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Koelewijn G, Hennus MP, Kort HSM, Frenkel J, van Houwelingen T. Games to support teaching clinical reasoning in health professions education: a scoping review. MEDICAL EDUCATION ONLINE 2024; 29:2316971. [PMID: 38394053 PMCID: PMC10896137 DOI: 10.1080/10872981.2024.2316971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Given the complexity of teaching clinical reasoning to (future) healthcare professionals, the utilization of serious games has become popular for supporting clinical reasoning education. This scoping review outlines games designed to support teaching clinical reasoning in health professions education, with a specific emphasis on their alignment with the 8-step clinical reasoning cycle and the reflective practice framework, fundamental for effective learning. METHODS A scoping review using systematic searches across seven databases (PubMed, CINAHL, ERIC, PsycINFO, Scopus, Web of Science, and Embase) was conducted. Game characteristics, technical requirements, and incorporation of clinical reasoning cycle steps were analyzed. Additional game information was obtained from the authors. RESULTS Nineteen unique games emerged, primarily simulation and escape room genres. Most games incorporated the following clinical reasoning steps: patient consideration (step 1), cue collection (step 2), intervention (step 6), and outcome evaluation (step 7). Processing information (step 3) and understanding the patient's problem (step 4) were less prevalent, while goal setting (step 5) and reflection (step 8) were least integrated. CONCLUSION All serious games reviewed show potential for improving clinical reasoning skills, but thoughtful alignment with learning objectives and contextual factors is vital. While this study aids health professions educators in understanding how games may support teaching of clinical reasoning, further research is needed to optimize their effective use in education. Notably, most games lack explicit incorporation of all clinical reasoning cycle steps, especially reflection, limiting its role in reflective practice. Hence, we recommend prioritizing a systematic clinical reasoning model with explicit reflective steps when using serious games for teaching clinical reasoning.
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Affiliation(s)
- Gilbert Koelewijn
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Department of Pediatrics, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marije P. Hennus
- Department of Pediatrics, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
- Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Helianthe S. M. Kort
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Building Healthy Environments for Future Users Group, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Joost Frenkel
- Department of Pediatrics, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thijs van Houwelingen
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, the Netherlands
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Vázquez-Calatayud M, García-García R, Regaira-Martínez E, Gómez-Urquiza J. Real-world and game-based learning to enhance decision-making. NURSE EDUCATION TODAY 2024; 140:106276. [PMID: 38851020 DOI: 10.1016/j.nedt.2024.106276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/16/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND The evolving healthcare landscape necessitates highly qualified nurses equipped with a myriad of soft skills, including decision-making. Traditional teaching models have led to innovative, active methods that prioritise student participation and enhance crucial soft skill development, such as decision- making. Considering the recognised importance of improving clinical decision-making skills and the need for innovative training, a literature gap is present in assessing the effect of real world and game-based learning on decision-making abilities. OBJECTIVES This study aimed to investigate the effect of real-world and game-based learning, specifically using case-based learning and escape room, on decision-making competence in postgraduate nursing students in academic and clinical settings. DESIGN A descriptive, cross-sectional, quantitative intervention study was conducted, combining case-based learning and escape room methods sequentially. SETTINGS The study was conducted among postgraduate nursing students at the University of Navarra in Spain. PARTICIPANTS Sixty-six postgraduate nursing students, mostly women, participated in the study. METHODS The study integrated case-based learning and escape room sequentially. Data were collected through an ad hoc online questionnaire, recorded escape times from the escape room, and academic scores. RESULTS The study enrolled 66 participants with an average professional experience of 4.2 years. Academic results showed high scores in case resolution (average: 8.34) and knowledge tests (average: 9.21). Out of 11 groups, 81.8 % successfully escaped the escape room within 30 min, with positive questionnaire responses indicating enthusiasm, enjoyment and perceived effectiveness of the activities. CONCLUSIONS Real-world and game-based learning significantly enhanced decision-making competence in postgraduate nursing students across academic and clinical settings, demonstrating the importance of diverse teaching methods. Further research, including comparative studies and longitudinal analyses, is needed to evaluate the educational benefits of integrating case-based learning and escape room methods in nurse education and to refine assessment tools while monitoring long-term student progress.
