%0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e14342 %T A Badge Design Framework for a Gamified Learning Environment: Cases Analysis and Literature Review for Badge Design %A Park,Sungjin %A Kim,Sangkyun %+ Management of Technology Lab, Kangwon National University, 417, Engineering Building 1, Kangwon Daehak GIl 1, Chuncheon,, Republic of Korea, 82 033 250 6287, saviour@kangwon.ac.kr %K badge design framework %K educational badge %K digital badge %K badge types %K gamified learning environment %D 2019 %7 29.05.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: In the past, the educational badge was an extrinsic means of rewarding the motivation to learn. Based on continued research, however, the badge began to be recognized as a scale to measure the learner’s knowledge and skill and an important means of helping learners to gradually build intrinsic motivation by using certain extrinsic motivators. As the badge’s value has grown, the importance of its design has garnered attention. Objective: The objective of this research was to establish a badge design framework that can be used in a gamified learning environment. Methods: Data were collected from previous studies on badge design, 943 badge cases were extracted from 11 online and offline gamification in education contents, and their patterns and features were analyzed. Results: Based on the analysis of results from previous studies and 943 collected badge cases, our study suggests three conditions for badge design. Through the literature review and collected badge cases, our study designed a badge design framework. First, it is necessary to distinguish whether the type of learning activity required for earning badges is physical or conceptual. Second, it is necessary to distinguish whether the scale of an activity required for earning badges requires individual learning or interaction-induced learning. Third, it is important to review whether the time and effort invested in earning badges is simple, repetitive, and short-term or continuous and long-term. Based on these three conditions, collected badge cases were analyzed. To verify self-developed badge types, we conducted a chi-square test on the collected cases and confirmed that there was a significant difference for each of the eight badge types (Pearson chi-square 1117.7, P<.001). Conclusions: Through its literature review on previous studies, this study demonstrated the badge’s educational effectiveness. The badge design framework suggested in our study is expected to resolve some of the difficulties experienced during the badge design process in a gamified learning environment, encourage efficient badge design, and maximize learning effect. %M 31144664 %R 10.2196/14342 %U http://games.jmir.org/2019/2/e14342/ %U https://doi.org/10.2196/14342 %U http://www.ncbi.nlm.nih.gov/pubmed/31144664 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e13442 %T Comparing the Effects on Learning Outcomes of Tablet-Based and Virtual Reality–Based Serious Gaming Modules for Basic Life Support Training: Randomized Trial %A Aksoy,Emin %+ Acibadem Mehmet Ali Aydinlar University, Center of Advanced Simulation and Education, Kayışdağı Cd No. 34, Istanbul, 34752, Turkey, 90 5052685158, emin.aksoy@acibadem.edu.tr %K serious gaming %K virtual reality %K health care education %D 2019 %7 01.05.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Serious gaming is recognized as a training tool due its potential for a risk-free educational environment. There is still limited research about using serious gaming modules for emergency skills training. Objective: The aim of this study is to compare the effects on the knowledge level of participants after using a tablet-based serious game and a virtual reality (VR)–based serious game for Basic Life Support using a pretest/posttest method. Methods: The study was designed as a randomized trial comparing pretest and posttest results. A tablet-based and VR-based serious game with identical content was used for 40 participants. Over half of them (22/40, 55%) were included in the VR group and just under half (18/40, 45%) were in the tablet group. Student t test and Wilcoxon signed rank tests were used to determine the relation between the dependent and independent variables. In order to determine the effect size of the results, the effect size calculator (Cohen d) for t test was used. There is a significant difference between pre- and posttest results in both groups (P=.001; Wilcoxon). Results: Mean posttest results were significantly higher in both groups. The posttest results were significantly higher in the VR group in terms of pre- and posttest changes (P=.021; Student t test). Conclusions: Past research studies have shown that serious gaming presents a favorable additional tool for medical education. The results indicate that both serious gaming modules are effective and that VR-based serious gaming is more efficient