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Journal Description

JMIR Serious Games (JSG, ISSN 2291-9279; Impact Factor: 3.351) is a multidisciplinary journal devoted to computer/web/virtual reality/mobile applications that incorporate elements of gaming, gamification or novel hardware platforms such as virtual reality headsets or Microsoft Kinect to solve serious problems such as health behavior change, physical exercise promotion (exergaming), medical rehabilitation, diagnosis and treatment of psychological/psychiatric disorders, medical education, health promotion, teaching and education, or social change. The journal also considers commentary and research in the fields of video games violence and video games addiction.

The journal is indexed in PubMed, PubMed Central, DOAJ, and SCIE/Web of Science, and JCR (Journal Citation Reports) where it received an official impact factor by Clarivate. In June 2019, JSG received an impact factor of 3.351, ranking JSG at the top of all gaming-related academic journals, ahead of (for example) more established competitor journals such as the Games for Health Journal. 

 

Recent Articles:

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/smiling-portrait-boy-using-laptop-sitting-with-girl-classroom_3735119.htm#page=1&query=boy%20using%20computer&position=2; License: Licensed by JMIR.
    Serious Games for Education

    Apr 2, 2020

    Using a Virtual Serious Game (Deusto-e-motion1.0) to Assess the Theory of Mind in Primary School Children: Observational Descriptive Study

    Authors List:

    Abstract:

    Background: Given the interactive media characteristics and intrinsically motivating appeal, virtual serious games are often praised for their potential for assessment and treatment. Objective: This study aims to validate and develop normative data for a virtual serious game (Deusto-e-motion1.0) for the evaluation of emotional facial expression recognition and social skills, both of which are components of the theory of mind. Methods: A total of 1236 children took part in the study. The children were classified by age (8-12 years old), gender (males=639, females=597), and educational level (between the third and sixth years of Primary Education). A total of 10 schools from the Basque Country and 20 trained evaluators participated in this study. Results: Differences were found in Deusto-e-motion1.0 scores between groups of children depending on age and gender. Moreover, there was a moderately significant correlation between the emotional recognition scores of Deusto-e-motion1.0 and those of the Feel facial recognition test. Conclusions: Deusto-e-motion1.0 shows concurrent validity with instruments that assess emotional recognition. Results support the adequacy of Deusto-e-motion1.0 in assessing components of the theory of mind in children.

  • User interacting with the serious motion-based exercise game in the ambient assisted living environment. Source: Image created by the Authors; Copyright: André Calero Valdez; URL: http://games.jmir.org/2020/1/e14182/; License: Licensed by JMIR.
    Serious Games for Health and Medicine

    Apr 1, 2020

    Serious Motion-Based Exercise Games for Older Adults: Evaluation of Usability, Performance, and Pain Mitigation

    Authors List:

    Abstract:

    Background: Many societies are facing demographic changes that challenge the viability of health and welfare systems. Serious games for health care and ambient assisted living (AAL) offer health benefits and support for older adults and may mitigate some of the negative effects of the demographic shift. Objective: This study aimed to examine the acceptance of serious games to promote physical health in AAL environments. Since AAL environments are designed specifically to support independent living in older adults, we studied the relationship among age and user diversity, performance in the game, and overall usability and acceptance evaluation. Methods: We developed a motion-based serious exercise game for prototypical AAL environments. In two evaluations, outside (n=71) and within (n=64) the AAL environment, we investigated the influence of age, gender, self-efficacy in interacting with technology, need for achievement on performance, effect of the game, usability evaluation of the game, and overall acceptance. Results: Both games were evaluated as easy to use and fun to play. Both game interventions had a strong pain-mitigating effect in older adults (game 1: −55%, P=.002; game 2: −66%, P=.01). Conclusions: Serious exercise games outside and inside AAL environments can contribute to individuals’ health and well-being and to the stability of health care systems. Trial Registration:

