evidence in the literature, some GBL activities may serve as useful tools to improve pharmacy student engagement and learning.

Escape Room Dual Mode Approach to Teach Maths during the COVID-19 Era

The COVID-19 pandemic and its social implications generate adverse psychological effects that affect success in education where educational methodologies are not ready to overcome the problem. This article presents the design and evaluation of a gamification activity, the Escape Room, applied to the subjects in Pharmacy and Nursing. The objective of using the Escape Room is to reduce the impact that COVID-19 has on students’ academic performance due to the psychological effects and the change in educational modality with which the vast majority of activities are carried out online. The Escape Room presented in this article is based on the search for a scientist who is fleeing with the COVID-19 vaccine around the world and the students have to find it by passing tests and missions related to mathematics. Due to the COVID measures imposed by the university, where double presentiality was imposed, the proposed Escape Room has the peculiarity of being designed in dual format, that is, allowing students to connect in face-to-face mode, online, or a mixture of both, depending on the maximum capacity of the classroom, the number of positive cases in the group, quarantines, etc. As a result, a great impact is shown on the initial perception of students towards mathematics and a null impact of the COVID-19 effect on the academic performance of students.

Reimagining Pharmacy Education through the Lens of a Choose Your Own Adventure Activity-A Qualitative Evaluation

Background: Successful pharmacy curricula expose students to a variety of teaching and assessment methods to prepare students for clinical practice. However, development of clinical decision-making skills is often challenging for learners. To meet this need, the Choose Your Own Adventure (CYOA) Patient Case Format was developed to enhance traditional paper patient cases by integrating problem-based and case-based learning to improve pharmacy student learning. The objectives of this evaluation were to qualitatively evaluate the CYOA case format. The qualitative assessment of the student pharmacist’s learning experience utilizing this novel patient case format was used to formulate a template for extrapolation to other disease states. Methods: Focus groups were conducted with second year Pharm.D. students enrolled at the University of Tennessee Health Science Center (UTHSC) College of Pharmacy. The focus groups were conducted in Fall 2020, beginning the week after they were exposed to the CYOA case format. The corpus of data was analyzed thematically to identify themes using inductive coding. To establish the validity of this evaluation, the team met to assess the consistency of the data reduction methods and guard against methodological issues that could influence and affect coding decisions. Results: Participants were recruited until thematic saturation was achieved. Out of 25 participants, 23 participants provided demographic information, with 74% identifying as female. Thematic analysis identified three themes: (1) “It was just fun!” (2) Empowering Pharmacy Students through Groupwork: “Collaboration [is] going to be vital” and (3) Meeting the Need for Real-Life Scenarios: “This is a real person.” Conclusions: The data highlight that there are numerous advantages of adopting the CYOA format for delivering applied pharmacotherapy content. The CYOA format presents students with a realistic scenario that is fun and engaging and challenges students to justify their decisions regarding patient care in a structured group environment.

Design and evaluation of a mobile serious game application to supplement instruction

BACKGROUND AND PURPOSE

Pharmacy students often exhibit minimal interest in pharmacy management courses. This pilot study reports on the design and testing of a mobile game application (app) prototype to improve student engagement and learning of financial management concepts.

EDUCATIONAL ACTIVITY AND SETTING

A mobile app (Planet Finance) was designed to supplement instruction for two key financial management topics. The app was introduced to students in two schools of pharmacy after content on financial management was taught. Students were requested to use the game app for a minimum of two weeks and complete a questionnaire assessing their knowledge of management content and perceptions of the app.

FINDINGS

The overall survey response rate was 41%. The majority of respondents played the game app two to four times (48.3%). Only 13.8% of respondents completed all 10 levels. Participants generally agreed that game instructions were clear, and that the game was easy to navigate, entertaining and made learning fun; allowed more engagement with content; and enhanced financial statements and ratios comfort. Those who played the game app more often had more favorable perceptions. User data from the game app showed that the majority of respondents accessed the game app on not more than two days (89.1%) and played up to four levels (69.6%).

SUMMARY

Overall, students enjoyed playing Planet Finance; however, uptake of the app was low. Future revisions may involve adding additional competitive features, content, levels, incentives, and focusing on strategies to incorporate the game into traditional classroom instruction.

