Using a videogame to facilitate nursing and medical students' first visit to the operating theatre. A randomized controlled trial

The effectiveness of serious games in nursing education: A meta-analysis of randomized controlled studies

OBJECTIVE

This systematic review and meta-analysis aimed to synthesize the effects of randomized controlled trials using serious gaming in nursing education on knowledge, skills, and confidence.

DESIGN

Systematic review and meta-analysis of randomized controlled trials.

DATA SOURCES

Randomized controlled trials published in English in PubMed, CINAHL, Web of Science, Scopus, Cochrane Library databases between 2000 and 2023.

REVIEW METHODS

Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Tool for Assessment of Risk of Bias for Randomized Controlled Trials and the review was reported according to the PRISMA-2020 protocol. The review was conducted by two independent reviewers.

RESULT

As a result of the database review, a total of 1886 studies were found and 8 studies were included in the meta-analysis. The use of serious games was found to have a low to moderate effect on the knowledge levels of nursing students (Hedge's g = 0.492; 95 % CI = -0.094-1.078), and a moderate effect on their skill (Hedge's g = 0.756; 95 % CI = 0.505-1.003) and self confidence levels (Hedge's g = 0.698; p = 0.362, 95 % CI = -0.801-2.196). The heterogeneity of the studies was found to be high for knowledge (I2 = 92 %), skill (I2 = 71.5 %) and self confidence (I2 = 95.9 %), and low for knowledge (p = 0.90; p = 0.29) and skill (p = 0.75; p = 0.69) in terms of bias analyses egger regression test and begg and mazumdar test, respectively.

CONCLUSION

The reviewed studies revealed that the use of serious games in nursing education has positive effects on knowledge, skills and self-confidence. In order to increase the reliability of the evidence, there is a need to increase the number of welldesigned randomized controlled trials using serious games and to examine the effects of these results in clinical practice with larger sample groups.

Gameful Experience Scale: Reliability and Validity in Nursing Students

Objective: Nursing students are among the groups where gamification applications are used effectively and frequently in educational technologies. This study aimed to adapt the Gameful Experience Scale (GAMEX) to the Turkish language and test its validity and reliability. Materials and Methods: The study was conducted with 620 nursing students studying an undergraduate nursing program between March and May, 2023. Data were collected using a personal information form and GAMEX-Turkish Form. Results: The validity and reliability of the five-factor structure scale with 27 items were confirmed. In confirmatory factor analysis, all factor loads were found to be >0.56. The fit indexes of the scale were χ2/df = 2.8, goodnessof-fit index = 0.90, comparative fit index = 0.94, and root mean square error of approximation = 0.55. Cronbach's alpha coefficient of the overall scale was 0.89. Conclusion: As a result of this study, the Turkish version of GAMEX was found to be a valid and reliable tool that can be used to evaluate the game experience in nursing students' training.

Effectiveness of a Game-Based Mobile App for Educating Intensive Critical Care Specialist Nurses in Extracorporeal Membrane Oxygenation Pipeline Preflushing: Quasi-Experimental Trial

Background

In the context of training specialist nurses and nursing education, a game-based mobile app was used as a simulation to teach intensive critical care specialist nurses the knowledge and skills of extracorporeal membrane oxygenation (ECMO) pipeline preflushing.

Objective

This study aimed to evaluate the impact of a game-based mobile app on improving ECMO pipeline preflushing skills in intensive critical care specialist nurses.

Methods

A total of 86 intensive critical care specialist nurses who were learning ECMO for the first time were included in this study. The nurses were divided into 2 groups: a control group (n=43) and an experimental group (n=43). Participants in the experimental group used a game-based mobile app for simulation exercises; the control group received no additional intervention. All participants took a theoretical test and a skill operation test at the beginning of the study and 1 week later. The differences in scores between the 2 groups were compared, and the learning curve of the experimental group was observed.

Results

The final theoretical test scores (88.44 and 85.02) and skill operation test scores (89.42 and 86.33) of the experimental group and control group, respectively, were significantly higher than those of the initial tests (theoretical test scores: 75.88 and 74.42; skill operation test scores: 75.44 and 75.93; all P<.001). The scores of the final theoretical test (88.44) and the final skill operation test (89.42) in the experimental group were higher than the scores of the control group (85.02; P<.001 and 86.33; P<.001, respectively). Learning curve analysis showed that the experimental group needed an average of 17 operations to master the skill.

Conclusions

This study suggests that a game-based mobile app may be more effective for intensive critical care specialist nurses in ECMO pipeline preflushing education than traditional Chinese lecture-practice education.