  • Source: freepik; Copyright: freepik; URL: https://www.freepik.com/free-photo/close-up-boy-holding-controller_5121492.htm#page=2&query=videogame+controller&position=14; License: Licensed by JMIR.
    Games for Medical Education and Training

    Mar 5, 2020

    Health Education Serious Games Targeting Health Care Providers, Patients, and Public Health Users: Scoping Review

    Authors List:

    Abstract:

    Background: Serious educational games have shown effectiveness in improving various health outcomes. Previous reviews of health education games have focused on specific diseases, certain medical subjects, fixed target groups, or limited outcomes of interest. Given the recent surge in health game studies, a scoping review of health education games is needed to provide an updated overview of various aspects of such serious games. Objective: This study aimed to conduct a scoping review of the design and evaluation of serious educational games for health targeting health care providers, patients, and public (health) users. Methods: We identified 2313 studies using a unique combination of keywords in the PubMed and ScienceDirect databases. A total of 161 studies were included in this review after removing duplicates (n=55) and excluding studies not meeting our inclusion criteria (1917 based on title and abstract and 180 after reviewing the full text). The results were stratified based on games targeting health care providers, patients, and public users. Results: Most health education games were developed and evaluated in America (82/161, 50.9%) and Europe (64/161, 39.8%), with a considerable number of studies published after 2012. We discovered 58.4% (94/161) of studies aiming to improve knowledge learning and 41.6% (67/161) to enhance skill development. The studies targeted various categories of end users: health care providers (42/161, 26.1%), patients (38/161, 23.6%), public users (75/161, 46.6%), and a mix of users (6/161, 3.7%). Among games targeting patients, only 13% (6/44) targeted a specific disease, whereas a growing majority targeted lifestyle behaviors, social interactions, cognition, and generic health issues (eg, safety and nutrition). Among 101 studies reporting gameplay specifications, the most common gameplay duration was 30 to 45 min. Of the 61 studies reporting game repetition, only 14% (9/61) of the games allowed the users to play the game with unlimited repetitions. From 32 studies that measured follow-up duration after the game intervention, only 1 study reported a 2-year postintervention follow-up. More than 57.7% (93/161) of the games did not have a multidisciplinary team to design, develop, or assess the game. Conclusions: Serious games are increasingly used for health education targeting a variety of end users. This study offers an updated scoping review of the studies assessing the value of serious games in improving health education. The results showed a promising trend in diversifying the application of health education games that go beyond a specific medical condition. However, our findings indicate the need for health education game development and adoption in developing countries and the need to focus on multidisciplinary teamwork in designing effective health education games. Furthermore, future health games should expand the duration and repetition of games and increase the length of the follow-up assessments to provide evidence on long-term effectiveness.

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://games.jmir.org/2020/1/e15349/; License: Creative Commons Attribution (CC-BY).
    Serious Games for Education

    Feb 27, 2020

    Using String Metrics to Improve the Design of Virtual Conversational Characters: Behavior Simulator Development Study

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    Abstract:

    Background: An emergency waiting room is a place where conflicts often arise. Nervous relatives in a hostile, unknown environment force security and medical staff to be ready to deal with some awkward situations. Additionally, it has been said that the medical interview is the first diagnostic and therapeutic tool, involving both intellectual and emotional skills on the part of the doctor. At the same time, it seems that there is something mysterious about interviewing that cannot be formalized or taught. In this context, virtual conversational characters (VCCs) are progressively present in most e-learning environments. Objective: In this study, we propose and develop a modular architecture for a VCC-based behavior simulator to be used as a tool for conflict avoidance training. Our behavior simulators are now being used in hospital environments, where training exercises must be easily designed and tested. Methods: We define training exercises as labeled, directed graphs that help an instructor in the design of complex training situations. In order to increase the perception of talking to a real person, the simulator must deal with a huge number of sentences that a VCC must understand and react to. These sentences are grouped into sets identified with a common label. Labels are then used to trigger changes in the active node of the graph that encodes the current state of the training exercise. As a consequence, we need to be able to map every sentence said by the human user into the set it belongs to, in a fast and robust way. In this work, we discuss two different existing string metrics, and compare them to one that we use to assess a designed exercise. Results: Based on the similarities found between different sets, the proposed metric provided valuable information about ill-defined exercises. We also described the environment in which our programs are being used and illustrated it with an example. Conclusions: Initially designed as a tool for training emergency room staff, our software could be of use in many other areas within the same environment. We are currently exploring the possibility of using it in speech therapy situations.