in terms of learning outcome than tablet-based gaming. %M 31042153 %R 10.2196/13442 %U http://games.jmir.org/2019/2/e13442/ %U https://doi.org/10.2196/13442 %U http://www.ncbi.nlm.nih.gov/pubmed/31042153 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e12713 %T Effect of an Augmented Reality Ultrasound Trainer App on the Motor Skills Needed for a Kidney Ultrasound: Prospective Trial %A Ebner,Florian %A De Gregorio,Amelie %A Schochter,Fabienne %A Bekes,Inga %A Janni,Wolfgang %A Lato,Krisztian %+ Helios Amper Klinikum, Klinikstrasse 15, Dachau, 85221, Germany, 49 8131 764298, dr.ebner@web.de %K ultrasound trainer %K mobile device %K mobile apps %K augmented reality %K kidney %K sensitivity and specificity %K ultrasonography %K education %K simulation training %K telemedicine %D 2019 %7 01.05.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Medical education is evolving from "learning by doing" to simulation-based hands-on tutorials. Objective: The aim of this prospective 2-armed study was to evaluate a newly developed augmented reality ultrasound app and its effect on educational training and diagnostic accuracy. Methods: We recruited 66 medical students and, using imaging and measuring a kidney as quality indicators, tested them on the time they needed for these tasks. Both groups used textbooks as preparation; in addition, the study group had access to a virtual ultrasound simulation app for mobile devices. Results: There was no significant difference between the study arms regarding age (P=.97), sex (P=.14), and previous ultrasound experience (P=.66). The time needed to complete the kidney measurements also did not differ significantly (P=.26). However, the results of the longitudinal kidney measurements differed significantly between the study and control groups, with larger, more realistic values in the study group (right kidney: study group median 105.3 mm, range 86.1-127.1 mm, control group median 92 mm, range 50.4-112.2 mm; P<.001; left kidney: study group median 100.3 mm, range 81.7-118.6 mm, control group median 85.3 mm, range 48.3-113.4 mm; P<.001). Furthermore, whereas all students of the study group obtained valid measurements, students of the control group did not obtain valid measurements of 1 or both kidneys in 7 cases. Conclusions: The newly developed augmented reality ultrasound simulator mobile app provides a useful add-on for ultrasound education and training. Our results indicate that medical students’ use of the mobile app for training purposes improved the quality of kidney measurements. %M 31042155 %R 10.2196/12713 %U http://games.jmir.org/2019/2/e12713/ %U https://doi.org/10.2196/12713 %U http://www.ncbi.nlm.nih.gov/pubmed/31042155 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12994 %T Serious Gaming and Gamification Education in Health Professions: Systematic Review %A Gentry,Sarah Victoria %A Gauthier,Andrea %A L’Estrade Ehrstrom,Beatrice %A Wortley,David %A Lilienthal,Anneliese %A Tudor Car,Lorainne %A Dauwels-Okutsu,Shoko %A Nikolaou,Charoula K %A Zary,Nabil %A Campbell,James %A Car,Josip %+ Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 456161, sarah.gentry@doctors.org.uk %K video games %K education, professional %K review %D 2019 %7 28.03.2019 %9 Review %J J Med Internet Res %G English %X Background: There is a worldwide shortage of health workers, and this issue requires innovative education solutions. Serious gaming and gamification education have the potential to provide a quality, cost-effective, novel approach that is flexible, portable, and enjoyable and allow interaction with tutors and peers. Objective: The aim of this systematic review was to evaluate the effectiveness of serious gaming/gamification for health professions education compared with traditional learning, other types of digital education, or other serious gaming/gamification interventions in terms of patient outcomes, knowledge, skills, professional attitudes, and satisfaction (primary outcomes) as well as economic outcomes of education and adverse events (secondary outcomes). Methods: A comprehensive search of MEDLINE, EMBASE, Web of Knowledge, Educational Resources Information Centre, Cochrane Central Register of Controlled Trials, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature was conducted from 1990 to August 2017. Randomized controlled trials (RCTs) and cluster RCTs were eligible for inclusion. Two reviewers independently searched, screened, and assessed the study quality and extracted data. A meta-analysis was not deemed appropriate due to the heterogeneity of populations, interventions, comparisons, and outcomes. Therefore, a narrative synthesis is presented. Results: A total of 27 RCTs and 3 cluster RCTs with 3634 participants were included. Two studies evaluated gamification interventions, and the remaining evaluated serious gaming interventions. One study reported a small statistically significant difference between