Effectiveness of a Game-Based Mobile Application in Educating Nursing Students on Venous Blood Specimen Collection: A Randomized Controlled Trial

Aim: Incorporating mobile applications into traditional clinical teaching methods to assess the impact of game-based mobile applications on the practical knowledge and skill levels of venous blood specimen collection among nursing students. Background: Although game-based mobile applications are recognized as teaching aids that replicate clinical practice in a safe environment, their impact and effectiveness are relatively unknown in the education of nursing students. Design: In September 2021, a single-blind randomized controlled trial was conducted in a university-affiliated hospital in China. Methods: One hundred five nursing students were randomly divided into the control group (n = 53) and the experimental group (n = 52). All participants received the same theoretical and operational training. For the next 7 days, the experimental group used a game-based mobile application, and the control group practiced venous blood specimen collection using traditional teaching methods. We observed the before-and-after comparison of the skill performance and learning curve of both groups of participants. Results: The final skill performance scores of the nursing students in the experimental group were higher than that of the nursing students in the control group (P < 0.001). Analysis of the learning curve showed that to master the skills, the experimental and control groups needed an average of 8 and 10 repetitions, respectively. Conclusion: This mobile application has a positive learning effect on nursing students' venous blood specimen collection skills in the short term. It should be applied to the training of clinical nursing skills.

Methods and Measures for Mental Stress Assessment in Surgery: A Systematic Review of 20 Years of Literature

Real-time mental stress monitoring from surgeons and surgical staff in operating rooms may reduce surgical injuries, improve performance and quality of medical care, and accelerate implementation of stress-management strategies. Motivated by the increase in usage of objective and subjective metrics for cognitive monitoring and by the gap in reviews of experimental design setups and data analytics, a systematic review of 71 studies on mental stress and workload measurement in surgical settings, published in 2001-2020, is presented. Almost 61% of selected papers used both objective and subjective measures, followed by 25% that only administered subjective tools - mostly consisting of validated instruments and customized surveys. An overall increase in the total number of publications on intraoperative stress assessment was observed from mid-2010 s along with a momentum in the use of both subjective and real-time objective measures. Cardiac activity, including heart-rate variability metrics, stress hormones, and eye-tracking metrics were the most frequently and electroencephalography (EEG) was the least frequently used objective measures. Around 40% of selected papers collected at least two objective measures, 41% used wearable devices, 23% performed synchronization and annotation, and 76% conducted baseline or multi-point data acquisition. Furthermore, 93% used a variety of statistical techniques, 14% applied regression models, and only one study released a public, anonymized dataset. This review of data modalities, experimental setups, and analysis techniques for intraoperative stress monitoring highlights the initiatives of surgical data science and motivates research on computational techniques for mental and surgical skills assessment and cognition-guided surgery.

Game-based learning in undergraduate nursing education: A systematic review of mixed-method studies

AIM

To investigate game-based learning in nursing education and summarize findings of its impact on nursing students' learning outcomes.

BACKGROUND

Nurses are the first point of contact for care and make up the largest proportion of the global health workforce. To respond effectively to the care needs of the population, nurses need to be adequately trained during their professional education. Game-based learning is increasingly becoming a strategy to complement simulation strategies in nursing education.

DESIGN

A systematic review of mixed-methods studies.

METHODS

A search was conducted in the electronic databases Medline, PubMed, Science Direct, Scopus and Web of Science. Quantitative, qualitative and mixed methods studies on nurse education published in English between 2000 and 2020 were considered. The Mixed Methods Assessment Tool was used for quality assessment. Data abstraction and synthesis was performed using a data extraction form.

RESULTS

A total of 46 studies from the 15 countries were included. The included studies were eight quantitative randomized controlled trials, 12 quantitative non-randomized controlled trials, 15 quantitative descriptive, five qualitative and six mixed methods studies. The results showed that game-based learning was used for many different courses or content in nursing education. Simulation games were the most used game type. Game-based learning facilitated the achievement of learning outcomes primarily in the cognitive domain. Some gamification elements and design-related aspects of game-based environments were evaluated as positive and negative. Game-based learning is a useful approach to assessing learning outcomes in only three studies.

CONCLUSION

Game-based learning is a useful method to achieve learning outcomes mainly in the cognitive domain, with some positive and negative aspects. Further research should investigate the effects of games on affective and behavioral learning outcomes, as well as the use of games to assess learning outcomes. Potential limitations of this review are that some studies could not be identified because of access issues and that some studies included participants other than nursing students.

Digital serious games in developing nursing clinical competence: A systematic review and meta-analysis

OBJECTIVE

This review aimed to synthesise evidence from experimental studies of the application of digital serious games in developing nursing clinical competence.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Eight databases were searched for randomized controlled trials and quasi-experimental studies published in English from 2000 to 2021.

REVIEW METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted in this review. Quality appraisal was conducted using Cochrane's Risk of Bias tool and the Joanna Brigg's Institute Critical Appraisal Tool for Quasi-Experimental Designs. A narrative synthesis of studies, and a meta-analysis and subgroup analysis, was performed on the study outcomes.

RESULTS

22 experimental studies including 13 randomized controlled trials and nine quasi-experimental studies were included. Of these, 19 studies examined nursing students and three examined qualified nurses. These studies applied serious games to develop nursing competencies in management of nursing care, clinical reasoning skills, procedural skills, legal practice and quality improvement. Compared with control groups, serious games improved knowledge (SMD = 1.30, 95% CI [0.75, 1.86]) and skills (SMD = 0.38, 95% CI [0.17, 0.60]). Subgroup analysis for both knowledge and skills outcomes demonstrated that serious games were more effective than control groups with either no intervention or other educational interventions. A large effect size (SMD = 1.13, 95% CI [0.91, 1.34]) was found in favour of serious games for improving knowledge scores in management of nursing care.