  • Career & Technical Education Emerging Health Professionals Program Students. Source: Precious Petty, Public Relations Coordinator Lehigh Career & Technical Institute; Copyright: Lehigh Career & Technical Institute; URL: http://www.lcti.org/prospective-student-course/emerging-health-professionals/; License: Creative Commons Attribution (CC-BY).
    Games for Medical Education and Training

    Feb 6, 2020

    Learner Analysis to Inform the Design and Development of a Serious Game for Nongaming Female Emerging Health Care Preprofessionals: Qualitative Sample Study

    Authors List:

    Abstract:

    Background: Overall, 75% of health care practitioners are women, but half of all females do not play digital games of any kind. There is no consensus in the literature regarding optimal design elements to maximize the efficacy of serious games. To capitalize on the promise of serious games in health care education, it is important for instructional designers to understand the underlying learners’ values, attitudes, and beliefs that might motivate nongaming female health care preprofessional students to independently choose to persistently play serious games to mastery. Objective: Specifically, the aim of this study was to seek answers to 2 questions. First, what values, attitudes, and beliefs contribute to the nongaming behaviors of 12th-grade female emerging health care preprofessionals? Second, how do the values, attitudes, and beliefs of 12th-grade female emerging health care preprofessionals align with important design features of serious games? Methods: In this study, a learner analysis was conducted using semistructured interviews with 8 12th-grade college-bound female health science students to better understand learners’ values, attitudes, and beliefs to inform the design and development of a serious game. These interviewees represented a diverse subset of the female emerging health care preprofessionals who self-identified themselves as not playing games at all, not very often, or infrequently. Results: The findings suggest that the study participants exhibited a complex fusion of desire for both accomplishment and affiliation. The participants were all independent, competitive, and prosocial leaders. They thought strategically and consciously self-limited their leisure time to achieve personally meaningful long-term goals. They embraced overcoming expected failures and aimed to achieve relevant high-stakes wins in all academic, athletic, extracurricular, and leisure activities they valued while consciously avoiding what they considered to be non–goal-oriented activities. Conclusions: The results of this study reinforce the need for a robust learner analysis to identify the multifaceted behavioral characteristics of targeted learners before the design and development of serious games. The common characteristics of the 12th-grade female health science students in this study suggest that they will choose to invest their limited leisure time playing a personally meaningful, preprofessionally authentic serious game if the collective design elements are aligned with the students’ self-conceptualization of their present or future selves.

  • Source: Naseem Ahmadpour; Copyright: The Authors; URL: http://games.jmir.org/2020/1/e14565/; License: Licensed by JMIR.
    Serious Games for Health and Medicine

    Jan 31, 2020

    Design Strategies for Virtual Reality Interventions for Managing Pain and Anxiety in Children and Adolescents: Scoping Review

    Authors List:

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    Background: Virtual reality (VR) technology has been explored in the health sector as a novel tool for supporting treatment side effects, including managing pain and anxiety. VR has recently become more available with the launch of low-cost devices and apps. Objective: This study aimed to provide an updated review of the research into VR use for pain and anxiety in pediatric patients undergoing medical procedures. Specifically, we wanted to gain an understanding of the techniques and goals used in selecting or designing VR apps in this context. Methods: We performed a scoping review. To identify relevant studies, we searched three electronic databases. Two authors screened the titles and abstracts for relevance and eligibility criteria. Results: Overall, 1386 articles published between 2013 and 2018 were identified. In total 18 articles were included in the review, with 7 reporting significant reduction in pediatric pain or anxiety, 3 testing but finding no significant impact of the VR apps employed, and the rest not conducting any test of significance. We identified 9 articles that were based on VR apps specifically designed and tailored for pediatric patients. The findings were analyzed to develop a holistic model and describe the product, experience, and intervention aspects that need to be considered in designing such medical VR apps. Conclusions: VR has been demonstrated to be a viable choice for managing pain and anxiety in a range of medical treatments. However, commercial products lack diversity and meaningful design strategies are limited beyond distraction techniques. We propose future VR interventions to explore skill-building goals in apps characterized by dynamic feedback to the patient and experiential and product qualities that enable them to be an active participant in managing their own care. To achieve this, design must be part of the development.

  • Source: The Authors/ Placeit; Copyright: The Authors; URL: http://games.jmir.org/2020/1/e16254/; License: Creative Commons Attribution (CC-BY).
    Serious Games for Health and Medicine

    Jan 31, 2020

    Engaging African American Youth in the Development of a Serious Mobile Game for Sexual Health Education: Mixed Methods Study

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    Abstract:

    Background: Although teen pregnancy rates decreased dramatically in the United States over the past decade, the rates of sexually transmitted infections (STIs) among adolescents and young adults increased. STI rates disproportionately affect African American youth and young adults. Innovative, accessible, and culturally relevant sexual health interventions are urgently needed. Objective: This study aimed to identify the optimal modality for a game-based sexual health intervention; develop the educational, entertainment, and technological aspects of the serious game; and demonstrate its usability and acceptance by the target population. Methods: This project was grounded in formative data collection with community-based participatory research principles and practices combined with a user-centered design and development approach. Sexually Active Adolescent–Focused Education (SAAFE) was developed using input and feedback from African American youths aged 15 to 21 years who participated in a youth advisory board and focus group discussions to inform the co-design and cocreation of the serious game. The process was highly iterative with multiple sessions for user input following design changes. It proceeded in 3 stages. Social cognitive theory and problem-solving theory were leveraged to provide evidence-based, trauma-informed education through a serious game. Usability testing assessed the quality of user experience with the prototype. Results: Across all 3 stages, a total of 86 self-identified African American males and females aged 15 to 21 years from the District of Columbia and Birmingham, Alabama, participated. Participants requested a dating simulation game. They wanted SAAFE to be customizable, realistic, entertaining, educational, modern, and experiential, linking consequences to their gameplay decisions. Usability testing resulted in an initial System Usability Survey score of 77.7, placing the game in the 82nd percentile and above average for usability. Conclusions: Initial results suggest that the SAAFE prototype is a promising intervention to engage African American youth in sexual health education using a role-playing game. If proven efficacious, the game has the potential to meet the need for sex education, counterbalance unhealthy portrayals of sex in popular media, and respond to the disparities in the STI epidemic.

  • Source: Image created by the Authors; Copyright: Thomas Sanjay Weber-Spickschen; URL: http://games.jmir.org/2020/1/e14282/; License: Licensed by JMIR.
    Serious Games for Health and Medicine

    Jan 24, 2020

    Improving Maximal Strength in the Initial Postoperative Phase After Anterior Cruciate Ligament Reconstruction Surgery: Randomized Controlled Trial of an...