serious gaming and digital education of primary care physicians in the time to control blood pressure in a subgroup of their patients already taking antihypertensive medications. There was evidence of a moderate-to-large magnitude of effect from five studies evaluating individually delivered interventions for objectively measured knowledge compared with traditional learning. There was also evidence of a small-to-large magnitude of effect from 10 studies for improved skills compared with traditional learning. Two and four studies suggested equivalence between interventions and controls for knowledge and skills, respectively. Evidence suggested that serious gaming was at least as effective as other digital education modalities for these outcomes. There was insufficient evidence to conclude whether one type of serious gaming/gamification intervention is more effective than any other. There was limited evidence for the effects of serious gaming/gamification on professional attitudes. Serious gaming/gamification may improve satisfaction, but the evidence was limited. Evidence was of low or very low quality for all outcomes. Quality of evidence was downgraded due to the imprecision, inconsistency, and limitations of the study. Conclusions: Serious gaming/gamification appears to be at least as effective as controls, and in many studies, more effective for improving knowledge, skills, and satisfaction. However, the available evidence is mostly of low quality and calls for further rigorous, theory-driven research. %M 30920375 %R 10.2196/12994 %U http://www.jmir.org/2019/3/e12994/ %U https://doi.org/10.2196/12994 %U http://www.ncbi.nlm.nih.gov/pubmed/30920375 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 1 %P e13028 %T Serious Games in Surgical Medical Education: A Virtual Emergency Department as a Tool for Teaching Clinical Reasoning to Medical Students %A Chon,Seung-Hun %A Timmermann,Ferdinand %A Dratsch,Thomas %A Schuelper,Nikolai %A Plum,Patrick %A Berlth,Felix %A Datta,Rabi Raj %A Schramm,Christoph %A Haneder,Stefan %A Späth,Martin Richard %A Dübbers,Martin %A Kleinert,Julia %A Raupach,Tobias %A Bruns,Christiane %A Kleinert,Robert %+ Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Kerpener Strasse 62, Cologne, 50937, Germany, 49 221 478 4864, seung-hun.chon@uk-koeln.de %K serious game %K surgical education %K clinical reasoning %K virtual emergency department %K medical education %D 2019 %7 05.03.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Serious games enable the simulation of daily working practices and constitute a potential tool for teaching both declarative and procedural knowledge. The availability of educational serious games offering a high-fidelity, three-dimensional environment in combination with profound medical background is limited, and most published studies have assessed student satisfaction rather than learning outcome as a function of game use. Objective: This study aimed to test the effect of a serious game simulating an emergency department (“EMERGE”) on students’ declarative and procedural knowledge, as well as their satisfaction with the serious game. Methods: This nonrandomized trial was performed at the Department of General, Visceral and Cancer Surgery at University Hospital Cologne, Germany. A total of 140 medical students in the clinical part of their training (5th to 12th semester) self-selected to participate in this experimental study. Declarative knowledge (measured with 20 multiple choice questions) and procedural knowledge (measured with written questions derived from an Objective Structured Clinical Examination station) were assessed before and after working with EMERGE. Students’ impression of the effectiveness and applicability of EMERGE were measured on a 6-point Likert scale. Results: A pretest-posttest comparison yielded a significant increase in declarative knowledge. The percentage of correct answers to multiple choice questions increased from before (mean 60.4, SD 16.6) to after (mean 76.0, SD 11.6) playing EMERGE (P<.001). The effect on declarative knowledge was larger in students in lower semesters than in students in higher semesters (P<.001). Additionally, students’ overall impression of EMERGE was positive. Conclusions: Students self-selecting to use a serious game in addition to formal teaching gain declarative and procedural knowledge. %M 30835239 %R 10.2196/13028 %U http://games.jmir.org/2019/1/e13028/ %U https://doi.org/10.2196/13028 %U http://www.ncbi.nlm.nih.gov/pubmed/30835239 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 1 %P e10915 %T Young People’s Knowledge of Antibiotics and Vaccinations and Increasing This Knowledge Through Gaming: Mixed-Methods Study Using e-Bug %A Eley,Charlotte Victoria %A Young,Vicki Louise %A Hayes,Catherine Victoria %A Verlander,Neville Q %A McNulty,Cliodna Ann Miriam %+ Primary Care Unit, Public Health England, Microbiology Department, Gloucester Royal Hospital, Gloucester, GL1 3NN, United Kingdom, 44 02084953253, charlotte.eley@phe.gov.uk %K education %K children %K knowledge %K antibiotics %K vaccines %D 2019 %7 01.02.