CONCLUSION

The reviewed studies identified a broad application of digital serious games for developing nursing competencies. The knowledge and skills performance outcomes supported the use of serious games, which were found to be superior to conventional educational interventions. More serious games are required to be incorporated into undergraduate and continuing nursing education for workplace training, with more rigorous studies examining the effect of serious games in improving the quality and safety of clinical nursing practice.

Comparison of the effects of virtual training by serious game and lecture on operating room novices' knowledge and performance about surgical instruments setup: a multi-center, two-arm study

BACKGROUND

Game-based training is increasingly implemented in different nursing fields, as it allows students to learn experientially, with the flexibility to regulate their training based on their personal progresses and abilities. This study aimed to compare the effects of virtual training by the "Playing with Surgical Instruments (PlaSurIn)" game and the lecture on the surgical instruments setup knowledge and performance of Operating Room (OR) novices.

METHODS

This study was conducted on 51 s-semester undergraduate OR technology students taking the course "An Introduction to Surgical Instruments and Equipment." An additional virtual training session was held via a learning management system using two different methods. The students of the Game Training Group (GTG, n = 27) played individually with the "PlaSurIn" game during a week, while the students of the Lecture Training Group (LTG, n = 24) received the lecture-based training during a week. To measure knowledge, all the students participated in a theoretical test with 10 multiple-choice questions before and immediately after the training. They also participated in an Objective Structured Clinical Examination (OSCE) after the training, and their performance was evaluated by the remained time for setup completion and the scores, errors, and bonuses.

RESULTS

The mean score of the theoretical test was significantly higher in the GTG than in the LTG after the training (p = 0.040). Additionally, the GTG participants had higher scores (p = 0.016), fewer errors (p = 0.001), and higher bonuses (p = 0.011) compared to the LTG ones. The remained time for setup completion was also significantly longer in the GTG than in the LTG (p < 0.001).

CONCLUSION

Virtual training by "PlaSurIn" was superior to the lecture-based method for the enhancement of surgical instruments setup knowledge and performance amongst OR novices.

The Effect of Serious Games for Nursing Students in Clinical Decision-Making Process: A Pilot Randomized Controlled Trial

Background: Serious games (SGs) have been proposed as a type of technology-enhanced simulation that may provide nursing students with an opportunity to practice their clinical reasoning and decision-making skills in a realistic and safe environment. Materials and Methods: The aim of this study is to determine the effect of serious play on nursing students' self-confidence (SC) and anxiety in clinical decision making. The randomized controlled trial evaluated the efficacy of SGs for undergraduate nursing students using pre- and posttests. The study was conducted during nursing students' clinical practice and teaching. All undergraduate nursing students (n = 120) attending internal medicine nursing lesson were approached. Sixty students out of 120 answered the questionnaires at both baseline and follow-up (30 in the experimental group [EG] and 30 in the control group). The students answered the questionnaire after taking the first clinical practice, taking the endocrine course. In the 1 week, the EG played the game and both groups returned to clinical practice. Questionnaire data were collected after clinical application. Results: SC and two subdimensions, using the information in hand to determine the problem, and knowing and taking action, were improved in the intervention group and a significant interaction effect was found for changes over time between the two groups. Anxiety scores between groups were not statistically significant differences. Conclusions: Nursing professional educators can adopt SGs to improve cognitive and attention skills, strengthen judgment, require making time efficient, practice making safe decisions, and encourage the exploration of decision.

Effectiveness of a game-based mobile application in educating nursing students on flushing and locking venous catheters with pre-filled saline syringes: A randomized controlled trial

AIM

This study aimed to determine the effect of a game-based mobile application on the skill levels of nursing students in respect of flushing and locking of venous catheters with pre-filled saline syringes.

BACKGROUND

In the context of the education of nursing students, a game-based mobile application was used as a motivational aid to improve nursing students' skills in flushing and locking of venous catheters.

DESIGN

A single-blind randomized controlled trial was conducted from August 2020, in a university-affiliated hospital in China.

METHODS

A total of 154 nursing students were divided randomly into two groups: a control group (n = 77) and an experimental group (n = 77). All the participants received a 30-min theoretical interpretation, 30-min demonstration, and one opportunity to practice. For the next seven days, the participants in the experimental group used a game-based mobile application as a motivational aid to practice their skills in flushing and locking of venous catheters; the control group received no additional intervention. We observed the skill performance and the incidence of errors in the procedural steps of the participants in the two groups at first and seven days later, along with the learning curve of the skills of the experimental group in respect of flushing and locking of venous catheters.

RESULTS

The final skill performance scores of the nursing students in the experimental group were higher than the average scores of the nursing students in the control group (p = 0.003); The incidence of errors in material preparation rate, hand hygiene, and flushing and locking in the experimental group were lower than that in the control group (p = 0.027, p = 0.035, p = 0.045). Analysis of the learning curve revealed that the experimental group needed an average of 11 repeat practices sessions to master the skills.