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    Background: Anterior cruciate ligament reconstruction surgery is one of the most common orthopedic procedures. One of the main factors that influence the outcome is regaining strength in the postoperative phase. Because anterior cruciate ligament reconstruction surgeries are often performed in young patients, we combined the concept of prehabilitation with an app-based serious gaming approach to improve maximal strength postoperatively. Objective: Our objective was to conduct a prospective randomized trial to evaluate whether an app-based active muscle training program (GenuSport Knee Trainer) can improve postoperative strength by starting rehabilitation immediately after primary anterior cruciate ligament reconstruction surgery. Methods: We designed a pilot study in which we randomly assigned patients receiving primary anterior cruciate ligament reconstruction to either the serious gaming training (intervention) group or a conventional rehabilitation (control) group. Except for the serious gaming-based training, both groups followed the same postoperative treatment protocol. Outcome parameters were absolute and relative change in maximal strength, as well as the International Knee Documentation Committee Subjective Knee evaluation form, Knee Injury and Osteoarthritis Outcome Score, and Lysholm Knee Score. Results: In total 26 patients agreed to participate (14 patients in the intervention group and 12 patients in the control group, 1 of whom was lost to follow-up). We noted a difference in absolute maximum strength between the exergaming intervention and the control groups. Mean maximum strength preoperatively was 155.1 (SD 79.2) N in the intervention group (n=14) and 157.0 (SD 40.8) N in the control group (n=11). Postoperative mean maximum strength was 212.8 (SD 78.5) N in the intervention group and 154.5 (SD 27.1) N in the control group. Mean absolute change in maximum strength was 57.7 (SD 95.2) N in the intervention group and –4.8 (22.2) N in the control group. The analysis of covariance model with absolute change as the dependent variable and treatment group and baseline maximum strength as covariates showed a relevant difference in relative change between treatment groups (intervention – control) of 59.7 N (95% CI 10.1-109.3; P=.02). Similarly to the absolute increase, the relative change in maximum strength was relevantly higher in the exergaming group. The mean relative change in maximum strength was 1.7 (SD 1.17) in the intervention group and 1 (SD 0.13) in the control group. No adverse events or problems were reported during the study period. Conclusions: Implementation of an app-based active muscle training program in the early postoperative therapy scheme was associated with an improvement in maximal strength. Therefore, we considered the use of GenuSport training after anterior cruciate ligament reconstruction to be a helpful complement to rehabilitation after anterior cruciate ligament reconstruction surgery to improve strength in the early postoperative phase. To our knowledge this was the first study to analyze immediate postoperative serious gaming-based training with the GenuSport device based on strength improvement.

  • Source: The Authors/ Placeit; Copyright: JMIR Publications; URL: http://games.jmir.org/2020/1/e14548/; License: Creative Commons Attribution (CC-BY).
    Serious Games for Education

    Jan 17, 2020

    The Adoption of a Virtual Reality–Assisted Training System for Mental Rotation: A Partial Least Squares Structural Equation Modeling Approach

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    Abstract:

    Background: Virtual reality (VR) technologies have been developed to assist education and training. Although recent research suggested that the application of VR led to effective learning and training outcomes, investigations concerning the acceptance of these VR systems are needed to better urge learners and trainees to be active adopters. Objective: This study aimed to create a theoretical model to examine how determining factors from relevant theories of technology acceptance can be used to explain the acceptance of a novel VR-assisted mental rotation (MR) training system created by our research team to better understand how to encourage learners to use VR technology to enhance their spatial ability. Methods: Stereo and interactive MR tasks based on Shepard and Metzler’s pencil and paper test for MR ability were created. The participants completed a set of MR tasks using 3D glasses and stereoscopic display and a 6-degree-of-freedom joystick controller. Following task completion, psychometric constructs from theories and previous studies (ie, perceived ease of use, perceived enjoyment, attitude, satisfaction, and behavioral intention to use the system) were used to measure relevant factors influencing behavior intentions. Results: The statistical technique of partial least squares structural equation modeling was applied to analyze the data. The model explained 47.7% of the novel, VR-assisted MR training system’s adoption intention, which suggests that the model has moderate explanatory power. Direct and indirect effects were also interpreted. Conclusions: The findings of this study have both theoretical and practical importance not only for MR training but also for other VR-assisted education. The results can extend current theories from the context of information systems to educational and training technology, specifically for the use of VR-assisted systems and devices. The empirical evidence has practical implications for educators, technology developers, and policy makers regarding MR training.

