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

The Success of Serious Games and Gamified Systems in HIV Prevention and Care: Scoping Review

BACKGROUND

AIDS, which is caused by HIV, has long been one of the most significant global public health issues. Since the beginning of the HIV epidemic, various types of nonelectronic communication tools have been commonly used in HIV/AIDS prevention and care, but studies that apply the potential of electronic games are still limited.

OBJECTIVE

We aimed to identify, compare, and describe serious games and gamified systems currently used in HIV/AIDS prevention and care that were studied over a specific period of time.

METHODS

A scoping review was conducted into serious games and gamified systems used in HIV prevention and care in various well-known digital libraries from January 2010 to July 2021.

RESULTS

After identifying research papers and completing the article selection process, 49 of the 496 publications met the inclusion criteria and were examined. A total of 32 articles described 22 different serious games, while 17 articles described 13 gamified systems for HIV prevention and care.

CONCLUSIONS

Most of the studies described in the publications were conducted in the United States, while only a few studies were performed in sub-Saharan African countries, which have the highest global HIV/AIDS infection rates. Regarding the development platform, the vast majority of HIV/AIDS gaming systems were typically deployed on mobile devices. This study demonstrates the effectiveness of using serious games and gamified systems. Both can improve the efficacy of HIV/AIDS prevention strategies, particularly those that encourage behavior change.

Japanese health and safety information for overseas visitors: a randomized controlled trial

INTRODUCTION

International travel to Japan increased steadily until the coronavirus disease 2019 (COVID-19) outbreak. Although international travel was curtailed worldwide due to the pandemic, the number of overseas visitors to Japan should increase again after the restrictions are lifted. We assessed the effect of a five-minute digital game on the knowledge of health information and the level of satisfaction with educational health resources of overseas visitors to Japan.

METHODS

We conducted a randomized controlled trial among 1062 previous and potential visitors to Japan utilizing an internet portal. We recruited previous and potential visitors to Japan from the internet portal sites of the UK, the US and Australia. We randomly allocated participants to two groups: an intervention group that played an animated game and a control group that viewed an online animation. All participants answered a self-administered questionnaire online from March 16 to 19, 2021. We assessed visitors' levels of health knowledge and satisfaction using the CSQ-8. We analyzed the data with a t test and the difference in differences test. Our RCT followed the SPIRIT guidelines.

RESULTS

Of the 1062 previous and potential visitors recruited via the three countries' internet portals (354 from each country), some had visited Japan previously (174 in the intervention group, 220 in the control group), while some were potential visitors to Japan (357 in the intervention group, 311 in the control group). Some had gathered health and safety information about Japan prior to this study (180 in the intervention group, 211 in the control group). Both groups improved their health information levels after the intervention. The level of satisfaction with health information in Japan was significantly increased in the intervention group (average difference of 4.5 points) compared to that in the control group (average difference of 3.9 points) (p < 0.05). Both groups' mean CSQ-8 scores increased significantly after the intervention (p < 0.001): from 23 to 28 in the intervention group and from 23 to 24 in the control group.

CONCLUSIONS

Our study introduced unique educational strategies using an online game to provide health and safety information to previous and potential visitors to Japan. The online game was a more effective way to increase satisfaction than the online animation about health information. This study was registered in the UMIN-CTR (University Hospital Medical Information Network Center Clinical Trials Registry) as Version 1, and the trial registration data are available as UMIN000042483, 17/11/2020.

TRIAL REGISTRATION

Trials UMIN-CTR (University Hospital Medical Information Network Center Clinical Trials Registry), UMIN000042483 (Japanese health and safety information for overseas visitors: A randomized controlled trial), 17/11/2020.

Candy Gland: A Diabetes Board Game for Medical Students

INTRODUCTION

Diabetes mellitus can be a challenging topic for medical students. Educational games can engage students, encourage collaboration and peer teaching, and support friendly competition. To enhance student training on diabetes diagnosis and management, we developed a flashcard-style board game to review these concepts and provide a formative assessment.