CONCLUSIONS

In the short term, the game-based mobile application was effective in improving the skills of nursing students in flushing and locking venous catheters with pre-filled saline syringes. It is an effective complement to existing training methods.

Escape-cardio: Gamification in cardiovascular physiotherapy. An observational study

INTRODUCTION

In recent years, innovative educational strategies of learning have appeared, to generate greater motivation in the students. Gamification has become popular in the educational area, including Escape Rooms. The primary aim of the study was to evaluate if this gamification activity led to better knowledge acquisition by the students, improving performance in their final exam. As a secondary objective, we surveyed the satisfaction of the students participating in the Educational Escape Room.

MATERIAL AND METHODS

An observational study of cases and controls was carried out. We designed an escape room based on the cardiovascular area of physiotherapy, titled Escape-Cardio. We provided scaffolded learning activities through the activity. Primary outcomes corresponded to the students' qualifications and the number of correct answers in the final exam. Qualitative questionnaire results of students of both courses were collected using a self-created survey, which was completed after the activity.

RESULTS

58 students participated in the Escape-Cardio. We observed better performance in the intervention group, improving their average mark and number of correct answers in the exam, with a statistically significant difference compared to the control group (p-value<0.05). In the qualitative assessment, students answered the survey, and all of them scored unanimously each item with the maximum score, aiming for 100% satisfaction.

CONCLUSION

Escape-Cardio students improved their professional knowledge application in the cardiovascular physiotherapy area in a statistically significant way. An excellent qualitative evaluation was achieved by them.

Emerging simulation technologies in global craniofacial surgical training

The last few decades have seen an exponential growth in the development and adoption of novel technologies in medical and surgical training of residents globally. Simulation is an active and innovative teaching method, and can be achieved via physical or digital models. Simulation allows the learners to repeatedly practice without the risk of causing any error in an actual patient and enhance their surgical skills and efficiency. Simulation may also allow the clinical instructor to objectively test the ability of the trainee to carry out the clinical procedure competently and independently prior to trainee's completion of the program. This review aims to explore the role of emerging simulation technologies globally in craniofacial training of students and residents in improving their surgical knowledge and skills. These technologies include 3D printed biomodels, virtual and augmented reality, use of google glass, hololens and haptic feedback, surgical boot camps, serious games and escape games and how they can be implemented in low and middle income countries. Craniofacial surgical training methods will probably go through a sea change in the coming years, with the integration of these new technologies in the surgical curriculum, allowing learning in a safe environment with a virtual patient, through repeated exercise. In future, it may also be used as an assessment tool to perform any specific procedure, without putting the actual patient on risk. Although these new technologies are being enthusiastically welcomed by the young surgeons, they should only be used as an addition to the actual curriculum and not as a replacement to the conventional tools, as the mentor-mentee relationship can never be replaced by any technology.

An evaluation of undergraduate student nurses' gameful experience while playing an escape room game as part of a community health nursing course

BACKGROUND

The integration of innovative strategies to teaching and learning in higher education, such as escape room games, can enhance the acquisition of key professional competencies including communication, teamwork and critical thinking.

OBJECTIVES

This study aimed to evaluate undergraduate student nurses' gameful experience while playing an escape room game as part of a nursing course.

DESIGN

Cross-sectional descriptive study.

PARTICIPANTS

A total of 126 third year student nurses enrolled in the "Community Health Nursing II" course.

METHOD

The escape room game took place in a classroom at the Faculty of Health Ciences. The measures included the GAMEX scale in its Spanish version and a self-reported questionnaire to evaluate the student's outcome of scape room game immediately after the end of the activity.

RESULTS

The vast majority (99.21%) considered the escape room game to be an appropriate and an innovative teaching and learning strategy. The mean score for each of the GAMEX dimensions was over 3, with the exception of Absence of negative effects. Our results suggest that the students enjoyed playing the game (mean = 4.40; SD = 0.71), that escape room games should be integrated in nursing courses (mean = 4.54; SD = 0.74) and that playing the game increased their motivation for learning (mean = 3.06; SD = 1.09). Gender differences were observed in the GAMEX Dominance dimension (p < 0.005).

CONCLUSION

Gamification in general, and escape rooms in particular, have proven to be a valid tool for the acquisition of professional competencies in higher education.

Efficacy of Serious Games in Healthcare Professions Education: A Systematic Review and Meta-analysis

SUMMARY STATEMENT

Serious games (SGs) are interactive and entertaining software designed primarily with an educational purpose. This systematic review synthesizes evidence from experimental studies regarding the efficacy of SGs for supporting engagement and improving learning outcomes in healthcare professions education. Randomized controlled trials (RCTs) published between January 2005 and April 2019 were included. Reference selection and data extraction were performed in duplicate, independently. Thirty-seven RCTs were found and 29 were included in random-effect meta-analyses. Compared with other educational interventions, SGs did not lead to more time spent with the intervention {mean difference 23.21 minutes [95% confidence interval (CI) = -1.25 to 47.66]}, higher knowledge acquisition [standardized mean difference (SMD) = 0.16 (95% CI = -0.20 to 0.52)], cognitive [SMD 0.08 (95% CI = -0.73 to 0.89)], and procedural skills development [SMD 0.05 (95% CI = -0.78 to 0.87)], attitude change [SMD = -0.09 (95% CI = -0.38 to 0.20)], nor behavior change [SMD = 0.2 (95% CI = -0.11 to 0.51)]. Only a small SMD of 0.27 (95% CI = 0.01 to 0.53) was found in favor of SGs for improving confidence in skills.