  • Source: Image created by the Authors; Copyright: Michael Winter; URL: http://games.jmir.org/2020/1/e15374/; License: Creative Commons Attribution (CC-BY).
    Serious Games for Education

    Jan 9, 2020

    Learning to Read by Learning to Write: Evaluation of a Serious Game to Foster Business Process Model Comprehension

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    Background: The management and comprehension of business process models are of utmost importance for almost any enterprise. To foster the comprehension of such models, this paper has incorporated the idea of a serious game called Tales of Knightly Process. Objective: This study aimed to investigate whether the serious game has a positive, immediate, and follow-up impact on process model comprehension. Methods: A total of two studies with 81 and 64 participants each were conducted. Within the two studies, participants were assigned to a game group and a control group (ie, study 1), and a follow-up game group and a follow-up control group (ie, study 2). A total of four weeks separated study 1 and study 2. In both studies, participants had to answer ten comprehension questions on five different process models. Note that, in study 1, participants in the game group played the serious game before they answered the comprehension questions to evaluate the impact of the game on process model comprehension. Results: In study 1, inferential statistics (analysis of variance) revealed that participants in the game group showed a better immediate performance compared to control group participants (P<.001). A Hedges g of 0.77 also indicated a medium to large effect size. In study 2, follow-up game group participants showed a better performance compared to participants from the follow-up control group (P=.01); here, a Hedges g of 0.82 implied a large effect size. Finally, in both studies, analyses indicated that complex process models are more difficult to comprehend (study 1: P<.001; study 2: P<.001). Conclusions: Participants who played the serious game showed better performance in the comprehension of process models when comparing both studies.

  • Source: The Authors / Getty Images; Copyright: The Authors; URL: http://games.jmir.org/2020/1/e15422/; License: Creative Commons Attribution + NoDerivatives (CC-BY-ND).
    Viewpoints and Personal Experiences...

    Jan 6, 2020

    Using 360-Degree Video as a Research Stimulus in Digital Health Studies: Lessons Learned

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    Abstract:

    Due to the accessibility of omnidirectional cameras to record 360-degree videos and the technology to view the videos via mobile phones and other devices, 360-degree videos are being used more frequently to place people in different contexts and convey health-related information. Increasingly, 360-degree videos are being employed in health marketing because they have the potential to enhance health-related attitudes and behaviors. As a case study on how this technology may be used for health-related information and its effect on health care providers, we created a 360-degree video that portrays the experience of a migraine sufferer to be used as a stimulus in an online study. We describe the challenges and lessons learned in designing and implementing a 360-degree video as part of an online experiment focused on inducing empathy among clinicians for understanding patient experience. Given the rapid change in digital technology, future research can use this knowledge to design and implement 360-degree video studies more effectively.

  • Battle in the Blood contestant at World AIDS Day Celebration in Davao 2017. Source: Charlotte Hemingway; Copyright: The Authors; URL: http://games.jmir.org/2019/4/e13695/; License: Licensed by JMIR.
    Formative Evaluation and Development...

    Dec 20, 2019

    Development of a Mobile Game to Influence Behavior Determinants of HIV Service Uptake Among Key Populations in the Philippines: User-Centered Design Process

    Authors List:

    Abstract:

    Background: Opportunities in digital distribution place mobile games as a promising platform for games for health. However, designing a game that can compete in the saturated mobile games market and deliver persuasive health messages can feel like an insurmountable challenge. Although user-centered design is widely advocated, factors such as the user’s subject domain expertise, budget constraints, and poor data collection methods can restrict the benefits of user involvement. Objective: This study aimed to develop a playable and acceptable game for health, targeted at young key populations in the Philippines. Methods: Authors identified a range of user-centered design methods to be used in tandem from published literature. The resulting design process involved a phased approach, with 40 primary and secondary users engaged during the initial ideation and prototype testing stages. Selected methods included participatory design workshops, playtests, playability heuristics, and focus group discussions. Subject domain experts were allocated roles in the development team. Data were analyzed using a framework approach. Conceptual frameworks in health intervention acceptability and game design guided the analysis. In-game events were captured through the Unity Analytics service to monitor uptake and game use over a 12-month period. Results: Early user involvement revealed a strong desire for online multiplayer gameplay, yet most reported that access to this type of game was restricted because of technical and economic constraints. A role-playing game (RPG) with combat elements was identified as a very appealing gameplay style. Findings guided us to a game that could be played offline and that blended RPG elements, such as narrative and turn-based combat, with match-3 puzzles. Although the game received a positive response during playtests, gameplay was at times perceived as repetitive and predicted to only appeal to casual gamers. Knowledge transfer was predominantly achieved through interpretation of the game’s narrative, highlighting this as an important design element. Uptake of the game was positive; between December 1, 2017, and December 1, 2018, 3325 unique device installs were reported globally. Game metrics provided evidence of adoption by young key populations in the Philippines. Game uptake and use were substantially higher in regions where direct engagement with target users took place. Conclusions: User-centered design activities supported the identification of important contextual requirements. Multiple data collection methods enabled triangulation of findings to mediate the inherent biases of the different techniques. Game acceptance is dependent on the ability of the development team to implement design solutions that address the needs and desires of target users. If target users are expected to develop design solutions, they must have adequate expertise and a significant role within the development team. Facilitating meaningful partnerships between health professionals, the games industry, and end users will support the games for health industry as it matures.

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  • Physician perceptions of Visual Clot – a situation awareness-oriented visualization technology for viscoelastic tests: a mixed methods study.

    Date Submitted: Apr 1, 2020

    Open Peer Review Period: Apr 1, 2020 - Apr 9, 2020

    Background: Point-of-care viscoelastic coagulation testing is a time-efficient and advantageous method used in goal-directed bleeding management. To simplify the non-intuitive conventional presentatio...

    Background: Point-of-care viscoelastic coagulation testing is a time-efficient and advantageous method used in goal-directed bleeding management. To simplify the non-intuitive conventional presentation of viscoelastic test results based on abstract plots and a multitude of numbers, we have developed Visual Clot. This visualization technology applies user-centered design principles to create an animated model of the blood clot during the hemostatic cascade, illustrating the blood clot in its current state. An earlier simulation study found that Visual Clot doubled diagnostic accuracy, reduced decision-making duration, and perceived workload, and improved care provider confidence. Objective: This study aimed to analyze the opinions of the participants of the first Visual Clot study about the technology and to assess its strengths and limitations and its clinical applicability as a tool for coagulation management. Methods: We performed a researcher-initiated, international, double-center qualitative/quantitative study among the physicians who participated in the previous Visual Clot study. After a brief personal introduction to the technology and the evaluation of six coagulation scenarios with Visual Clot, we interviewed the participants asking them to tell us about the perceived pros and cons of the new tool. The identification of recurring patterns in the answers for the qualitative part of this study enabled us to formulate high-level topics and subtopics, based on which we defined six statements. The study participants rated their agreement to these statements on five-point Likert scales in an online survey, providing the quantitative part of this study. Results: Of the 60 physicians in the primary Visual Clot study, 36 gave an interview, and 42 completed the online survey. In the interviews, we identified the three most common themes to be "intuitive design" (mentioned by 50% of the participants), accelerating diagnostic and treatment" (50%), and "less brainwork needed" (28%). In the online survey, 92% percent of the participants agreed that they would like to have both Visual Clot and the standard result on the screen next to each other. Ninety percent of the participants agreed that Visual Clot is intuitive and easy to learn. Eighty-two percent indicated that Visual Clot might allow them to deal with complex coagulation situations more quickly. Conclusions: A group of anesthesia and intensive care physicians from two University hospitals in central Europe considered Visual Clot technology to be intuitive, easy to learn, and useful for decision-making in a situation of active bleeding. From the responses that these possible future users of the technology provided, Visual Clot appeared to constitute an efficient and well-accepted way to streamline the decision-making process in viscoelastic test-based coagulation management. Clinical Trial: Business Management System for Ethics Committees Number 2018-00933

  • Virtual simulation for measuring brain electrical activity: Intervention study in clinical neurophysiology course

    Date Submitted: Mar 18, 2020

    Open Peer Review Period: Mar 17, 2020 - May 12, 2020

    Background: Virtual simulation is the recreation of reality depicted on a computer screen. It offers the possibility to exercise motoric and psychomotor skills. In biomedical and medical education the...