METHODS

In this 50-minute session, 102 second-year medical students used a game board and playing cards to compete in small groups. To play, teams took turns answering flashcard-style playing cards and moved forward on the board with correct answers. The first team to reach the end of the board won. Students completed a survey about their confidence in the topic and a multiple-choice test before and after the session to measure the effectiveness of this intervention.

RESULTS

Medical knowledge scores improved from 7.3 before the intervention to 8.0 after (10-point scale, p < .001). Students' ratings of their confidence in diabetes pharmacology, diagnosis, and management all improved (ps < .05 for all), with the greatest improvement seen in pharmacology. Student satisfaction ratings and narrative feedback were very positive.

DISCUSSION

This educational game effectively improved student knowledge and confidence in diabetes diagnosis, pharmacology, and management in an engaging, unique session. The intervention would be easy for other institutions to implement.

Gamification in otolaryngology: A narrative review

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Toward Inclusive Landscape Governance in Contested Landscapes: Exploring the Contribution of Participatory Tools in the Upper Suriname River Basin

Nowadays, tropical forest landscapes are commonly characterized by a multitude of interacting institutions and actors with competing land-use interests. In these settings, indigenous and tribal communities are often marginalized in landscape-level decision making. Inclusive landscape governance inherently integrates diverse knowledge systems, including those of indigenous and tribal communities. Increasingly, geo-information tools are recognized as appropriate tools to integrate diverse interests and legitimize the voices, values, and knowledge of indigenous and tribal communities in landscape governance. In this paper, we present the contribution of the integrated application of three participatory geo-information tools to inclusive landscape governance in the Upper Suriname River Basin in Suriname: (i) Participatory 3-Dimensional Modelling, (ii) the Trade-off! game, and (iii) participatory scenario planning. The participatory 3-dimensional modelling enabled easy participation of community members, documentation of traditional, tacit knowledge and social learning. The Trade-off! game stimulated capacity building and understanding of land-use trade-offs. The participatory scenario planning exercise helped landscape actors to reflect on their own and others' desired futures while building consensus. Our results emphasize the importance of systematically considering tool attributes and key factors, such as facilitation, for participatory geo-information tools to be optimally used and fit with local contexts. The results also show how combining the tools helped to build momentum and led to diverse yet complementary insights, thereby demonstrating the benefits of integrating multiple tools to address inclusive landscape governance issues.

Simulation Versus Interactive Mobile Learning for Teaching Extracorporeal Membrane Oxygenation to Clinicians: A Randomized Trial

OBJECTIVES

Extracorporeal membrane oxygenation has become integral to critical care. Data informing optimal extracorporeal membrane oxygenation education modalities are lacking. We aimed to compare the effect of high-fidelity simulation versus interactive mobile learning on extracorporeal membrane oxygenation knowledge acquisition and retention among clinicians.

DESIGN

Observer-blinded, randomized controlled trial.

SETTING

A single academic medical center.

SUBJECTS

Forty-four critical care clinicians with limited extracorporeal membrane oxygenation experience.

INTERVENTIONS

Participants were randomized to receive: 1) simulation: three high-fidelity training scenarios, 2) QuizTime: 15 total multiple-choice questions delivered over 3 weeks via mobile device, or 3) experiential: no formal training. Participants completed a survey, written knowledge examination, and simulation assessment prior to randomization, immediately following the intervention, and 4 month postintervention.