Gamification for the Improvement of Diet, Nutritional Habits, and Body Composition in Children and Adolescents: A Systematic Review and Meta-Analysis

Currently, one of the main public health problems among children and adolescents is poor adherence to healthy habits, leading to increasingly high rates of obesity and the comorbidities that accompany obesity. Early interventions are necessary, and among them, the use of gamification can be an effective method. The objective was to analyse the effect of game-based interventions (gamification) for improving nutritional habits, knowledge, and changes in body composition. A systematic review and meta-analysis were performed in CINAHL, EMBASE, LILACS, MEDLINE, SciELO, and Scopus databases, following the PRISMA recommendations. There was no restriction by year of publication or language. Only randomized controlled trials were included. Twenty-three articles were found. After the intervention, the consumption of fruit and vegetables increased, as well as the knowledge on healthy food groups. The means difference showed a higher nutritional knowledge score in the intervention group 95% CI 0.88 (0.05–1.75). No significant effect of gamification was found for body mass index z-score. Gamification could be an effective method to improve nutritional knowledge about healthier nutritional habits. Promoting the development of effective educational tools to support learning related to nutrition is necessary in order to avoid and prevent chronic diseases.

Examining Student Motivation to Use a Gamified System in an Immunology and Immunization Training Course

Background:

Gamification is the process of adding game elements into classroom activities to encourage student participation and motivation. Classcraft^® is a gamified learning system designed to integrate easily with normal classroom activities and to enhance collaboration and teamwork.

Educational activity and setting:

This study explored the use of the Classcraft^® system in an Immunology and Immunization Training course, specifically examining students’ motivation to use the system and potential impacts on their motivation.

Findings:

Results showed that value and enjoyment motivated students to use Classcraft^®. Furthermore,the ease of use of the system positively impacted students’ enjoyment of the system. Students’ choice regarding how much they were required to engage with the system positively impacted the value and enjoyment that they experienced with the system.

Summary:

Students’ demonstrated motivation to use Classcraft^® provides a foundation for further research into the use of gamified learning systems within pharmacy classrooms. Research is needed to understand if use of a gamified learning system positively impacts learning outcomes.

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.

Using a Web-Based Quiz Game as a Tool to Summarize Essential Content in Medical School Classes: Retrospective Comparative Study

BACKGROUND

Kahoot! is a web-based technology quiz game in which teachers can design their own quizzes via provided game templates. The advantages of these games are their attractive interfaces, which contain stimulating music, moving pictures, and colorful, animated shapes to maintain students' attentiveness while they perform the quizzes.

OBJECTIVE

The aim of this study was to evaluate the use of Kahoot! compared with a traditional teaching approach as a tool to summarize the essential content of a medical school class in the aspects of final examination scores and the perception of students regarding aspects of their learning environment and of process management.

METHODS

This study used an interrupted time series design, and retrospective data were collected from 85 medical students. Of these 85 students, 43 completed a Kahoot! quiz, while 42 students completed a paper quiz. All students attended a lecture on the topic of bone and joint infection and participated in a short case discussion. Students from both groups received the same content and study material, with the exception that at the end of the lesson, students in the Kahoot! group completed a quiz summarizing the essential content from the lecture, whereas the other group received a paper quiz with the same questions and the teacher provided an explanation after the students had finished. The students' satisfaction was evaluated after the class, and their final examination was held 2 weeks after the class.

RESULTS

The mean final examination score in the Kahoot! group was 62.84 (SD 8.79), compared to 60.81 (SD 9.25) in the control group (P=.30). The students' satisfaction with the class environment, learning process management, and teacher were not significantly different between the 2 groups (all P>.05).

CONCLUSIONS

In this study, it was found that using Kahoot! as a tool to summarize the essential content in medical school classes involving a lecture and case discussion did not affect the students' final examination scores or their satisfaction with the class environment, learning process management, or teacher.

Game-Based Learning Outcomes Among Physiotherapy Students: Comparative Study

BACKGROUND

University teaching methods are changing, and in response to a classical teacher-centered approach, new methods continue to strengthen knowledge acquisition by involving students more actively in their learning, thus achieving greater motivation and commitment.

OBJECTIVE

This study aimed to analyze the degree of satisfaction of physiotherapy students who used a board game-based approach, as well as to compare the difference between traditional and gamification teaching methods and their influence on the final evaluation of these students.

METHODS

A comparative study was conducted. Participants were physiotherapy students who were enrolled in the subject of "physiotherapy in geriatric and adult psychomotricity" (n=59). They were divided into two groups (experimental [n=29] and control [n=30] groups) through convenience sampling. The experimental group received gamification lessons, where the students performed different tests adapted from Party&Co, and the control group received traditional lessons. A total of 16 theoretical lessons were received in both groups.

