Serious Gaming in Medical Education: A Proposed Structured Framework for Game Development

Summary Statement Serious games are increasingly being used for medical education. However, the design and development of serious games for the education of health professionals is highly variable, and very few articles report the development process used for game development. There are many established processes for software development that can improve and streamline development, and incorporating the best practices from educational pedagogy and software development may enhance teamwork and communication, decrease development costs, and improve the quality of serious games. In this article, we review and summarize the literature for serious game development for medical education, and combining the best practices, we propose a structured three-phase iterative development framework for serious game development.

[1]  Johan Creutzfeldt,et al.  Using Virtual World Training to Increase Situation Awareness during Cardiopulmonary Resuscitation , 2014, MMVR.

[2]  Ryan Brydges,et al.  Technology-Enhanced Simulation for Health Professions Education , 2012 .

[3]  R. Kanthan,et al.  The impact of specially designed digital games-based learning in undergraduate pathology and medical education. , 2011, Archives of pathology & laboratory medicine.

[4]  DiehlLeandro Arthur,et al.  User Assessment of "InsuOnLine," a Game to Fight Clinical Inertia in Diabetes: A Pilot Study. , 2015 .

[5]  Adam Dubrowski,et al.  A Serious Game for Off-Pump Coronary Artery Bypass Surgery Procedure Training , 2011, MMVR.

[6]  Michael J. Roy,et al.  Simulation and Virtual Reality in Medical Education and Therapy: A Protocol , 2006, Cyberpsychology Behav. Soc. Netw..

[7]  Erle Ch Lim,et al.  Using an online neurological localisation game , 2008, Medical education.

[8]  Wm. LeRoy Heinrichs,et al.  Exploring Virtual Worlds for Scenario-Based Repeated Team Training of Cardiopulmonary Resuscitation in Medical Students , 2010, Journal of medical Internet research.

[9]  S. DeMaria,et al.  Serious Gaming to Improve the Safety of Central Venous Catheter Placement , 2011 .

[10]  Natália Del' Angelo Aredes,et al.  Serious game e-Baby: nursing students' perception on learning about preterm newborn clinical assessment. , 2015, Revista brasileira de enfermagem.

[11]  Adam Dubrowski,et al.  Z-DOC: A Serious Game for Z-Plasty Procedure Training , 2013, MMVR.

[12]  Tanya J. Fabian,et al.  Evaluation of Branched-Narrative Virtual Patients for Interprofessional Education of Psychiatry Residents , 2017, Academic Psychiatry.

[13]  Karen McKenzie,et al.  A comparison of the effectiveness of a game informed online learning activity and face to face teaching in increasing knowledge about managing aggression in health settings , 2012, Advances in Health Sciences Education.

[14]  E O'Neill,et al.  Graphic (games research applied to public health with innovative collaboration)--designing a serious game pilot for dental public health. , 2013, Bulletin du Groupement international pour la recherche scientifique en stomatologie & odontologie.

[15]  H A Schwid,et al.  Screen-Based Anesthesia Simulation With Debriefing Improves Performance in a Mannequin-Based Anesthesia Simulator , 2001, Teaching and learning in medicine.

[16]  Marc Cavazza,et al.  Towards Interactive Narrative Medicine , 2013, MMVR.

[17]  Marshall L. Smith,et al.  Design and Development of a Virtual Reality Simulator for Advanced Cardiac Life Support Training , 2014, IEEE Journal of Biomedical and Health Informatics.

[18]  Ann Whitney Gleason,et al.  RELM: Developing a Serious Game to Teach Evidence-Based Medicine in an Academic Health Sciences Setting , 2015, Medical reference services quarterly.

[19]  G. Taffet,et al.  An Online Spaced-Education Game to Teach and Assess Medical Students: A Multi-Institutional Prospective Trial , 2012, Academic medicine : journal of the Association of American Medical Colleges.

[20]  Panagiotis D Bamidis,et al.  Exploring Design Requirements for Repurposing Dental Virtual Patients From the Web to Second Life: A Focus Group Study , 2014, Journal of medical Internet research.

[21]  W. L. Heinrichs,et al.  Design, Development, and Evaluation of an Online Virtual Emergency Department for Training Trauma Teams , 2008, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[22]  Baruch Fischhoff,et al.  Assessing the Validity of Using Serious Game Technology to Analyze Physician Decision Making , 2014, PloS one.

[23]  Ladislav Dušek,et al.  Interactive Algorithms for Teaching and Learning Acute Medicine in the Network of Medical Faculties MEFANET , 2013, Journal of medical Internet research.