MEASUREMENTS AND MAIN RESULTS

The primary outcome was knowledge about extracorporeal membrane oxygenation assessed by score on the immediate postintervention written examination. Secondary outcomes included performance in extracorporeal membrane oxygenation simulation postintervention and 4 months later assessed by a rater blinded to group assignment. Clinicians randomized to simulation (n = 15), QuizTime (n = 14), and experiential (n = 15) had similar baseline characteristics. Adjusting for baseline knowledge, postintervention examination scores were higher in the simulation group (90.0%; interquartile range, 85.0-90.0%) than the QuizTime group (70.0%; interquartile range, 65.0-80.0%; p = 0.0003) and the experiential group (75.0%; interquartile range, 65.0-80.0%; p = 0.001). Scores did not differ between the groups at 4 months (p > 0.05 in all analyses). In postintervention extracorporeal membrane oxygenation simulations, the simulation group demonstrated shorter time to critical action compared with QuizTime (80.0 s [interquartile range, 54.0-111.0 s] vs 300.0 s [interquartile range 85.0-300.0 s]; p = 0.02) and compared with both QuizTime (45.0 s [interquartile range, 34.0-92.5 s] vs 255.5 s [interquartile range, 102.0-300.0 s]; p = 0.008) and experiential (300.0 s [interquartile range, 58.0-300.0 s]; p = 0.009) at 4 months.

CONCLUSIONS

Simulation was superior to QuizTime and experiential learning with regard to extracorporeal membrane oxygenation knowledge acquisition. Further studies are needed to ascertain the effect of these interventions on knowledge retention, clinical performance, and patient outcomes.

Geriatric Educational Interventions for Physicians Training in Non-Geriatric Specialties: A Scoping Review

BACKGROUND

Physicians require the expertise to care for an increasingly aging population. A robust understanding of geriatric educational interventions is needed to improve geriatric training for physicians.

OBJECTIVE

To map the breadth of geriatric educational interventions for residents (in non-geriatric specialties).

METHODS

We used a scoping review methodology. We searched MEDLINE, Embase, EMCare, CENTRAL, ERIC, and Scopus from 2004 to September 2019 for search terms related to "educational approaches" AND "geriatric" AND "residents." Two authors independently selected eligible studies, extracted data (categorized by educational approaches and Kirkpatrick level outcomes), and critically appraised studies using the Mixed Methods Appraisal Tool.

RESULTS

There were 63 included studies, with a total of 6976 participants. Twelve studies had comparators, including 5 randomized controlled trials. Fifty-three studies (84%) described multicomponent interventions, incorporating combinations of didactic or self-directed approaches with interactive, simulation, experiential, and/or group-based learning. Use of curricular process was explicitly reported in 34 studies (59%). Most studies met at least 4 of 5 Mixed Methods Appraisal Tool criteria. Studies commonly measured outcomes at Kirkpatrick levels 1 and 2 (reaction and learning), with 15 studies measuring performance outcomes (Kirkpatrick levels 3 and 4b). All included studies had at least one positive result.

CONCLUSIONS

All educational interventions had positive outcomes; however, curriculum-informed multicomponent interventions were the most common. This scoping review demonstrates that robust methodology with comparators, longer-term designs, and use of higher-level Kirkpatrick outcome measures is possible but not commonly used. Clear direction for future research is provided.

Japanese health and safety information for overseas visitors: protocol for a randomized controlled trial

BACKGROUND

Before the COVID-19 pandemic occurred in January 2020, the number of overseas visitors to Japan had increased threefold over the last decade. To minimize the risk of health problems, visitors should be able to access information on the health care systems of the places they visit. Most short-term overseas visitors are young adults. Although they are not very likely to get sick from noncommunicable diseases, they are at high risk for injury and often experience stomach ailments, fever, or nausea when travelling. The objective of this study is to evaluate culturally and linguistically appropriate health information on preventive health behaviours and the health care system in Japan. We will examine the level of satisfaction of overseas visitors to Japan with health care-related educational materials using a five-minute digital game named Sa-Chan Japan.

