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Del Cura-González I, Ariza-Cardiel G, Polentinos-Castro E, López-Rodríguez JA, Sanz-Cuesta T, Barrio-Cortes J, Andreu-Ivorra B, Rodríguez-Barrientos R, Ávila-Tomas JF, Gallego-Ruiz-de-Elvira E, Lozano-Hernández C, Martín-Fernández J. Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster. BMC MEDICAL EDUCATION 2022; 22:893. [PMID: 36564769 PMCID: PMC9789537 DOI: 10.1186/s12909-022-03843-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 10/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) have teaching potential for health professionals in training clinical reasoning and decision-making, although their use is limited. The objective was to evaluate the effectiveness of a game-based educational strategy e-EDUCAGUIA using simulated clinical scenarios to implement an antimicrobial therapy GPC compared to the usual dissemination strategies to improve the knowledge and skills on decision-making of family medicine residents. Additionally, adherence to e-EDUCAGUIA strategy was assessed. METHODS A multicentre pragmatic cluster-randomized clinical trial was conducted involving seven Teaching Units (TUs) of family medicine in Spain. TUs were randomly allocated to implement an antimicrobial therapy guideline with e-EDUCAGUIA strategy ( intervention) or passive dissemination of the guideline (control). The primary outcome was the differences in means between groups in the score test evaluated knowledge and skills on decision-making at 1 month post intervention. Analysis was made by intention-to-treat and per-protocol analysis. Secondary outcomes were the differences in mean change intrasubject (from the baseline to the 1-month) in the test score, and educational game adherence and usability. Factors associated were analysed using general linear models. Standard errors were constructed using robust methods. RESULTS Two hundred two family medicine residents participated (104 intervention group vs 98 control group). 100 medicine residents performed the post-test at 1 month (45 intervention group vs 55 control group), The between-group difference for the mean test score at 1 month was 11 ( 8.67 to 13.32) and between change intrasubject was 11,9 ( 95% CI 5,9 to 17,9). The effect sizes were 0.88 and 0.75 respectively. In multivariate analysis, for each additional evidence-based medicine training hour there was an increase of 0.28 points (95% CI 0.15-0.42) in primary outcome and in the change intrasubject each year of increase in age was associated with an improvement of 0.37 points and being a woman was associated with a 6.10-point reduction. 48 of the 104 subjects in the intervention group (46.2%, 95% CI: 36.5-55.8%) used the games during the month of the study. Only a greater number of evidence-based medicine training hours was associated with greater adherence to the educational game ( OR 1.11; CI 95% 1.02-1.21). CONCLUSIONS The game-based educational strategy e-EDUCAGUIA shows positive effects on the knowledge and skills on decision making about antimicrobial therapy for clinical decision-making in family medicin residents in the short term, but the dropout was high and results should be interpreted with caution. Adherence to educational games in the absence of specific incentives is moderate. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02210442 . Registered 6 August 2014.
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Affiliation(s)
- Isabel Del Cura-González
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain.
- Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain.
| | - Gloria Ariza-Cardiel
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
- Multiprofessional Family and Community Care Teaching Unit Madrid, Madrid, Spain
| | - Elena Polentinos-Castro
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain
- Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
| | - Juan A López-Rodríguez
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain
- Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
- General Ricardos Health Center, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | - Teresa Sanz-Cuesta
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
| | - Jaime Barrio-Cortes
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain
- Primary Health Care Research and Innovation Foundation. FIIBAP, Madrid, Spain
- Universidad Camilo José Cela, Madrid, Spain
| | - Blanca Andreu-Ivorra
- Preventive Medicine Unit, Alcorcon Foundation University Hospital, Alcorcón, Madrid Health Service, Madrid, Spain
| | - Ricardo Rodríguez-Barrientos
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
| | - José F Ávila-Tomas
- Santa Isabel Health Center, Primary Care Assistance Management, Madrid Health Service Leganes, Madrid, Spain
| | - Elisa Gallego-Ruiz-de-Elvira
- Servicio de Medicina Preventiva, Hospital Infantil Universitario Niño Jesús, Madrid Health Service, Madrid, Spain
| | - Cristina Lozano-Hernández
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
- Primary Health Care Research and Innovation Foundation. FIIBAP, Madrid, Spain
| | - Jesús Martín-Fernández
- Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
- Multiprofessional Family and Community Care Teaching Unit Madrid, Madrid, Spain
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Giannakas F, Troussas C, Krouska A, Voyiatzis I, Sgouropoulou C. Blending cybersecurity education with IoT devices: A u-Learning scenario for introducing the man-in-the-middle attack. INFORMATION SECURITY JOURNAL: A GLOBAL PERSPECTIVE 2022. [DOI: 10.1080/19393555.2022.2100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Filippos Giannakas