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Affiliation(s)
- Mónica Vázquez-Calatayud
- Clínica Universidad de Navarra, Pamplona, Spain; University of Navarra, Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Pamplona, Spain; Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
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Zhao X, Brand G, Kovach N, Bonnamy J. Escape Rooms in Nursing Education: A Systematic Review. Nurse Educ 2024; 49:E238-E243. [PMID: 38691511 DOI: 10.1097/nne.0000000000001641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Escape rooms (ERs) are being increasingly used in nursing education as an active and game-based learning method. PURPOSE To conduct a systematic review to synthesize evidence on the current use of ERs in nursing education. METHODS A mixed methods systematic review was performed to identify and synthesize existing literature. Five databases were searched in July 2023. Descriptive and thematic analysis were used to synthesize quantitative and qualitative data, respectively. RESULTS A total of 333 studies were found after searching 5 databases. After 2 independent reviews, a total of 57 studies were identified across 5 countries. There were 16 qualitative studies, 34 quantitative studies, and 7 mixed methods studies. Four main themes were identified. CONCLUSIONS ERs are widely used across different topics and settings in nursing education and are enjoyed by the majority of participants; however, more rigorous research is needed to confirm whether ERs improve learning outcomes.
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Affiliation(s)
- Xue Zhao
- Research Student (Ms Zhao), Associate Professor (Dr Brand), Lecturer (Ms Kovach), and Research Fellow (Mr Bonnamy), School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
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Stanek RJ, Montgomery KE, Anibas M. Implementing a Pediatric Escape Room Simulation to Improve Student Learning. Nurse Educ 2024:00006223-990000000-00481. [PMID: 38876139 DOI: 10.1097/nne.0000000000001685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
BACKGROUND Escape room simulations are an innovative teaching methodology that may be useful in addressing pediatric-specific content and clinical placement limitations of generalist nursing programs. PROBLEM This project studied if a pediatric escape room simulation improved students' knowledge and confidence in pediatric nursing to support the development of the pediatric nursing workforce. APPROACH A pediatric escape room simulation was developed for a large Midwestern university's prelicensure nursing program. Students completed surveys to assess knowledge and confidence in pediatric nursing. Simulation quality was assessed using the Simulation Learning Effectiveness Inventory. OUTCOMES Students' (N = 37) knowledge and confidence in pediatric nursing concepts significantly increased after the simulation. Students responded positively to the simulation and recommended it be included in the undergraduate curriculum. CONCLUSIONS The pediatric escape room simulation offers a promising alternative for students to gain pediatric-specific knowledge and confidence for prelicensure nursing programs in the context of limited pediatric clinical placements.
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Affiliation(s)
- Rachel J Stanek
- University of Wisconsin-Madison School of Nursing (Dr Stanek, Dr Montgomery), Madison, Wisconsin and Edgewood College, Center for Healthcare Education and Simulation (Ms Anibas), Madison, Wisconsin
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González-de la Torre H, Hernández-De Luis MN, Mies-Padilla S, Camacho-Bejarano R, Verdú-Soriano J, Rodríguez-Suárez CA. Effectiveness of "Escape Room" Educational Technology in Nurses' Education: A Systematic Review. NURSING REPORTS 2024; 14:1193-1211. [PMID: 38804424 PMCID: PMC11130902 DOI: 10.3390/nursrep14020091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Escape room games are educational gamification technologies that consist of introducing a team of players into a physical or digital space in search of clues to answer puzzles, riddles or enigmas and solve a mystery or problem. This study aims to determine the effectiveness of escape room games on the training of nursing students in an international context. A systematic review was carried out in MEDLINE, WOS, SCOPUS, CINAHL and LILACS databases using the MeSH terms "Education, Nursing" and "Educational Technology", and the free term "Escape room", combined with Boolean operators AND/OR. Intervention studies in Spanish, English and Portuguese were included, without limitation for the year of publication. Selection and critical appraisal were conducted by two independent reviewers. A total of n = 13 interventional studies were included (n = 2 Randomized Clinical Trials and n = 11 quasi-experimental design). Escape rooms are a recent and growing educational methodology, increasingly used in academia and in the training of nurses and nursing students. However, it is necessary to expand their use and the quality of the studies in a greater number of contexts. Furthermore, it is necessary to homogenize and standardize validated instruments to evaluate the effectiveness of escape rooms in the nursing education area.