METHODS

Our study is a randomized controlled trial (RCT). We will assess both satisfaction and motivation before, during, and after the interventions and examine the changes over time. The intervention group will comprise overseas visitors who will view and answer questions in an animation named Sa-Chan Japan. The control group will comprise overseas visitors who will watch an English digital animation named Mari Info Japan. We will recruit 1002 participants through the Macromill Internet portal. We will contact overseas visitors who have either visited or wish to visit Japan from the United Kingdom, United States, and Australia. The participants will fill out a self-administered questionnaire online in the first quarter of 2021. We will determine the participants' levels of satisfaction with the CSQ-8 (8-item Client Satisfaction Questionnaire). We will analyse the median score of the overseas visitors with both the Wilcoxon rank-sum and the Wilcoxon signed-rank tests. Our protocol of randomized controlled trials follows the SPIRIT guidelines.

DISCUSSION

Our research will utilize unique digital education strategies in a game that promotes health and safety among overseas visitors to Japan. We believe the results of this study will be useful in overcoming the current challenges regarding pretravel health requirements for overseas visitors worldwide.

TRIAL REGISTRATION

Version 1 of this trial was registered in the UMIN-CTR (University Hospital Medical Information Network Center Clinical Trials Registry), and the trial registration data are available on UMIN000042483 , November 17, 2020.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A Feasibility Study of Expanded Home-Based Telerehabilitation After Stroke

Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program. Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors to real objects, ingesting a daily experimental (placebo) pill, and generating automated actionable reports. Results: Enrollees (n = 13) were median age 61 (IQR 52-65.5), and 129 (52-486) days post-stroke. Patients initiated therapy on 79.9% of assigned days and completed therapy on 65.7% of days; median therapy dose was 50.4 (33.3-56.7) h. Non-compliance doubled during weeks 7-12. Modified Rankin scores improved in 6/13 patients, 3 of whom were >3 months post-stroke. Fugl-Meyer motor scores increased by 6 (2.5-12.5) points in the arm and 1 (-0.5 to 5) point in the leg. Assessments spanning numerous dimensions of stroke outcomes were successfully implemented; some, including a weekly measure that documented a decline in fatigue (p = 0.004), were successfully scored without therapist supervision. Using data from an attached sensor, real objects could be used to drive game play. The experimental pill was taken on 90.9% of therapy days. Automatic actionable reports reliably notified study personnel when critical values were reached. Conclusions: Several new features performed well, and useful insights were obtained for those that did not. A home-based telehealth system supports a holistic approach to rehabilitation care, including intensive rehabilitation therapy, secondary stroke prevention, screening for complications of stroke, and daily ingestion of a pill. This feasibility study informs future efforts to expand stroke TR. Clinical Trial Registration: Clinicaltrials.gov, # NCT03460587.

Serious Game for Teaching Undergraduate Medical Students in Cleft lip and Palate Treatment Protocol

OBJECTIVES

To develop and evaluate a serious game to deliver knowledge about the cleft lip with or without cleft palate (CL/P) protocol used in Craniofacial Center, Chiang Mai University.

METHODS

The game "Cleft Island" was developed then extensively evaluated using different criteria, including the measured knowledge gained by participants, and gameplay experience. A group of 53 fourth and fifth-year medical students (male: 24, female: 29) were recruited to take part in an experiment. They were from the Faculty of Medicine, Chiang Mai University, and had just rotated to the Department of Surgery. Three evaluations were conducted: 1) to test whether the players had competently gained CL/P knowledge; 2) to evaluate the usability of the game according to the System Usability Scale (SUS); and 3) to evaluate the game experience in terms of a Game Experience Questionnaire (GEQ) test.

RESULTS

The results indicate a statistically significant improvement of medical students' knowledge after performing the Wilcoxon Signed-Ranks test (p < 0.5) between pre-test and post-test scores of the same medical student group; the acceptable average SUS score (M = 55.28) of the serious game; a moderate degree of experience of the GEQ components including positive affect (M = 2.64), competence (M = 2.49), and immersion (M = 2.21).

CONCLUSIONS

Cleft Island can be used as an effective supplementary instructional material, which has the potential to provide significant knowledge of CL/P treatment protocol for the players. As far as the authors are aware, this is the first study to implement and assess a serious game for training in CL/P protocol.