RESULTS

The scores in the final examination of the subject were higher in the experimental group (mean 7.53, SD 0.95) than in the control group (mean 6.24, SD 1.34), showing a statistically significant difference between the two groups (P=.001).

CONCLUSIONS

Overall, the "Physiotherapy Party" game not only stimulated learning and motivated students, but also improved learning outcomes among participants, and the improvements were greater than those among students who received traditional teaching.

Student nurses' experience using a serious game to learn environmental hazard and safety assessment

Knowledge acquisition facilitated by computer games, also referred to as digital game-based learning, is growing in popularity as an educational modality for healthcare disciplines. There is a dearth of research specifically focused on students' perception and lived experience of a serious game, which is a game primarily designed for educational purposes. This qualitative study aimed to evaluate the efficacy of using a serious game to teach hazard and safety assessments in community and residential healthcare settings. Using a phenomenological approach semi-structured interviews collected data about students' experience using the game 'Safe Environments'. Eight students from undergraduate healthcare programs participated. Interpretive Phenomenological Analysis was conducted. Themes and sub-themes identified nuances explaining the impact of prior knowledge, technical ability, and engagement on achievement of learning outcomes. The dynamic interrelationship and influence of themes are illustrated in the KNavEL Model, which explains the complexity of individuals' understanding and perceptions of learning through gaming. This study demonstrates that learning outcomes are directly influenced by the degree of engagement with the game. This in turn is influenced by what the student brings to the game by way of knowledge, experience navigating technology, and the subject matter. The results give voice to students' experiences and provide new insights into understanding the learning processes inherent in using serious games in health education.

Increasing engagement in pharmacology and pharmacogenetics education using games and online resources: The PharmacoloGenius mobile app

Mobile applications represent useful instruments to convey information and engage the users even during traveling, thanks to the wide diffusion of smartphones, tablets, smartwatches, and similar devices. As such, they have high potential as learning tools that can act complementary to traditional teaching approaches. In the field of pharmacology, mobile applications are increasingly being used to improve adherence of patients or to help them report suspect adverse drug reactions. However, they have been scarcely applied to pharmacology education. In this article, we present PharmacoloGenius, a free Android mobile application integrating resources useful for students as well as healthcare professionals or researchers to expand knowledge on pharmacological topics. We gave particular emphasis to pharmacogenetics, as it is a fundamental tool to achieve personalized treatment. The application offers original games such as pharmacological trivia based on textbooks or special "journal club" trivia based on research articles conveying the state of the art on specific topics. Additionally, the app offers a curated list of online resources to study pharmacology and pharmacogenetics (e.g., free online courses, videos, and databases) as well as updated news on conferences, grants, and opportunities for pharmacologists. In conclusion, PharmacoloGenius aims to be a useful instrument for people interested in expanding their knowledge on pharmacology in an engaging way.

Students' perceptions of playing a serious game intended to enhance therapeutic decision-making in a pharmacy curriculum

BACKGROUND AND PURPOSE

Therapeutic decision-making is a critical part of the skill set required by practicing pharmacists. A potentially straightforward way to teach and evaluate decision-making skills is use of real-time simulations. This study aimed to evaluate pharmacy students' perceptions of using a real-time simulation game to treat their own virtual patient.

EDUCATIONAL ACTIVITY AND SETTING

Second professional year (Y2) and fourth professional year (Y4) pharmacy students were provided an opportunity to use a virtual patient simulation in their courses. Student perceptions of the game and use of the game for decision-making were evaluated by a questionnaire. The qualitative findings were analysed using an inductive thematic analysis.

FINDINGS

The questionnaire was completed by 120 Y2 and 115 Y4 students. Four themes arose from the analysis that reflected the students' perceptions of autonomy in their learning and practice, the difficulty in committing to a decision, and having fun while learning.

SUMMARY

This work provides an initial exploration of the perceptions of pharmacy students about playing a real-time, autonomous, simulation-based game for treating a patient. Future research should focus on more detailed evaluation of this game for learning therapeutic decision-making.

On-call duties in hospital pharmacies: National survey and elaboration of a training program for pharmacy residents

OBJECTIVES

During their residency, pharmacy residents are required to attend a hospital on-call program in order to insure the continuum of care for inpatients. This activity is subject to risks, and requires a prior training. Our aim was to develop and to optimize such a training program.

METHODS

To this end, we first established a baseline study of the existing training methods in our hospital and those in the different hospitals of France in which pharmacy residents realize in-house on-call duties, associated with an identification of both pharmacists and students' needs in our institution. These preliminary studies were used to create a transversal, structured and harmonized training program.