    Background: Virtual simulation is the recreation of reality depicted on a computer screen. It offers the possibility to exercise motoric and psychomotor skills. In biomedical and medical education there is an attempt to find new ways to support students’ learning in neurophysiology. Traditionally, recording EEG (electroencephalography) has been trained through practical hands-on exercises. So far, virtual simulations in the EEG measurement have not been used. Objective: This study aimed to examine the development of students’ theoretical knowledge and practical skills in the EEG measurement when using a virtual EEG simulator in biomedical laboratory science in the context of a neurophysiology course. Methods: A computer-based EEG simulator was created. The simulator allows virtual electrode placement and EEG graph interpretation. The usefulness of the simulator on learning EEG measurement was tested with 35 participants divided into three groups. Experimental group 1 used a simulator with fuzzy feedback, experimental group 2 used a simulator with exact feedback and the control group did not use a simulator. The study comprised pre- and post-tests on theoretical knowledge and practical hands-on evaluation of EEG electrode placement. Results: The Wilcoxon signed-rank test indicates that two groups who utilized a computer-based electrode placement simulator showed significant improvement both in theoretical knowledge and practical skills compared to the group which studied without a simulator. Conclusions: Training electrode placement using a simulator enhances student’s ability to place electrodes and increases understanding of EEG measurement together with practical hands-on training.

  • Normal Play or Dark Play in a Serious Game for Medical Students: Differences in Student Characteristics, Play Strategy, and Learning Experiences

    Date Submitted: Feb 28, 2020

    Open Peer Review Period: Feb 28, 2020 - Apr 24, 2020

    Background: Although many studies have been published on the value of serious games for medical education recently, only little attention has been given to the role of dark play (choosing inappropriat...

    Background: Although many studies have been published on the value of serious games for medical education recently, only little attention has been given to the role of dark play (choosing inappropriate or unethical actions in games). Objective: To investigate potential differences in medical students who have the opportunity to play a serious game normal or dark play and to compare their reasons for choosing a play strategy and their perceptions of what they have learned from their game play. Methods: We asked undergraduate medical students to play a serious game in which they had to take care of a patient with delirium (The Delirium Experience). After getting acquainted with the game, students could opt for normal or dark play. Student characteristics (age, gender, experience with caring for older or delirious patients, and number of completed clerkships) were collected, and the Delirium Attitude Scale and Learning Motivation and Engagement Questionnaire were administered. Reasons for choosing normal or dark play were evaluated with an open-ended question. Information on lessons they had learned from the game were collected using an open-ended question and self-reported knowledge on delirium. Results: 160 students participated in this study (89 normal play, 71 dark play). Male students (n=26, 56.5%) had chosen dark play significantly more often than female students (n=45, 39.5%, p=0.049). We did not find significant differences between both play strategies concerning other student characteristics and measurement outcomes. Participants’ main reason for choosing normal play was to learn how to provide care to delirious patients and for dark play it was to gain insight into what a delirious patient has to endure during delirious episodes. All participants learned what to do when taking care of a delirious patient and gained insight into how a patient experiences delirium. We found no differences in self-reported knowledge. Conclusions: When medical students have the opportunity to play a serious game dark play, probably half of them will choose this play strategy. Male students will more likely opt for dark play than female students. Choice of play strategy is not affected by any other student characteristic or measurement outcome. All students learned the same lessons from playing the game, irrespective of their learning strategy. Clinical Trial: N/A: Registration of the trial was not necessary in accordance with the ICMJE (International Committee of Medical Journal Editors) recommendations.

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