Learners and Luddites in the Twenty-first Century: Bringing Evidence-based Education to Anesthesiology

Anesthesiologists are both teachers and learners and alternate between these roles throughout their careers. However, few anesthesiologists have formal training in the methodologies and theories of education. Many anesthesiology educators often teach as they were taught and may not be taking advantage of current evidence in education to guide and optimize the way they teach and learn. This review describes the most up-to-date evidence in education for teaching knowledge, procedural skills, and professionalism. Methods such as active learning, spaced learning, interleaving, retrieval practice, e-learning, experiential learning, and the use of cognitive aids will be described. We made an effort to illustrate the best available evidence supporting educational practices while recognizing the inherent challenges in medical education research. Similar to implementing evidence in clinical practice in an attempt to improve patient outcomes, implementing an evidence-based approach to anesthesiology education may improve learning outcomes.

A meta-analysis for comparing effective teaching in clinical education

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

Using an online quiz-based reinforcement system to teach healthcare quality and patient safety and care transitions at the University of California

Quality issue

Implementing quality improvement (QI) education during clinical training is challenging due to time constraints and inadequate faculty development in these areas.

Initial assessment

Quiz-based reinforcement systems show promise in fostering active engagement, collaboration, healthy competition and real-time formative feedback, although further research on their effectiveness is required.

Choice of solution

An online quiz-based reinforcement system to increase resident and faculty knowledge in QI, patient safety and care transitions.

Implementation

Experts in QI and educational assessment at the 5 University of California medical campuses developed a course comprised of 3 quizzes on Introduction to QI, Patient Safety and Care Transitions. Each quiz contained 20 questions and utilized an online educational quiz-based reinforcement system that leveraged spaced learning.

Evaluation

Approximately 500 learners completed the course (completion rate 66-86%). Knowledge acquisition scores for all quizzes increased after completion: Introduction to QI (35-73%), Patient Safety (58-95%), and Care Transitions (66-90%). Learners reported that the quiz-based system was an effective teaching modality and preferred this type of education to classroom-based lectures. Suggestions for improvement included reducing frequency of presentation of questions and utilizing more questions that test learners on application of knowledge instead of knowledge acquisition.

Lessons learned

A multi-campus online quiz-based reinforcement system to train residents in QI, patient safety and care transitions was feasible, acceptable, and increased knowledge. The course may be best utilized to supplement classroom-based and experiential curricula, along with increased attention to optimizing frequency of presentation of questions and enhancing application skills.

A Game-Based Approach to Teaching and Learning Anatomy of the Liver and Portal Venous System

Introduction

The use of games and game elements as teaching tools has received increasing attention in the medical education literature. Used formatively, games promote student engagement and satisfaction, and encourage collaboration and teamwork among students. They may also help students retain knowledge, although research supporting this notion is limited. This resource contains a 30-minute interactive lab station involving two different game-based activities aimed at teaching functional anatomy of the liver and portal venous system.

Methods

The first activity is a flipped version of a traditional pinned anatomy practical, wherein students place their own pins on a body donor in response to application-level prompts. The second activity is an outlay-type card game where students assemble cards to depict the venous drainage of gut organs in a healthy patient versus one with portal hypertension.

Results

In end-of-session reviews, several students volunteered feedback that the activities were effective and enjoyable. Additionally, average student scores on two subject exam questions increased by approximately 13% and 4%, compared with students who took the exam before the game elements were introduced.

Discussion

These game-based activities may serve as a starting point for others wishing to deal with historically difficult topics in a more engaging way. The tools presented are low-cost, low-tech, and easy to modify for use with different student populations.

Development of an Educational Game to Set Up Surgical Instruments on the Mayo Stand or Back Table: Applied Research in Production Technology

Background

Existing research suggests that digital games can be used effectively for educational purposes at any level of training. Perioperative nursing educators can use games to complement curricula, in guidance and staff development programs, to foster team collaboration, and to give support to critical thinking in nursing practice because it is a complex environment.