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Affiliation(s)
- Héctor González-de la Torre
- Research Support Unit, Insular Maternal and Child University Hospital Complex, Canary Health Service, 35016 Las Palmas de Gran Canaria, Spain
- Nursing Department, Faculty of Healthcare Science, Universidad de Las Palmas de Gran Canaria (ULPGC), 35016 Las Palmas de Gran Canaria, Spain
| | | | - Sergio Mies-Padilla
- Department of Obstetrics and Gynaecology, Insular Maternal and Child University Hospital Complex, Canary Health Service, 35016 Las Palmas de Gran Canaria, Spain;
| | | | - José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante (UA), 03690 Alicante, Spain;
| | - Claudio-Alberto Rodríguez-Suárez
- Research Support Unit, Insular Maternal and Child University Hospital Complex, Canary Health Service, 35016 Las Palmas de Gran Canaria, Spain
- Nursing Department, Faculty of Healthcare Science, Universidad de Las Palmas de Gran Canaria (ULPGC), 35016 Las Palmas de Gran Canaria, Spain
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Chang SJ, Kim GM, Kim JA. The effects of flipped learning and gamification on nursing students' patient safety education: A mixed method study. Heliyon 2024; 10:e29538. [PMID: 38655326 PMCID: PMC11036057 DOI: 10.1016/j.heliyon.2024.e29538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
Background The importance of enhancing education to promote nursing students' patient safety competency is increasing. Hence, implementing diverse educational programs and assessing their outcomes is essential. Objectives To examine the effects of flipped learning and gamification on nursing students' patient safety education. Design A mixed-method design employing a quasi-experimental design with a pre-post control group design and qualitative thematic analysis. Methods The study was conducted at a South Korean university in W City from September to December 2022. It included 55 s-year nursing students. The experimental group (n = 28) participated in a 30-h patient safety education course using flipped learning and gamification, whereas the control group (n = 27) received only written patient safety education materials. Learning motivation, collective efficacy, patient safety competency, and game evaluations were measured. Data were analyzed using the χ2 test, Fisher's exact test, t-test, repeated-measures multivariate analysis of covariance, repeated measure analysis of covariance, and generalized estimating equations. Self-reflection journals on game participation experiences were analyzed using qualitative thematic analysis. Results Learning motivation scores did not differ significantly between groups for time, or interactions between groups and time, but collective efficacy and patient safety competency scores showed significant differences in the interactions between groups and time. The experimental group showed a high satisfaction score in game evaluation. Qualitative analyses were used to extract four themes-three positives: "fun and immersion differentiated from existing classes," "improved the learning outcomes and learning motivation," and "realized the value of collaboration and communication," and one negative: "feeling down due to unfamiliarity." Conclusions This program creates positive learning experiences and enhances nursing students' collective efficacy and patient-safety competencies. It is expected to be utilized in various future nursing courses.
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Affiliation(s)
- Soo Jung Chang
- Department of Nursing, Gangneung-Wonju National University, South Korea
| | - Geun Myun Kim
- Department of Nursing, Gangneung-Wonju National University, South Korea
| | - Jeong Ah Kim
- Department of Nursing, Seoil University, South Korea
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Burbage AK, Pace AA. A scoping review of international allied health professions escape room practices and scholarship. MEDICAL TEACHER 2024:1-16. [PMID: 38466936 DOI: 10.1080/0142159x.2024.2322151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The purpose of this scoping review is to assess the literature on allied health professions escape rooms (AHPERs), investigating their common purposes and practices, and the trends in scholarship. METHODS This scoping review followed PRISMA-ScR guidelines to assess the size and scope of evidence in the literature, categorize common purposes and practices, and explore trends in AHPER scholarship. Two reviewers developed a review protocol, collected literature using a search strategy aligned with inclusion criteria, and charted review results. RESULTS The literature search yielded 6,170 articles. After the final review, 34 unique records met inclusion criteria. Studies were conducted in the United States, Spain, Australia, France, Brazil, and Canada. Most escape rooms reported participants, team size, puzzle type, and outcomes, but few used causal research designs, primarily using pre-post with no control designs. AHPERs represent an increasingly popular pedagogical approach. AHPERs tend to be simply structured, patient themed, and convey either disciplinary or interprofessional lessons. Generally, AHPERs were self-reported as effective and satisfying, but scholarship supporting AHPERs was insufficient in design for causal claims. CONCLUSION Developers and scholars may benefit from considering frameworks and guidelines for consistent creation and increased trustworthiness in the AHPER practice and knowledge base. Where AHPER scholars can increase attention to learning outcomes, and plan scholarly works in advance of the escape room, the AHPER body of knowledge will increase.