Enhancing students learning experiences in nursing programmes: An integrated review

Nursing as a profession is both fragmented and complex. The education setting is demanding, and prepared students are more clinically and academically robust. Therefore, nursing programmes should implement high-quality teaching based on the best available scientific evidence to improve learning quality and students' experience. This study aimed to identify the teaching tools used to enhance students' perceived experiences in undergraduate nursing programmes. Nine databases were systematically searched to identify quantitative and qualitative studies regarding the teaching tools utilised across nursing education programmes. Results were summarised following a systematic integrated review framework. The searches identified 15,886 citations, and after title/abstract/full-text screening, 66 primary research studies were included comprising data from 4,411 participants with a mean sample size of 66 (range 6-447). Educators utilising a student-centred wrapping approach exploiting knowledge building and self-development were found to improve students' experiences; however, consensus on success factors was lacking. The findings indicate that educators' knowledge and pedagogical skills used in a flexible way, tailored and sensible to students and the learning context, enhance student experiences. Nursing educators should identify learning situations that make students vulnerable and pay particular attention to the students' learning experiences. We identified several tools accommodating the students' experience.

Outcomes assessment pitfalls: challenges to quantifying knowledge gain in a sex education game

Background: The use of videogames as a public health tool is rapidly expanding. Accurate assessment of the efficacy of such games is complicated by many factors. We describe challenges associated with measuring the impact of playing a videogame with information about human sexual anatomy and reproduction and discuss motivations for, and solutions to, these challenges. Methods: The My Future Family Game (MFF) is a validated tool for collecting data about family planning intentions which includes information about human anatomy and sexual reproduction. We sought to assess the efficacy of the game as a tool for teaching sexual education using a pre-post model which was deployed in three schools in and around Chennai, India in summer of 2018. Results: The MFF game was successfully modified to collect data about players' pre-gameplay knowledge of sexual anatomy and processes. The post gameplay assessment process we used did not effectively assess knowledge gain. Designing assessments for games dealing with sexuality presents challenges including: effectively communicating about biological parts and processes, designing usable and intuitive interfaces with minimal text, ensuring that all parts of the process are fun, and integrating assessments into the game in a way that makes them invisible. Conclusion: Games can be an effective means of gathering data about knowledge of sex and reproduction that it is difficult to obtain through other means. Assessing knowledge about human sexual reproduction is complicated by cultural norms and taboos, and technical hurdles which can be addressed through careful design. This study adds to the sparse literature in the field by providing information about pitfalls to avoid and best practices in this evolving area.

An Educational Network for Surgical Education Supported by Gamification Elements: Protocol for a Randomized Controlled Trial

Background

Traditionally, medical students have learned surgical skills by observing a resident physician or surgeon who is performing the technique. Due to inconsistent practice opportunities in the clinical setting, a disparity of skill levels among students has been observed. In addition, the poor availability of faculty professors is a limiting factor in teaching and adequately preparing medical students for their clerkship years. With the ongoing COVID-19 pandemic, medical students do not have access to traditional suturing learning opportunities. Didactic courses are available on videoconferencing platforms; however, these courses do not include technical training.

Objective

Our overarching goal is to evaluate the efficacy and usability of web-based peer-learning for advanced suturing techniques (ie, running subcuticular sutures). We will use the Gamified Educational Network (GEN), a newly developed web-based learning tool. We will assess students’ ability to identify and perform the correct technique. We will also assess the students’ satisfaction with regard to GEN.

Methods

We will conduct a prospective randomized controlled trial with blinding of expert examiners. First-year medical students in the Faculty of Medicine of Université de Montréal will be randomized into four groups: (1) control, (2) self-learning, (3) peer-learning, and (4) peer-learning with expert feedback. Each arm will have 15 participants who will learn how to perform running subcuticular sutures through videos on GEN. For our primary outcome, the students’ ability to identify the correct technique will be evaluated before and after the intervention on GEN. The students will view eight videos and rate the surgical techniques using the Objective Structured Assessment of Technical Skills Global Rating Scale and the Subcuticular Suture Checklist as evaluation criteria. For our secondary outcomes, students will anonymously record themselves performing a running subcuticular suture and will be evaluated using the same scales. Then, a survey will be sent to assess the students’ acceptance of the intervention.

Results

The study will be conducted in accordance with the Declaration of Helsinki and has been approved by our institutional review board (CERSES 20-068-D). No participants have been recruited yet.