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: e-Bug, led by Public Health England, educates young people about important topics: microbes, infection prevention, and antibiotics. Body Busters and Stop the Spread are 2 new e-Bug educational games. Objective: This study aimed to determine students’ baseline knowledge, views on the games, and knowledge improvement. Methods: Students in 5 UK educational provisions were observed playing 2 e-Bug games. Before and after knowledge and evaluation questionnaires were completed, and student focus groups were conducted. Results: A total of 123 junior and 350 senior students completed the questionnaires. Vaccination baseline knowledge was high. Knowledge increased significantly about antibiotic use, appropriate sneezing behaviors, and vaccinations. In total, 26 student focus groups were conducted. Body Busters was engaging and enjoyable, whereas Stop the Spread was fast-paced and challenging but increased vaccination and health behavior intentions. Conclusions: e-Bug games are an effective learning tool for students to enhance knowledge about microbes, infection prevention, and antibiotics. Game-suggested improvements should help increase enjoyment. %M 30707096 %R 10.2196/10915 %U https://games.jmir.org/2019/1/e10915/ %U https://doi.org/10.2196/10915 %U http://www.ncbi.nlm.nih.gov/pubmed/30707096 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e189 %T Serious Games for Improving Genetic Literacy and Genetic Risk Awareness in the General Public: Protocol for a Randomized Controlled Trial %A Oliveri,Serena %A Mainetti,Renato %A Gorini,Alessandra %A Cutica,Ilaria %A Candiani,Giulia %A Borghese,Nunzio Alberto %A Pravettoni,Gabriella %+ Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Via Festa del Perdono 7, Milan, 20141, Italy, 39 3296761854, serena.oliveri@unimi.it %K adventure games %K cardiovascular risk %K decision making %K genetic literacy %K genetic risk %K heredity %K knowledge transfer %K mini-games %K mutation %K serious games %D 2018 %7 18.12.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Genetic testing and genetic risk information are gaining importance in personalized medicine and disease prevention. However, progress in these fields does not reflect increased knowledge and awareness of genetic risk in the general public. Objective: Our aim is to develop and test the efficacy of a suite of serious games, developed for mobile and Web platforms, in order to increase knowledge of basic genetic concepts and promote awareness of genetic risk management among lay people. Methods: We developed a new ad-hoc game and modified an arcade game using mechanics suitable to explain genetic concepts. In addition, we developed an adventure game where players are immersed in virtual scenarios and manage genetic risk information to make health-related and interpersonal decisions and modulate their lifestyle. The pilot usability testing will be conducted with a convenience sample of 30 adults who will be categorized into 3 groups and assigned to one game each. Participants will be asked to report any positive or negative issues arising during the game. Subsequently, they will be asked to complete the Game Experience Questionnaire. Finally, a total of 60 teenagers and adults will be enrolled to assess knowledge transfer. Thirty participants will be assigned to the experimental group and asked to play the serious games, and 30 participants will be assigned to the control group and asked to read leaflets on the genetic concepts conveyed by the games. Participants of both groups will fill out a questionnaire before and after the intervention to assess their topic-specific knowledge of genetics. Furthermore, both groups will complete the self-efficacy questionnaire, which assesses the level of confidence in using genetic information. Results: We obtained evidence of game usability in 2017. The data will be submitted to a peer-reviewed journal and used to improve the game design. Knowledge-transfer testing will begin in 2018, and we expect to collect preliminary data on the learning outcomes of serious games by December 2018. Conclusions: It is important to educate the general public about the impact of genetics and genetic testing on disease prevention and the consequent decision-making implications. Without such knowledge, individuals are more likely to make uninformed decisions or handover all decisions regarding genetic testing to their doctors. Technological innovations such as serious games might become a valid instrument to support public education and empowerment. International Registered Report Identifier (IRRID): DERR1-10.2196/9288 %M 30563813 %R 10.2196/resprot.9288 %U https://www.researchprotocols.org/2018/12/e189/ %U https://doi.org/10.2196/resprot.9288 %U http://www.ncbi.nlm.nih.gov/pubmed/30563813 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 4 %P e19 %T Potential of an Interactive Drug Prevention Mobile Phone App (Once Upon a High): Questionnaire Study Among Students %A Kapitány-Fövény,Máté %A Vagdalt,Eszter %A Ruttkay,Zsófia %A Urbán,Róbert %A Richman,Mara J %A Demetrovics,Zsolt %+ Department of Addiction, Semmelweis University Faculty of Health Sciences, Vas Street 17, Budapest, 1088, Hungary, 36 20 5221850, m.gabrilovics@gmail.com %K secondary prevention %K adolescent %K mHealth %K energy drinks %K substance use %K alcohol abuse %K cannabis %D 2018 %7 04.12.