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Affiliation(s)
- Amanda K Burbage
- Medical & Health Professions Education, School of Health Professions, Eastern Virginia Medical School, Norfolk, VA, USA
| | - April A Pace
- Brickel Library, Eastern Virginia Medical School, Norfolk, VA, USA
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Quek LH, Tan AJQ, Sim MJJ, Ignacio J, Harder N, Lamb A, Chua WL, Lau ST, Liaw SY. Educational escape rooms for healthcare students: A systematic review. NURSE EDUCATION TODAY 2024; 132:106004. [PMID: 37924674 DOI: 10.1016/j.nedt.2023.106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES To synthesize evidence on the implementation and evaluation of educational escape rooms for healthcare students. DESIGN A systematic review. DATA SOURCES A search of seven databases including PubMed, Scopus, Web of Science, Cochrane, EMBASE, CINAHL, and Education Resources Information Center was conducted for published studies from inception to January 2023. The selected articles were assessed by two independent researchers for meeting the inclusion criteria and methodological quality. The data was narratively synthesised. RESULTS Fifty-two studies were included in the review. Escape rooms were employed as learning and assessment strategies for the delivery of diverse topics within dentistry, medical, nursing, pharmacy and physiotherapy pre-registration healthcare education. Most were conducted on nursing students with learning topics focusing on the development of knowledge related to patient care management. Virtual escape rooms became more prevalent following the COVID-19 pandemic. The specific design features of escape rooms were based on the elements of game-based learning including team learning with appropriate size, time limit and sequential path-design of puzzles. Applying the experiential learning approach, the facilitators played a pivotal role in pre-briefing, facilitating the gameplay, and debriefing. Escape rooms were evaluated to be enjoyable and have an impact on students' cognitive, psychomotor, non-technical and affective skills learning outcomes. However, the learning outcomes compared with conventional learning strategies were inconclusive due to lack of randomised controlled trials. CONCLUSION Escape rooms are increasingly being used as experiential and game-based learning in healthcare education. It will continue to evolve with virtual technology advancement and is a promising tool to provide virtual team training within interprofessional education for the development of teamwork and communication skills. While more rigorous research using a randomised controlled trial design is needed to evaluate the effectiveness of escape rooms and their design features, qualitative studies, particularly on the perspective of facilitators are needed to unravel the learning process.
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Affiliation(s)
- Lin Hui Quek
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Apphia J Q Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Marcia J J Sim
- Nursing Department, Ng Teng Fong General Hospital, Singapore
| | - Jeanette Ignacio
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicole Harder
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Aimee Lamb
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Hudson A, Franklin K, Edwards TR, Slivinski A. Escaping the Silos: Utilization of a Pediatric Trauma Escape Room to Promote Interprofessional Education and Collaboration. J Trauma Nurs 2023; 30:364-370. [PMID: 37937879 DOI: 10.1097/jtn.0000000000000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Millions of children are treated annually for trauma-related injuries but comprise a smaller proportion of emergency department visits than adults. As a result, emergency department teams may not have the knowledge, skills, and confidence to care for pediatric patients, and specialty teams may not interact enough as an interprofessional team to provide high-quality patient care. OBJECTIVE The purpose of this project is to describe a novel interprofessional simulation-based education initiative to assist pediatric trauma team readiness. METHODS An escape room was designed to provide an interactive educational environment focused on pediatric trauma education. Using an interprofessional dyad of a trauma nursing specialist and a pediatric nursing expert, the escape room was designed as a series of clues to improve pediatric skills and interprofessional collaboration between specialty teams. The escape room training was conducted (from February to March, 2023) in a large Southeastern U.S. Level II adult trauma center. RESULTS Twenty-one registered nurses from different specialty teams participated in the simulation exercises with overwhelmingly positive feedback. Colleagues reported this was a unique way to deliver education that resulted in innovative team building and enriched collegiality between the specialty teams. CONCLUSIONS The escape room educational format was positively received, and future events are planned across disciplines and various topics. Trauma centers with lower pediatric volumes seeking to provide engaging team-based education may use this format as a unique and innovative way to develop teams for clinical success.
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Abstract
Developing a diverse talent pool starting at the high-school level, while students are making future education and career decisions, should be a national priority, given the need to build a diverse health-care workforce. This article describes a 6-week immersive simulation-based summer program to introduce 20 junior high-school students (13-15 years old) to the range of health professions. Because precollege students typically receive limited exposure to clinical settings, high-fidelity simulation is an excellent surrogate for providing realistic experiences in health care. Students heard lectures on health careers, earned basic life support certification, learned to perform basic vital signs measurement, practiced the management of acute asthma, and received an introduction to the daily activities in the life of a nurse and an anesthesiologist. They researched, developed, and presented public service announcement videos about a health-care issue affecting their community. Participants reported being excited about health careers. Future programs will focus on longitudinal support and mentoring, essential for mitigating the higher rates of attrition from health professions among minoritized individuals.
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Affiliation(s)
- Kellie Bryant
- Assistant Dean of Clinical Affairs & Simulation and an Associate Professor in the School of Nursing at Columbia University in New York City, New York, US
| | - Allison Lee
- Associate Professor in the Department of Anesthesiology at Columbia University Medical Center and Medical Director of the Margaret Wood Center for Simulation and Education at Columbia University in New York City, New York, US
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Bright E, Ulmen B. Escaping Lecture: Does Delivery Method of an Escape Room Matter? Nurse Educ 2023; 48:343-344. [PMID: 37130359 DOI: 10.1097/nne.0000000000001444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Elizabeth Bright
- Clinical Assistant Professor (Ms Bright, Dr Ulmen), College of Health Sciences, Carroll University, Waukesha, Wisconsin
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