Objective

To describe the process of developing an educational game to set up surgical instruments on the Mayo stand or back table as a resource to assist the instructor in surgical instrumentation training for students and nursing health professionals in continued education.

Methods

The study was characterized by applied research in production technology. It included the phases of analysis and design, development, and evaluation. The objectives of the educational game were developed through Bloom’s taxonomy. Parallel to the physical development of the educational game, a proposed model for the use of digital elements in educational game activities was applied to develop the game content.

Results

The development of the game called “Playing with Tweezers” was carried out in 3 phases and was evaluated by 15 participants, comprising students and professional experts in various areas of knowledge such as nursing, information technology, and education. An environment was created with an initial screen, menu buttons containing the rules of the game, and virtual tour modes for learning and assessment.

Conclusions

The “digital” nursing student needs engagement, stimulation, reality, and entertainment, not just readings. “Playing with Tweezers” is an example of educational gaming as an innovative teaching strategy in nursing that encourages the strategy of involving the use of educational games to support theoretical or practical classroom teaching. Thus, the teacher does not work with only 1 type of teaching methodology, but with a combination of different methodologies. In addition, we cannot forget that skill training in an educational game does not replace curricular practice, but helps.

A Jeopardy-Style Review Game Using Team Clickers

INTRODUCTION

Gaming has been used for many years as a useful supplemental instruction method in the biomedical sciences. However, the effective use of games can be challenging in a large classroom setting due to the difficulty of engaging all students. The goal of this exercise was to design an interactive way to review material that promoted small-group discussion in a large class of 104 students. A review game comparable to Jeopardy was utilized that enabled small teams to engage in friendly competition, using team clickers and a team leaderboard that tracked the team scores in a lowstakes, fun environment.

METHODS

Individual team clickers were used with a Jeopardy-style review game. TurningPoint served as the audience response system. Nineteen preassigned teams comprised of five to six students per team considered all questions during the closed-book review game. Discussion within teams was encouraged prior to each team's selection of an answer using the team clicker. A team leaderboard tracking the team scores was periodically displayed throughout the exercise, which helped keep the students engaged in a fun and relaxed atmosphere, as no extra points were awarded to the winning team.

RESULTS

The review game was enthusiastically received by the students and was frequently cited as an aspect the students enjoyed most about the course. The review game was also positively received by both pharmacy faculty and medical school faculty of the university when presented as a teaching tool during a faculty development session.

DISCUSSION

Although this resource was intended to serve as a serious game to review immunology topics for third-year pharmacy students, it can be used to teach a variety of science topics within the medical education setting. Similarly, while this review game was used within the context of team-based learning pedagogy, it can also be used in a traditional classroom setting, with preassigned teams for the review game.

Mobile spaced education for surgery rotation improves National Board of Medical Examiners scores

BACKGROUND

Use of mobile devices for medical education is increasing. The aim of this study was to describe the implementation of a spaced education-based app study program in a third year medical school surgery rotation and examine its effects on National Board of Medical Examiners (NBME) examination performance.

MATERIALS AND METHODS

Case-based questions were created and distributed to students on a voluntary basis via a mobile app. Questions were repeated in a spaced based manner until mastered. Students completed surveys regarding study habits and app use. NBME examination scores and prior academic measures were obtained. Users of the app were compared to non-users of the app and the previous years' class.

RESULTS

One hundred fifty-two students were offered the app; 121 (80%) used it. App users had a final NBME score of 77.5% compared with 68.8% (P < 0.01) in non-users, although their prior academic achievement was better. Categorizing them by their academic achievement and intensity of app use demonstrated significantly higher scores in regular users of the app as compared with casual and non-users in mid (78 versus 75 versus 71.2%, P < 0.01) and low-achieving students (71.4 versus 70 versus 64.6, P < 0.01), but not high-achieving students (85.3 versus 81.1 versus 79.7, P = 0.09). Stepwise linear regression modeling revealed intensity of app use accounted for 6% of the variance in NBME scores.