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: In recent years, drug prevention networks and drug education programs have started using Web-based or mobile phone apps as novel prevention tools, testing their efficacy compared with face-to-face prevention. Objective: The aim of this study was to assess the potential of an interactive app called Once Upon a High (VoltEgySzer). Methods: The app approaches drug prevention from 6 different aspects, and it addresses youngsters with 6 different modules: (1) interactive comics/cartoons, telling stories of recovery; (2) quiz game; (3) roleplay game; (4) introduction of psychoactive drugs; (5) information on the somatic and psychological effects of psychoactive substances; (6) list of available treatment units, rehabs, and self-support groups in Hungary. Students of 2 vocational schools and 2 high schools filled out a questionnaire at a baseline (T0) and a 2-month follow-up (T1) data collection session. Students of 1 vocational school and 1 high school downloaded the Once Upon a High app (app group), whereas students from the other vocational school and high school did not (nonapp group). The time points of T0 and T1 questionnaires contained demographic variables, items with regard to substance use characteristics for both legal and illegal substances, including novel psychoactive substance, exercise habits, knowledge about psychoactive substances, attitudes toward substance users and validated instruments measuring the severity of tobacco (Fagerström Test for Nicotine Dependence), alcohol (Alcohol Use Disorder Identification Test), cannabis (Cannabis Abuse Screening Test), and synthetic cannabinoid consumption. Beliefs about substance use (Beliefs About Substance Abuse) and perceived self-efficacy (General Perceived Self-Efficacy) were also measured. At T1, members of the app group provided additional evaluation of the app. Results: There were 386 students who participated in the T0 session. After dropout, 246 students took part in T1 data collection procedure. Alcohol was the most frequently consumed psychoactive substance (334/364, 91.8% lifetime use), followed by tobacco (252/386, 65.3%, lifetime use) and cannabis (43/323, 13.3% lifetime use). Decreased self-efficacy (beta=−.29, P=.04) and increased daily physical exercise frequencies (beta=.04, P<.001) predicted higher frequencies of past month energy drink consumption, whereas elevated past month alcohol consumption was mainly predicted by a decrease in negative attitudes toward substance users (beta=−.13, P=.04) in the regression models. Once Upon a High was found to be effective only in reducing energy drink consumption (beta=−1.13, P=.04) after controlling for design effect, whereas perceived utility of the app showed correlation with a decreasing alcohol use (rS(44)=.32, P=.03). The roleplay module of the app was found to be the most preferred aspect of the app by the respondents. Conclusions: The Once Upon a High app can be a useful tool to assist preventive intervention programs by increasing knowledge and self-efficacy; however, its efficacy in reducing or preventing substance use needs to be improved and further studied. Additional potential impacts of the app need further testing. %M 30514697 %R 10.2196/games.9944 %U http://games.jmir.org/2018/4/e19/ %U https://doi.org/10.2196/games.9944 %U http://www.ncbi.nlm.nih.gov/pubmed/30514697 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 4 %N 2 %P e10088 %T Improving Shared Decision Making Between Patients and Clinicians: Design and Development of a Virtual Patient Simulation Tool %A Jacklin,Simon %A Maskrey,Neal %A Chapman,Stephen %+ School of Pharmacy, Keele University, Hornbeam Building, School of Pharmacy, Keele, ST55BG, United Kingdom, 44 07597935501, s.jacklin@keele.ac.uk %K clinical decision making %K education %K medical education %K mobile phone %K pharmacy education %K virtual patient %K virtual reality %D 2018 %7 06.11.2018 %9 Original Paper %J JMIR Med Educ %G English %X Background: Shared decision making (SDM) involves the formation of a collaborative partnership between the patient and clinician combining both of their expertise in order to benefit decision making. In order for clinicians to be able to carry out this skilled task, they require