[24]  Maurits Graafland,et al.  Prospective cohort study on surgeons’ response to equipment failure in the laparoscopic environment , 2014, Surgical Endoscopy.

[25]  L. Atack,et al.  The impact of an online interprofessional course in disaster management competency and attitude towards interprofessional learning , 2009, Journal of interprofessional care.

[26]  Mary Ottolini,et al.  Virtual Reality for Pediatric Sedation: A Randomized Controlled Trial Using Simulation , 2016, Cureus.

[27]  Mogamat Razeen Davids,et al.  Development and evaluation of a multimedia e-learning resource for electrolyte and acid-base disorders. , 2011, Advances in physiology education.

[28]  Nicholas Kman,et al.  Using second life virtual simulation environment for mock oral emergency medicine examination. , 2011, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[29]  David Fleiszer,et al.  Learning While Having Fun: The Use of Video Gaming to Teach Geriatric House Calls to Medical Students , 2008, Journal of the American Geriatrics Society.

[30]  Carlos Alberto Seixas,et al.  Development of the e-Baby Serious Game With Regard to the Evaluation of Oxygenation in Preterm Babies: Contributions of the Emotional Design , 2014, Computers, informatics, nursing : CIN.

[31]  P. Andreatta,et al.  Virtual reality triage training provides a viable solution for disaster-preparedness. , 2010, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[32]  Sergei N. Kurenov,et al.  Game-Based Mass Casualty Burn Training , 2009, MMVR.

[33]  Martin Boeker,et al.  Game-Based E-Learning Is More Effective than a Conventional Instructional Method: A Randomized Controlled Trial with Third-Year Medical Students , 2013, PloS one.

[34]  Johan Creutzfeldt,et al.  Effects of Repeated CPR Training in Virtual Worlds on Medical Students' Performance , 2008, MMVR.

[35]  Pablo Ruisoto,et al.  Anatomical-Ultrasound Visor for Regional Anaesthesia , 2016, Journal of Medical Systems.

[36]  Uno Fors,et al.  Implementation of a Web-Based Patient Simulation Program to Teach Dental Students in Oral Surgery. , 2016, Journal of dental education.

[37]  J. B. Brooke,et al.  SUS: A 'Quick and Dirty' Usability Scale , 1996 .

[38]  Ann L. Fruhling,et al.  A Serious Game for Teaching Nursing Students Clinical Reasoning and Decision-Making Skills , 2016, Nursing Informatics.

[39]  Joanne Foster,et al.  Teaching Undergraduate Nursing Students Renal Care in a 3D Gaming Environment , 2009, Nursing Informatics.

[40]  Phillip M. Harter,et al.  Simulation for Team Training and Assessment: Case Studies of Online Training with Virtual Worlds , 2008, World Journal of Surgery.

[41]  B Price Kerfoot,et al.  An Online Spaced-Education Game for Global Continuing Medical Education: A Randomized Trial , 2012, Annals of surgery.

[42]  Lori R. Newman,et al.  Twelve tips for facilitating Millennials’ learning , 2012, Medical teacher.

[43]  Paul N. Kizakevich,et al.  Virtual Simulation-Enhanced Triage Training for Iraqi Medical Personnel , 2007, MMVR.

[44]  Paul M. Maggio,et al.  Septris: A Novel, Mobile, Online, Simulation Game That Improves Sepsis Recognition and Management , 2015, Academic medicine : journal of the Association of American Medical Colleges.

[45]  Alexander Turchin,et al.  An Online Spaced-Education Game Among Clinicians Improves Their Patients’ Time to Blood Pressure Control: A Randomized Controlled Trial , 2014, Circulation. Cardiovascular quality and outcomes.

[46]  Mark Cohen,et al.  Pilot test of a serious gaming/immersion environment to teach clinical cancer genetics , 2007, MMVR.

[47]  Steven D. Tripp,et al.  Rapid prototyping: An alternative instructional design strategy , 1990 .

[48]  Katherine A Sward,et al.  Use of a Web-based game to teach pediatric content to medical students. , 2008, Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association.

[49]  J. F. Avila-Tomas,et al.  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 , 2022, BMC medical education.

[50]  Bryan Bergeron Augmented assessment as a means to augmented reality. , 2006, Studies in health technology and informatics.

[51]  S. Oei,et al.  Serious gaming in women’s health care , 2011, BJOG : an international journal of obstetrics and gynaecology.