RESULTS

The results of our national survey highlighted great disparities of training between the establishments and point out the lack of structure, organization and harmonization of the training, which residents expected to be improved. Our training program contains 3 parts: initial theoretical training, initial practical training and continuous training. Beyond the harmonization of the theoretical training's materials between the different sectors of the pharmacy, new tools were introduced like an in-house on-call duty notebook complementary to trainings adapted to note taking, simulation's workshops and interactive quizzes. The training was gradually implemented in our hospital pharmacy, in collaboration with the pharmacists of the different activity sectors.

CONCLUSIONS

The next steps of our work will be to assess pharmacists and pharmacy residents' satisfaction about our program and its efficacy.

Harnessing single-stranded DNA binding protein to explore protein-protein and protein-DNA interactions

Proteins must interact with a variety of other cellular components to properly perform their functions. We have developed a series of five experiments based on the robust bacterial single-stranded DNA binding protein (SSB) to characterize both known and unknown protein-protein and protein-DNA interactions. Students work in groups to generate and process data from electrophoretic mobility shift assays (EMSA), yeast two-hybrid, far Western, chromatin immunoprecipitation (ChIP), and fluorescence microscopy experiments, including choosing a novel condition for each. A gamification approach was used to encourage student participation and laboratory safety. Student learning was assessed using pre- and post-surveys and course grade data. The results indicate a clear increase in both content knowledge and confidence in the topics presented. Ranking of course activities indicated that performing the hands-on laboratory exercises was the most valuable course component, and over half of the students would choose to take another course with a similar gamification component. Each of the five laboratory experiments can be performed in combination with each other or integrated separately into a related course, and the gamification structure can be applied to any course.

Pilot Study Suggests Smartphone Application Knowledge Improves Resident Transesophageal Echocardiography Knowledge: A Randomized Controlled Trial

OBJECTIVE

The objective of this study was to determine whether an asynchronous smartphone-based application with image-based questions would improve anesthesiology resident transesophageal echocardiography (TEE) knowledge compared with standard intraoperative teaching alone.

DESIGN

Prospective, single-blinded, pilot, randomized controlled trial.

SETTING

Large university teaching hospital.

PARTICIPANTS

Participants were anesthesiology residents on their cardiac anesthesiology rotation.

INTERVENTIONS

EchoEducator, a TEE image-based smartphone application of learning content through questions, was developed. Content was derived from the Examination of Special Competence in Basic Perioperative Transesophageal Echocardiography and the Objective Structured Clinical Examination portion of the APPLIED Examination and focused on identification of basic TEE views, cardiac structures, and pathology. Residents were randomly assigned to receive access to either the application or to standard intraoperative teaching. Thirty residents met inclusion criteria, and 18 residents completed the study. A pre-intervention assessment was given at the beginning of the rotation, and a post-intervention assessment was given after 2 weeks.

MEASUREMENTS

The primary outcome was the difference between the post-test score and the pre-test score. Standard bivariate statistics and the chi-square test were used for categorical variables, and the Student t test was used for continuous variables. Tests were 2-sided, and statistical significance was set at p < 0.05. The intervention group demonstrated a greater increase in score; (+19.19% [95% confidence interval 4.14%-34.24%]; p = 0.02) compared with the control group.

CONCLUSIONS

This study supports the hypothesis that use of a smartphone-based asynchronous educational application improves TEE knowledge compared with traditional modalities alone. This supports an opportunity to improve medical education by expanding the role of web-based asynchronous learning.

Gamification of a Mobile Applications Lecture in a Pharmacy Course

This report describes a librarian's development of an interactive and competitive trivia game using Poll Everywhere, an audience response system software. The trivia game was implemented during a live lecture session on drug information mobile applications taught to first-year pharmacy students. To add a fun and engaging reference for students, the librarian decided to model the game after HQ, a free trivia gaming app. Development of the session, student response, changes to future iterations, and lessons learned by the librarian are described.

A web-based review game as a measure of overall course knowledge in pharmacotherapeutics

BACKGROUND AND PURPOSE

Implementation of games is common in pharmacy education, but limited information exists about the relationship between students' game performances and course grades. Our study was designed to determine if scores on a comprehensive web-based review game correlate to overall pharmacotherapeutics course and course series grades.