Conclusions

Peer learning through GEN has the potential to overcome significant limitations related to the COVID-19 pandemic and the lack of availability of faculty professors. Further, a decrease of the anxiety related to traditional suturing classes can be expected. We aim to create an innovative and sustainable method of teaching surgical skills to improve the efficiency and quality of surgical training in medical faculties. In the context of the COVID-19 pandemic, the need for such tools is imperative.

Trial Registration

ClinicalTrials.gov NCT04425499; https://clinicaltrials.gov/ct2/show/NCT04425499

International Registered Report Identifier (IRRID)

PRR1-10.2196/21273

Outcomes assessment pitfalls: challenges to quantifying knowledge gain in a sex education game

Background: The use of videogames as a public health tool is rapidly expanding. Accurate assessment of the efficacy of such games is complicated by many factors. We describe challenges associated with measuring the impact of playing a videogame with information about human sexual anatomy and reproduction and discuss motivations for, and solutions to, these challenges. Methods: The My Future Family Game (MFF) is a validated tool for collecting data about family planning intentions which includes information about human anatomy and sexual reproduction. We sought to assess the efficacy of the game as a tool for teaching sexual education using a pre-post model which was deployed in three schools in and around Chennai, India in summer of 2018. Results: The MFF game was successfully modified to collect data about players' pre-gameplay knowledge of sexual anatomy and processes. The post gameplay assessment process we used did not effectively assess knowledge gain. Designing assessments for games dealing with sexuality presents challenges including: effectively communicating about biological parts and processes, designing usable and intuitive interfaces with minimal text, ensuring that all parts of the process are fun, and integrating assessments into the game in a way that makes them invisible. Conclusion: Games can be an effective means of gathering data about knowledge of sex and reproduction that it is difficult to obtain through other means. Assessing knowledge about human sexual reproduction is complicated by cultural norms and taboos, and technical hurdles which can be addressed through careful design. This study adds to the sparse literature in the field by providing information about pitfalls to avoid and best practices in this evolving area.

Gamification in Nursing Education: An Integrative Literature Review

The objective of this literature review and evaluation project was to determine what evidence exists on the use of interactive digital learning and gamification for adult learners in nursing, for the purpose of guiding a redesign of our organization's online clinical education courses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used in the literature search, with the critical analysis and leveling of evidence. After determining the search terms, four electronic databases (PubMed, CINAHL, ERIC, and Cochrane) were searched with the guidance of a medical librarian. Eight reviewers participated, and an evidence-based practice specialist served as auditor. Twenty-three articles were included in the review, which revealed overall support for the gamification process with specific findings about optimizing the process. The review further suggested that interactive digital learning in the form of games, gamification, or scenario-based learning has a positive effect on learner engagement and satisfaction; however, none of the studies were able to quantify objective data about knowledge retention. Further research is needed to test different modalities that improve both learner engagement and knowledge retention. [J Contin Educ Nurs. 2020;51(11):509-515.].

Nursing students' experiences and perceptions of learner-centred education in a disaster nursing course: A qualitative study

Learner-centred education has been shown to be an effective teaching method in the healthcare disciplines that integrate practical skills and theoretical knowledge. However, the elements of learner-centred education that influence students' motivation and engagement in learning remain unclear. In this descriptive qualitative research study, 43 nursing students in a baccalaureate nursing programme in Hong Kong who enrolled in a disaster and trauma nursing course were recruited through purposive sampling. Data were collected through semi-structured, face-to-face, focus group interviews. The transcribed interviews were interpreted through the use of qualitative analysis. This study revealed that adopting learner-centred education techniques in a disaster nursing course could cater to the hedonic nature and practical nature of learning disaster nursing, which consequently strengthens student's motivation and engagement in learning. The findings also suggested that learner-centred education could improve nursing students' learning experience and promote their transformation from passive and receptive students into proactive learners. The present study provides a greater and more focused understanding of the elements of learner-centred education that promote motivation and engagement in learning among nursing students. This study could offer insights into the development and evaluation of disaster nursing courses and other subjects in the undergraduate nursing curriculum.

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.

The Effect of Web-Based Preoperative and Postoperative Patient Care Education on Nursing Students: A Randomized Controlled Study

This study examined the effect of Web-based preoperative and postoperative patient care education among undergraduate nursing students. This was an experimental, randomized controlled study. The study included 305 nursing students (experimental group: n = 155, control group: n = 150), who were assessed with the following instruments: the Preoperative and Postoperative Care Knowledge Test, Preoperative and Postoperative Care Skill Control List, Clinical Decision Making in Nursing Scale, and Nursing Student Clinical Performance Evaluation Scale. t Tests and χ tests were used to evaluate the data. There was no statistically significant difference between the students' posttest knowledge levels, clinical performance assessment, or clinical decision-making scores. The experimental group was found to perform the skills of "check patient's documents and prophylactic antibiotics when going to surgery" (χ = 4.88; P = .02), "controls the surgical safety checklist (before surgery) before going to surgery" (χ = 10.41; P = .00), and "observes surgical site/dressing (χ = 7.77; P = .00)" at a statistically significantly higher level. The education provided in the Web-based education was equivalent to that provided in traditional education. Thus, Web-based education appears to be a useful tool to educate student nurses in preoperative and postoperative patient care.