[52]  Niranjan Kissoon,et al.  The Development of an Internet-Based Knowledge Exchange Platform for Pediatric Critical Care Clinicians Worldwide* , 2014, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[53]  L. Diehl,et al.  InsuOnline, a Serious Game to Teach Insulin Therapy to Primary Care Physicians: Design of the Game and a Randomized Controlled Trial for Educational Validation , 2013, JMIR research protocols.

[54]  Gianluca De Leo,et al.  Measuring Sense of Presence and User Characteristics to Predict Effective Training in an Online Simulated Virtual Environment , 2014, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[55]  Wm. LeRoy Heinrichs,et al.  CliniSpaceTM: A Multiperson 3D Online Immersive Training Environment Accessible through a Browser , 2011, MMVR.

[56]  M. Strehlow,et al.  Evaluating the efficacy of simulators and multimedia for refreshing ACLS skills in India. , 2010, Resuscitation.

[57]  Carla M Pugh,et al.  Piloting Virtual Surgical Patient Cases with 3rd-year medical students during the surgery rotation. , 2016, American journal of surgery.

[58]  Luca Chittaro,et al.  Evaluation of a 3D serious game for advanced life support retraining , 2013, Int. J. Medical Informatics.

[59]  Uno Fors,et al.  The effect of constructing versus solving virtual patient cases on transfer of learning: a randomized trial , 2016, Perspectives on medical education.

[60]  Maurits Graafland,et al.  A Serious Game Can Be a Valid Method to Train Clinical Decision-Making in Surgery , 2014, World Journal of Surgery.

[61]  D. Cook,et al.  Virtual patients: a critical literature review and proposed next steps , 2009, Medical education.

[62]  Deborah V Dawson,et al.  Development and evaluation of an interactive dental video game to teach dentin bonding. , 2011, Journal of dental education.

[63]  John Morris,et al.  The Blank-Page Technique: Reinvigorating Paper Prototyping in Usability Testing , 2010, IEEE Transactions on Professional Communication.

[64]  E. Akl,et al.  An educational game for teaching clinical practice guidelines to Internal Medicine residents: development, feasibility and acceptability , 2008, BMC medical education.

[65]  Daniel Katz,et al.  A Systematic Review of Serious Games in Training Health Care Professionals , 2016, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[66]  Guido Makransky,et al.  Simulation based virtual learning environment in medical genetics counseling: an example of bridging the gap between theory and practice in medical education , 2016, BMC medical education.

[67]  Dana T Lin,et al.  Validity evidence for Surgical Improvement of Clinical Knowledge Ops: a novel gaming platform to assess surgical decision making. , 2015, American journal of surgery.

[68]  James F. Knight,et al.  Serious gaming technology in major incident triage training: a pragmatic controlled trial. , 2010, Resuscitation.

[69]  Bradley J. Morris,et al.  Gaming science: the “Gamification” of scientific thinking , 2013, Front. Psychol..

[70]  Luciana Mara Monti Fonseca,et al.  Serious game e-Baby: percepção dos estudantes de enfermagem sobre a aprendizagem da avaliação clínica do bebê prematuro , 2015 .

[71]  Marcel G M Olde Rikkert,et al.  A randomized controlled trial on teaching geriatric medical decision making and cost consciousness with the serious game GeriatriX. , 2014, Journal of the American Medical Directors Association.

[72]  Riitta Jääskeläinen Think-aloud protocol , 2010 .

[73]  Domitile Lourdeaux,et al.  Perturbed Communication in a Virtual Environment to Train Medical Team Leaders , 2016, MMVR.

[74]  Fernanda Chiarion Sassi,et al.  Computer game-based and traditional learning method: a comparison regarding students’ knowledge retention , 2013, BMC Medical Education.

[75]  M. Schijven,et al.  Systematic review of serious games for medical education and surgical skills training , 2012, The British journal of surgery.

[76]  James B McGee,et al.  The Virtual Pathology Instructor: a medical student teaching tool developed using patient simulator software. , 2014, Human pathology.

[77]  Jakob Nielsen,et al.  Estimating the number of subjects needed for a thinking aloud test , 1994, Int. J. Hum. Comput. Stud..

[78]  Maurits Graafland,et al.  A serious game to improve situation awareness in laparoscopic surgery , 2013, GFHEU.

[79]  Cord Spreckelsen,et al.  eMedOffice: A web-based collaborative serious game for teaching optimal design of a medical practice , 2012, BMC medical education.

[80]  Johan Creutzfeldt,et al.  Effects of pre-training using serious game technology on CPR performance – an exploratory quasi-experimental transfer study , 2012, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.