- Department of Informatics and Computer Engineering, University of West Attica, Athens, Greece
| | - Christos Troussas
- Department of Informatics and Computer Engineering, University of West Attica, Athens, Greece
| | - Akrivi Krouska
- Department of Informatics and Computer Engineering, University of West Attica, Athens, Greece
| | - Ioannis Voyiatzis
- Department of Informatics and Computer Engineering, University of West Attica, Athens, Greece
| | - Cleo Sgouropoulou
- Department of Informatics and Computer Engineering, University of West Attica, Athens, Greece
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Abstract
Progress in communication technologies and social isolation caused by the COVID-19 pandemic have supported the acceptance of e-learning. In the e-learning context, gamification has been identified as one of the most promising trends. Many researchers believe in the game elements’ capacity to drive learning, skills acquisition, and changes for more sustainable behavior. However, the literature on the subject is dispersed, addressing behavioral attitudes and elements in an isolated and fragmented way. This study aims to present a framework relating game elements to behavioral attitudes to promote sustainability and ensure quality of learning. The methodology is based on a systematic literature review using the PRISMA protocol, covering the content analysis of 130 articles indexed in the Web of Science database. For the framework construction, the following were identified: behavioral attitudes stimulated by gamification; main game elements and how they relate to each other. Based on this, a framework called 7GOALS (Gamification-Oriented Active Learning Steps) associated with the PDCA (Plan, Do, Check, Act) was established. The proposed structure is multidisciplinary and can be used in any knowledge field that uses gamification. With this, themes such as sustainability can be widely disseminated and leverage changes towards more sustainable behaviors that adhere to the real world.
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Raupach T, de Temple I, Middeke A, Anders S, Morton C, Schuelper N. Effectiveness of a serious game addressing guideline adherence: cohort study with 1.5-year follow-up. BMC MEDICAL EDUCATION 2021; 21:189. [PMID: 33785000 PMCID: PMC8008024 DOI: 10.1186/s12909-021-02591-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/28/2021] [Indexed: 06/10/2023]
Abstract
BACKGROUND Patients presenting with acute shortness of breath and chest pain should be managed according to guideline recommendations. Serious games can be used to train clinical reasoning. However, only few studies have used outcomes beyond student satisfaction, and most of the published evidence is based on short-term follow-up. This study investigated the effectiveness of a digital simulation of an emergency ward regarding appropriate clinical decision-making. METHODS In this prospective trial that ran from summer 2017 to winter 2018/19 at Göttingen Medical University Centre, a total of 178 students enrolled in either the fourth or the fifth year of undergraduate medical education took six 90-min sessions of playing a serious game ('training phase') in which they managed virtual patients presenting with various conditions. Learning outcome was assessed by analysing log-files of in-game activity (including choice of diagnostic methods, differential diagnosis and treatment initiation) with regard to history taking and patient management in three virtual patient cases: Non-ST segment elevation myocardial infarction (NSTEMI), pulmonary embolism (PE) and hypertensive crisis. Fourth-year students were followed up for 1.5 years, and their final performance was compared to the performance of students who had never been exposed to the game but had otherwise taken the same five-year undergraduate course. RESULTS During the training phase, overall performance scores increased from 57.6 ± 1.1% to 65.5 ± 1.2% (p < 0.001; effect size 0.656). Performance remained stable over 1.5 years, and the final assessment revealed a strong impact of ever-exposure to the game on management scores (72.6 ± 1.2% vs. 63.5 ± 2.1%, p < 0.001; effect size 0.811). Pre-exposed students were more than twice as likely to correctly diagnose NSTEMI and PE and showed significantly greater adherence to guideline recommendations (e.g., troponin measurement and D-dimer testing in suspected PE). CONCLUSIONS The considerable difference observed between previously exposed and unexposed students suggests a long-term effect of using the game although retention of specific virtual patient cases rather than general principles might partially account for this effect. Thus, the game may foster the implementation of guideline recommendations.
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Affiliation(s)
- Tobias Raupach
- Department of Cardiology and Pneumology, Göttingen University Medical Centre, Robert-Koch-Straße 40, 37075 Göttingen, Germany
- Department of Medical Education, University Hospital Bonn, Venusberg-Campus 1, Gebäude 33, 53127 Bonn, Germany
| | - Insa de Temple
- Department of Cardiology and Pneumology, Göttingen University Medical Centre, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Angélina Middeke
- Department of Cardiology and Pneumology, Göttingen University Medical Centre, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Sven Anders
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - Caroline Morton
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Nikolai Schuelper
- Medius KLINIK Ostfildern-Ruit, Hedelfinger Straße 166, 73760 Ostfildern-Ruit, Germany
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