Educational games developed for students in perioperative nursing: A systematic review and appraisal of the evidence

A systematic review was conducted on electronic databases of MEDLINE/PubMed, Scopus, ISI Web of Science, CINAHL, and Embase until December 2017, using relevant keywords for educational games developed for nursing students in perioperative field. To evaluate the level of strength and quality of the evidence, the Association of periOperative Registered Nurses (AORN) revised model for evidence appraisal was used. Of the 852 evidence, only 10 met the criteria and were reviewed and appraised. Educational games had focused on different learning domains, including skills, feelings, emotion, knowledge, performance, attitude, motivation, and interest. With respect to the evidence level, most evidence was categorized as V (expert opinion = 2, case report = 2, literature review = 1, and organizational experiences = 1), and only one was in level I (randomized controlled trial). The quality level of most evidence was high (n = 4) and low (n = 4), and the rating of most of them was moderate (n = 4) and limited (n = 4). Based on the findings, most evidence had inappropriate quality and was found to be weak. It seems that the investigated games are insufficient to promote the nursing students' learning outcomes in different domains. Accordingly, more high-quality studies are required to design and develop innovative and practical games for students in perioperative nursing by considering validity and reliability process.

Development and Assessment of a Three-Dimensional Tooth Morphology Quiz for Dental Students

Tooth morphology has a pivotal role in the dental curriculum and provides one of the important foundations of clinical practice. To supplement tooth morphology teaching a three-dimensional (3D) quiz application (app) was developed. The 3D resource enables students to study tooth morphology actively by selecting teeth from an interactive quiz, modify their viewpoint and level of zoom. Additionally, students are able to rotate the tooth to obtain a 3D spatial understanding of the different surfaces of the tooth. A cross-over study was designed to allow comparison of students' results after studying with the new application or traditionally with extracted/model teeth. Data show that the app provides an efficient learning tool and that students' scores improve with usage (18% increase over three weeks, P < 0.001). Data also show that student assessment scores were correlated with scores obtained while using the app but were not influenced by the teaching modality initially accessed (r²  = 0.175, P < 0.01). Comparison of the 2016 and 2017 class performance shows that the class that had access to the app performed significantly better on their final tooth morphology assessment (68.0% ±15.0 vs. 75.3% ±13.4, P < 0.01). Furthermore, students reported that the 3D application was intuitive, provided useful feedback, presented the key features of the teeth, and assisted in learning tooth morphology. The 3D tooth morphology app thus provides students with a useful adjunct teaching tool for learning dental anatomy. Anat Sci Educ 00: 000-000. © 2018 American Association of Anatomists.

Serious Gaming and Gamification Education in Health Professions: Systematic Review

Background

There is a worldwide shortage of health workers, and this issue requires innovative education solutions. Serious gaming and gamification education have the potential to provide a quality, cost-effective, novel approach that is flexible, portable, and enjoyable and allow interaction with tutors and peers.

Objective

The aim of this systematic review was to evaluate the effectiveness of serious gaming/gamification for health professions education compared with traditional learning, other types of digital education, or other serious gaming/gamification interventions in terms of patient outcomes, knowledge, skills, professional attitudes, and satisfaction (primary outcomes) as well as economic outcomes of education and adverse events (secondary outcomes).

Methods

A comprehensive search of MEDLINE, EMBASE, Web of Knowledge, Educational Resources Information Centre, Cochrane Central Register of Controlled Trials, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature was conducted from 1990 to August 2017. Randomized controlled trials (RCTs) and cluster RCTs were eligible for inclusion. Two reviewers independently searched, screened, and assessed the study quality and extracted data. A meta-analysis was not deemed appropriate due to the heterogeneity of populations, interventions, comparisons, and outcomes. Therefore, a narrative synthesis is presented.

Results

A total of 27 RCTs and 3 cluster RCTs with 3634 participants were included. Two studies evaluated gamification interventions, and the remaining evaluated serious gaming interventions. One study reported a small statistically significant difference between serious gaming and digital education of primary care physicians in the time to control blood pressure in a subgroup of their patients already taking antihypertensive medications. There was evidence of a moderate-to-large magnitude of effect from five studies evaluating individually delivered interventions for objectively measured knowledge compared with traditional learning. There was also evidence of a small-to-large magnitude of effect from 10 studies for improved skills compared with traditional learning. Two and four studies suggested equivalence between interventions and controls for knowledge and skills, respectively. Evidence suggested that serious gaming was at least as effective as other digital education modalities for these outcomes. There was insufficient evidence to conclude whether one type of serious gaming/gamification intervention is more effective than any other. There was limited evidence for the effects of serious gaming/gamification on professional attitudes. Serious gaming/gamification may improve satisfaction, but the evidence was limited. Evidence was of low or very low quality for all outcomes. Quality of evidence was downgraded due to the imprecision, inconsistency, and limitations of the study.

Conclusions

Serious gaming/gamification appears to be at least as effective as controls, and in many studies, more effective for improving knowledge, skills, and satisfaction. However, the available evidence is mostly of low quality and calls for further rigorous, theory-driven research.