CONCLUSIONS

Use of the app-based program was an effective tool associated with higher scores on standardized tests in lower level achieving students.

Systems-based practice: learning the concepts using a teamwork competition model

BACKGROUND

Systems-based practice (SBP) is a core competency of the Accreditation Council for Graduate Medical Education (ACGME) that must be integrated into residency training. We sought to develop a method to improve resident understanding using a teamwork competition model.

METHODS

The residents were given a pretest to assess their understanding of SBP followed by a didactic lecture. They were then divided into teams to solve a programmatic "problem" in the residency. Each team had to prove that their solution best fulfilled the expectations of SBP. Their solutions were then presented at a departmental conference followed by a post-test to evaluate knowledge.

RESULTS

In the pretest, 33% of the residents understood what SBP meant and only 15% knew the components of SBP. In the post-test, this increased to 85% and 89%, respectively.

CONCLUSIONS

SBP is a competency mandated by the Accreditation Council for Graduate Medical Education in residency training. Using a novel approach, we were able to improve the residents' understanding of SBP.

Use of Internet viral marketing to promote smoke-free lifestyles among Chinese adolescents

Purpose

Youth smoking is a global public health concern. Health educators are increasingly using Internet-based technologies, but the effectiveness of Internet viral marketing in promoting health remains uncertain. This prospective pilot study assessed the efficacy of an online game-based viral marketing campaign in promoting a smoke-free attitude among Chinese adolescents.

Methods

One hundred and twenty-one Hong Kong Chinese adolescents aged 10 to 24 were invited to participate in an online multiple-choice quiz game competition designed to deliver tobacco-related health information. Participants were encouraged to refer others to join. A zero-inflated negative binomial model was used to explore the factors contributing to the referral process. Latent transition analysis utilising a pre- and post-game survey was used to detect attitudinal changes toward smoking.

Results

The number of participants increased almost eightfold from 121 to 928 (34.6% current or ex-smokers) during the 22-day campaign. Participants exhibited significant attitudinal change, with 73% holding negative attitudes toward smoking after the campaign compared to 57% before it. The transition probabilities from positive to negative and neutral to negative attitudes were 0.52 and 0.48, respectively. It was also found that attempting every 20 quiz questions was associated with lower perceived smoking decision in future (OR  = 0.95, p-value <0.01).

Conclusions

Our online game-based viral marketing programme was effective in reaching a large number of smoking and non-smoking participants and changing their attitudes toward smoking. It constitutes a promising practical and cost-effective model for engaging young smokers and promulgating smoking-related health information among Chinese adolescents.

Using educational games to promote the seeking of a pharmacist and to teach key medication use messages: results from an inner city health party

BACKGROUND

Low health literacy affects 80-90 million Americans with low-income, minority populations being more vulnerable to this condition. One method of addressing limited literacy that may be particularly well accepted within vulnerable populations is the use of educational board games in order to emphasize seeking health information from reliable sources such as pharmacists.

OBJECTIVE

The research objective was to determine if the use of educational board games could impact community pharmacy patron intentions to seek pharmacist advice in an urban, minority, economically-disadvantaged population.

METHODS

Four medication-related educational games were played at an urban community pharmacy under the leadership of pharmacy students in the setting of a health party. Game messages, design, and evaluation processes were uniquely guided by community members' input. A verbally administered questionnaire measured game impact via knowledge and perception questions with responses compared between a non-randomly allocated intervention group and a control group.

RESULTS

Ninety-nine adults were included in the intervention (or game) group and 94 adults were in the control group. Game participants were significantly more likely than the control group to indicate they would seek pharmacist medication advice in the future.

CONCLUSION

Educational board games played in the setting of a health party can be a fun and effective way to convey selected health messages within an urban, minority, economically disadvantaged population. Community input into game development and layering multiple strategies for overcoming health literacy barriers were essential components of this initiative.