practice. Virtual reality, in the form of a virtual patient, could offer a potential method of facilitating this. Objective: The objective of this study was to create a virtual patient that simulated a primary care consultation, affording the opportunity to practice SDM. A second aim was to involve patients in the design of a virtual patient simulation and report the process of the design. Methods: We employed a multistep design process drawing on patient and expert involvement. Results: A virtual patient, following a narrative style, was built, which allows a user to practice and receive feedback; both clinical and communication skills are required for the simulation. The patient group provided multiple insights, which the academic team had overlooked. They pertained mostly to issues concerning the patient experience. Conclusions: It is possible to design a virtual patient that allows a learner to practice their ability to conduct SDM. Patient input into the design of virtual patient simulations can be a worthwhile activity. %M 30401667 %R 10.2196/10088 %U http://mededu.jmir.org/2018/2/e10088/ %U https://doi.org/10.2196/10088 %U http://www.ncbi.nlm.nih.gov/pubmed/30401667 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 4 %P e17 %T A Web-Based Serious Game on Delirium as an Educational Intervention for Medical Students: Randomized Controlled Trial %A Buijs-Spanjers,Kiki R %A Hegge,Harianne HM %A Jansen,Carolien J %A Hoogendoorn,Evert %A de Rooij,Sophia E %+ Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001 HP AA43, Groningen, 9700 RB, Netherlands, 31 503613464, k.r.spanjers@umcg.nl %K delirium %K education %K medical students %K serious game %D 2018 %7 26.10.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Adequate delirium recognition and management are important to reduce the incidence and severity of delirium. To improve delirium recognition and management, training of medical staff and students is needed. Objective: In this study, we aimed to gain insight into whether the serious game, Delirium Experience, is suited as an educational intervention. Methods: We conducted a three-arm randomized controlled trial. We enrolled 156 students in the third year of their Bachelor of Medical Sciences degree at the University Medical Centre Groningen. The Game group of this study played Delirium Experience. The Control D group watched a video with explanations on delirium and a patient’s experience of delirious episodes. The Control A group watched a video on healthy aging. To investigate students’ skills, we used a video of a delirious patient for which students had to give care recommendations and complete the Delirium Observations Screening Scale and Delirium Rating Scale R-98. Furthermore, students completed the Delirium Attitude Scale, the Learning Motivation and Engagement Questionnaire, and self-reported knowledge on delirium. Results: In total, 156 students participated in this study (Game group, n=51; Control D group, n=51; Control A group, n=55). The Game group scored higher with a median (interquartile range) of 6 (4-8) for given recommendations and learning motivation and engagement compared with the Control D (1, 1-4) and A (0, 0-3) groups (P<.001). Furthermore, the Game group scored higher (7, 6-8) on self-reported knowledge compared with the Control A group (6, 5-6; P<.001). We did not find differences between the groups regarding delirium screening (P=.07) and rating (P=.45) skills or attitude toward delirious patients (P=.55). Conclusions: The serious game, Delirium Experience, is suitable as an educational intervention to teach delirium care to medical students and has added value in addition to a lecture. %M 30368436 %R 10.2196/games.9886 %U http://games.jmir.org/2018/4/e17/ %U https://doi.org/10.2196/games.9886 %U http://www.ncbi.nlm.nih.gov/pubmed/30368436 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 3 %P e11061 %T The Modification of Vital Signs According to Nursing Students’ Experiences Undergoing Cardiopulmonary Resuscitation Training via High-Fidelity Simulation: Quasi-Experimental Study %A Fernández-Ayuso,David %A Fernández-Ayuso,Rosa %A Del-Campo-Cazallas,Cristino %A Pérez-Olmo,José Luis %A Matías-Pompa,Borja %A Fernández-Carnero,Josué %A Calvo-Lobo,Cesar %+ Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Avenida de Atenas s/n, Alcorcón, Madrid, 28922, Spain, 34 0034914888949, josuefernandezcarnero@gmail.com %K high-fidelity simulation training %K nursing students %K vital signs %K stress %K anxiety. %D 2018 %7 15.08.