The importance of humans in simulation: allowing the lure of technology to drive development

Serious games that simulate the subtle complexities of real life, pose a significant challenge in regards to requirements gathering. This case study involves a multi-player, inter-disciplinary medical game that simulates a hospital ward with medical scenarios based on the prescribed curriculum for junior doctors. Initially, both medical professionals and developers were focussed on finding ways to apply innovative 3D serious game technologies to build an eLearning environment for practical skills based medical training. The proposed system would allow an intern to play the role of an on-call doctor while employing AI and expert medical knowledge to simulate patients and supporting medical staff. However, a flaw in the basic premise of the project and the complexity of requirements forced unexpected changes during the development process. After the creation of text based documentation and flow charts for the medical diagnostic decision making processes, it became obvious that the subtly and complexities of the hospital ward and the interactions between patients and staff could not be adequately described through traditional documentation. To this end, the medical professionals developed video walkthroughs of real life scenarios reflecting good diagnostic practices and varying degrees of bad diagnostic practices. Along with the videos, PowerPoint slides were provided with key points, behaviours, and actions in the diagnostic and decision making process. Over an extended period of evolutionary requirements gathering, adaptive planning, prototyping, and testing, further inadequacies became evident. Email communications and videoconference proved to be inadequate. After extensive development, the only way to move forward was to organise face-to-face discussions between major stakeholders (a cross disciplinary team with educators, medical professionals, and IT professionals). At this point, a major flaw was identified and essential project requirements began to emerge. It was realised that teaching and learning outcomes had not driven the project. Rather, new technologies had been allowed to drive the project with learning outcomes constrained by the chosen technologies. It was further realised that the problem domain involved people and communications employing various mediums. It also became clear that the expert medical knowledge underlying the complexity of speech and behaviours required for the AI (such as a difficult patient or psychological issues) was far too complex to implement. This led to a movement away from AI driven avatars and a refocussing of the project on to human interactions and communication. This change in focus is currently being implemented through role-play of patients and health care professionals in a real time multi-player networked environment with the narrative set up through back stories. Testing was also refocussed on to clinical reasoning, problem solving, and communication skills with responses recorded in detail in communication logs for later evaluation and reflection. Features of the simulation are scheduled for testing at the Cairns Base Hospital using a group of 16 interns. A questionnaire will be administered before and after a play session involving a predefined medical scenario in a single player environment to help extract and refine the multi-player requirements for the current stage of development.