EDUCATIONAL ACTIVITY AND SETTING

Two cohorts of students in Pharmacotherapeutics IV, the last course in a four course series, were administered a web-based quiz review game (Kahoot!) at the end of the course. Student performance on the game was compared to grades throughout the Pharmacotherapeutics course sequence to determine if the games were reflective of the students' performances. All students enrolled in Pharmacotherapeutics IV in 2016 and 2017 were included in the analysis. Pearson correlation was performed on the scores from the review game compared to the grades in the pharmacotherapeutics course series.

FINDINGS

A total of 197 students, 111 in the 2016 cohort and 86 in the 2017 cohort, were included in the analysis. The correlation coefficient (r) for the review scores and Pharmacotherapeutics IV course grade was 0.399 and 0.461 for the 2 cohorts (p < 0.001). Almost all component comparisons between the review scores and the other pharmacotherapeutics course grades were also significantly correlated (p < 0.01).

SUMMARY

Student performance on the review game significantly correlated with pharmacotherapeutics course grades. Review games are fun tools to review course content and can serve as an effective method to determine student understanding, progression, and knowledge.

Gamifying the memorization of brand/generic drug names

BACKGROUND AND PURPOSE

The objective of this study was to determine how the implementation of Quizlet, an electronic flashcard/quiz/gaming platform, affected the doctor of pharmacy candidate's ability to successfully complete quizzes based on brand and generic names of the most commonly used medications.

EDUCATIONAL ACTIVITY AND SETTING

Brand name, generic name, and class of Top 300 Prescription Medications were uploaded into the program in four different study sets. Students were encouraged to utilize the provided games to prepare for quizzes. Quiz results were compared to results from the previous year. A survey was administered to measure the student's perception of the efficacy of and engagement in the program in comparison to traditional printed text-based materials.

FINDINGS

Students who played the games in spring 2017 scored significantly higher than the spring 2016 cohort who did not utilize gaming (average 94.1% vs. 86.9%). Most (61.2%) of the students in the 2017 course reported that they primarily utilized the games to study vs. other methods.

SUMMARY

The use of gaming could be a resource that increases student motivation to independently memorize material for quizzes in didactic courses.

Exploratory implementation of a blended format escape room in a large enrollment pharmacy management class

BACKGROUND AND PURPOSE

Adapting the popular entertainment activity "Escape Rooms" for educational purposes is an innovative teaching method with the potential to improve the learning experience. This implementation of an educational escape room explored the feasibility of using a blended online/offline escape room activity in a large enrollment pharmacy management course.

EDUCATIONAL ACTIVITY AND SETTING

An educational escape room activity based on a mixture of online and paper-based clues was designed and implemented in the human resources module of a third professional year pharmacy management course with 141 students. The proof of concept was assessed via an instructor post-activity feasibility analysis and a log of estimated time for all design, development, and delivery components. The instructional objectives of creating a fun, engaging, and collaborative method of teaching were evaluated through an anonymous online student survey.

FINDINGS

The blended environment escape room was implemented successfully. Student perceptions of the activity were generally very positive. In comparison with a typical classroom experience, 91% (n = 126) of participants indicated they were more engaged in thinking about the problems and 89% (n = 123) enjoyed the escape room more.

SUMMARY

With an instructional design that addresses logistical requirements, educational escape rooms can be conducted in courses with large enrollments. Time requirements for this type of teaching method are substantial, but reasonable, if the activity is repeated in subsequent semesters. Educational escape rooms can be used to provide a more enjoyable student experience that immerses them as active participants in the learning environment.

An open randomized controlled study comparing an online text-based scenario and a serious game by Belgian and Swiss pharmacy students

INTRODUCTION

To compare online learning tools, looped, branch serious game (SG) and linear text-based scenario (TBS), among a sample of Belgian and Swiss pharmacy students.

METHODS

Open randomized controlled study. The lesson was based on the case of a benign cough in a healthy child. A randomized sample of 117 students: only the Swiss students had attended a previous lecture on coughs. Participation rate, pre- and post-experience Likert scales and students' clinical knowledge were measured.

RESULTS

Our primary hypothesis was demonstrated: students favored the SG even if navigation was rated as more complex, and students who performed the SG better understood the aim of pharmacist triage in case of cough. The influence of the SG appeared to be linked to the presence of a previous lecture in the curriculum.

DISCUSSION AND CONCLUSION

SG and TBS are effective to teach pharmacist triage. Higher SG complexity should be used to teach the aim of pharmacist triage in the case of a specific disease and could be an alternative to simulated patients. A simpler TBS does not require a previous lecture and a debriefing to be fully effective.