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: High-fidelity simulation represents a primary tool in nursing education, especially when hands-on practical training is involved. Objective: We sought to determine the influence of high-fidelity clinical simulation, applied during cardiopulmonary resuscitation (CPR) training, on blood pressure, heart rate, stress, and anxiety levels in 2 groups of nursing students. One group had experience in health contexts, whereas the other group had none. Methods: We performed a quasi-experimental study. Data were collected between May and June 2015 and included measurements of all the resting values, before and after participation in CPR clinical simulations regarding the 2 groups of university students (ie, with and without experience). Results: An increase in vital signs was observed in students after participating in a clinical simulation scenario, especially the heart rate. In all students, increased stress and anxiety levels were observed before the first simulation case scenario. Also, in all study groups, a decrease in vital signs, stress levels, and anxiety was observed throughout the study. Conclusions: Participation in high-fidelity simulation experiences has both physiological and psychological effects on students. %M 30111529 %R 10.2196/11061 %U http://games.jmir.org/2018/3/e11061/ %U https://doi.org/10.2196/11061 %U http://www.ncbi.nlm.nih.gov/pubmed/30111529 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 3 %P e10693 %T Web-Based Immersive Patient Simulator as a Curricular Tool for Objective Structured Clinical Examination Preparation in Surgery: Development and Evaluation %A Chon,Seung-Hun %A Hilgers,Sabrina %A Timmermann,Ferdinand %A Dratsch,Thomas %A Plum,Patrick Sven %A Berlth,Felix %A Datta,Rabi %A Alakus,Hakan %A Schlößer,Hans Anton %A Schramm,Christoph %A Pinto dos Santos,Daniel %A Bruns,Christiane %A Kleinert,Robert %+ Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Kerpener Str. 62, Cologne, 50937, Germany, 49 2214786254, robert.kleinert@uk-koeln.de %K immersive patient simulator %K simulator-based curriculum %K Objective Structured Clinical Examination %K artificial learning interface %D 2018 %7 04.07.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Objective Structured Clinical Examination is a standard method of testing declarative and process knowledge in clinical core competencies. It is desirable that students undergo Objective Structured Clinical Examination training before participating in the exam. However, establishing Objective Structured Clinical Examination training is resource intensive and therefore there is often limited practice time. Web-based immersive patient simulators such as ALICE (Artificial Learning Interface of Clinical Education) can possibly fill this gap as they allow for the training of complex medical procedures at the user’s individual pace and with an adaptable number of repetitions at home. ALICE has previously been shown to positively influence knowledge gain and motivation. Objective: Therefore, the aim of this study was to develop a Web-based curriculum that teaches declarative and process knowledge and prepares students for a real Objective Structured Clinical Examination station. Furthermore, we wanted to test the influence of ALICE on knowledge gain and student motivation. Methods: A specific curriculum was developed in order to implement the relevant medical content of 2 surgical Objective Structured Clinical Examination stations into the ALICE simulator framework. A total of 160 medical students were included in the study, where 100 students had access to ALICE and their performance was compared to 60 students in a control group. The simulator performance was validated on different levels and students’ knowledge gain and motivation were tested at different points during the study. Results: The curriculum was developed according to the Kern cycle. Four virtual clinical cases were implemented with different teaching methods (structured feedback, keynote speech, group discussion, and debriefing by a real instructor) in order to consolidate declarative and process knowledge. Working with ALICE had significant impact on declarative knowledge gain and Objective Structured Clinical Examination performance. Simulator validation was positive for face, content, construct, and predictive validity. Students showed high levels of motivation and enjoyed working with ALICE. Conclusions: ALICE offers Web-based training for Objective Structured Clinical Examination preparation and can be used as a selective didactic intervention as it has positive effect on knowledge gain and student motivation. %M 29973333 %R 10.2196/10693 %U http://games.jmir.org/2018/3/e10693/ %U https://doi.org/10.2196/10693 %U http://www.ncbi.nlm.nih.gov/pubmed/29973333 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e195 %T Evaluation of App-Based Serious Gaming as a Training Method in Teaching Chest Tube Insertion to Medical Students: Randomized Controlled Trial %A Haubruck,Patrick %A Nickel,Felix %A Ober,Julian %A Walker,Tilman %A Bergdolt,Christian %A Friedrich,Mirco %A Müller-Stich,Beat Peter %A Forchheim,Franziska %A Fischer,Christian %A Schmidmaier,Gerhard %A Tanner,Michael C %+ Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200 a, Heidelberg, 69121, Germany, 49 06221 ext 5635987, patrick.haubruck@med.uni-heidelberg.de %K games, experimental %K education, professional %K general surgery %K emergency medicine %K problem-based learning %K chest tubes %K simulation training %K clinical competence %D 2018 %7 21.