The impact on nursing students' opinions and motivation of using a "Nursing Escape Room" as a teaching game: A descriptive study

BACKGROUND

According to previous studies on nursing education, although the use of games can produce positive results, the vast majority are based on questions and answers or on clinical situations. As an alternative, the 'Escape Room' teaching game is a much more dynamic option to asses theoretical and practical knowledge, and it may also promote teamwork and the ability to perform under pressure.

OBJECTIVES

To analyse nursing students' opinions and study motivations after using the nursing 'Escape Room' teaching game.

DESIGN

Cross-sectional descriptive study.

PARTICIPANTS

Second-year nursing students enrolled in the 'Adult Nursing 1' subject.

METHOD

After completing the teaching game, the students who had taken part in it were asked to fill in an ad-hoc questionnaire on the matter. In this game, students have 30 min in which they must solve the riddles and puzzles presented, and thus escape. In doing so, they must demonstrate both theoretical and practical knowledge, and a teacher will remain in the classroom to assess whether the nursing techniques in question are correctly performed.

RESULTS

The nursing students who took part in the game strongly believed that this 'helped them learn the subject' (4.8 points) and that 'more games of this type should be included in their nursing studies' (4.8 points). Overall, they considered that 'the game was enjoyable' (4.6 points), 'helped them in the exam' (4.6 points), and 'motivated them to study' (4.5 points).

CONCLUSIONS

The 'Escape Room' is a useful game; it stimulates learning, is fun to play, and motivates studying.

Haptic, Physical, and Web-Based Simulators: Are They Underused in Maxillofacial Surgery Training?

PURPOSE

Surgical residencies have increasingly incorporated both digital and mannequin simulation into their training programs. The aim of our review was to identify all digital and mannequin maxillofacial simulators available for education and training, highlight their benefit, and critically assess the evidence in support of these educational resources.

MATERIALS AND METHODS

We performed a comprehensive literature review of all peer-reviewed publications of digital and mannequin simulators that met the inclusion criteria, defined as any simulator used in education or training. All simulators used in surgical planning were excluded. Before the query, it was hypothesized that most studies would be descriptive in nature and supported by low levels of evidence. Literature search strategies included the use of multiple combinations of key search terms, review of titles and abstracts, and precise identification of the use of the simulator described. All statistics were descriptive.

RESULTS

The primary search yielded 259 results, from which 22 total simulators published on from 2001 to 2016 were identified using the inclusion and exclusion criteria: 10 virtual reality haptic-based simulators, 6 physical model simulators, and 6 Web-based simulators used for a variety of procedures such as dental skills, instrument handling, orthognathic surgery (Le Fort I osteotomy, vertical ramus osteotomy, bilateral sagittal split ramus osteotomy), genioplasty, bone grafting, sinus surgery, cleft lip repair, orbital floor repair, and oral biopsy. Only 9 formalized studies were completed; these were classified as low-level evidence-based cohort studies (Levels IV and V). All other simulator reports were descriptive in nature. There were no studies with high levels of evidence completed (Level I to III).

CONCLUSIONS

The results of this review suggest that, although seemingly beneficial to the trainee in maxillofacial surgery, simulation in education in this field is an underused commodity because of the significant lack of scientific and validated study designs reported on in the literature thus far. The maxillofacial and simulation communities would benefit from studies on utility and efficacy with higher levels of evidence.

Using game authoring platforms to develop screen-based simulated functional assessments in persons with executive dysfunction following traumatic brain injury

The assessment of functional status is a critical component of clinical neuropsychological evaluations used for both diagnostic and therapeutic purposes in patients with cognitive brain disorders. There are, however, no widely adopted neuropsychological tests that are both ecologically valid and easily administered in daily clinical practice. This discrepancy is a roadblock to the widespread adoption of functional assessments. In this paper, we propose a novel approach using a serious game authoring platform (eAdventure) for creating screen-based simulated functional assessments. We created a naturalistic functional task that consisted of preparing a cup of tea (SBS-COT) and applied the assessment in a convenience sample of eight dyads of therapists/patients with mild executive dysfunction after traumatic brain injury. We had three main aims. First, we performed a comprehensive review of executive function assessment in activities of daily living. Second, we were interested in measuring the feasibility of this technology with respect to staffing, economic and technical requirements. Third, a serious game was administered to patients to study the feasibility of this technology in the clinical context (pre-screening test). In addition, quantitative (Technology Acceptance Model (TAM) questionnaires) and qualitative (semistructured interviews) evaluations were applied to obtain user input. Our results suggest that the staffing, economic and technical requirements of the SBS-COT are feasible. The outcomes of the pre-screening test provide evidence that this technology is useful in the functional assessment of patients with executive dysfunction. In relation to subjective data, the TAM questionnaire showed good user acceptability from a professional perspective. Interview analyses with professionals and patients showed positive experiences related to the use of the SBS-COT. Our work indicates that the use of these types of authoring platforms could have positive long-term implications for neuropsychological research, opening the door to more reproducible, cooperative and efficient research by allowing the facilitated production, reuse and sharing of neuropsychological assessment tools.