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The insertion of a chest tube should be as quick and accurate as possible to maximize the benefit and minimize possible complications for the patient. Therefore, comprehensive training and assessment before an emergency situation are essential for proficiency in chest tube insertion. Serious games have become more prevalent in surgical training because they enable students to study and train a procedure independently, and errors made have no effect on patients. However, up-to-date evidence regarding the effect of serious games on performance in procedures in emergency medicine remains scarce. Objective: The aim of this study was to investigate the serious gaming approach in teaching medical students an emergency procedure (chest tube insertion) using the app Touch Surgery and a modified objective structural assessment of technical skills (OSATS). Methods: In a prospective, rater-blinded, randomized controlled trial, medical students were randomized into two groups: intervention group or control group. Touch Surgery has been established as an innovative and cost-free app for mobile devices. The fully automatic software enables users to train medical procedures and afterwards self-assess their training effort. The module chest tube insertion teaches each key step in the insertion of a chest tube and enables users the meticulous application of a chest tube. In contrast, the module “Thoracocentesis” discusses a basic thoracocentesis. All students attended a lecture regarding chest tube insertion (regular curriculum) and afterwards received a Touch Surgery training lesson: intervention group used the module chest tube insertion and the control group used Thoracocentesis as control training. Participants’ performance in chest tube insertion on a porcine model was rated on-site via blinded face-to-face rating and via video recordings using a modified OSATS tool. Afterwards, every participant received an individual questionnaire for self-evaluation. Here, trainees gave information about their individual training level, as well as previous experiences, gender, and hobbies. Primary end point was operative performance during chest tube insertion by direct observance. Results: A total of 183 students enrolled, 116 students participated (63.4%), and 21 were excluded because of previous experiences in chest tube insertion. Students were randomized to the intervention group (49/95, 52%) and control group (46/95, 48%). The intervention group performed significantly better than the control group (Intervention group: 38.0 [I50=7.0] points; control group: 30.5 [I50=8.0] points; P<.001). The intervention group showed significantly improved economy of time and motion (P=.004), needed significantly less help (P<.001), and was more confident in handling of instruments (P<.001) than the control group. Conclusions: The results from this study show that serious games are a valid and effective tool in education of operative performance in chest tube insertion. We believe that serious games should be implemented in the surgical curriculum, as well as residency programs, in addition to traditional learning methods. Trial Registration: German Clinical Trials Register (DRKS) DRKS00009994; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00009994 (Archived by Webcite at http://www.webcitation.org/6ytWF1CWg) %M 29784634 %R 10.2196/jmir.9956 %U http://www.jmir.org/2018/5/e195/ %U https://doi.org/10.2196/jmir.9956 %U http://www.ncbi.nlm.nih.gov/pubmed/29784634 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 4 %N 1 %P e8 %T Mobile Technology in E-Learning for Undergraduate Medical Education on Emergent Otorhinolaryngology–Head and Neck Surgery Disorders: Pilot Randomized Controlled Trial %A Lee,Li-Ang %A Wang,Shu-Ling %A Chao,Yi-Ping %A Tsai,Ming-Shao %A Hsin,Li-Jen %A Kang,Chung-Jan %A Fu,Chia-Hsiang %A Chao,Wei-Chieh %A Huang,Chung-Guei %A Li,Hsueh-Yu %A Chuang,Cheng-Keng %+ Department of Surgery, Linkou Chang Gung Memorial Hospital, No 5, Fu-Hsing Street, Guishan District, Taoyuan, 33305, Taiwan, 886 33281200 ext 3971, chuang89@cgmh.org.tw %K e-learning %K gamification %K mobile technology %K randomized controlled trial %K video lecture %D 2018 %7 08.03.2018 %9 Original Paper %J JMIR Med Educ %G English %X Background: The use of mobile technology in e-learning (M-TEL) can add new levels of experience and significantly increase the attractiveness of e-learning in medical education. Whether an innovative interactive e-learning multimedia (IM) module or a conventional PowerPoint show (PPS) module using M-TEL to teach emergent otorhinolaryngology–head and neck surgery (ORL-HNS) disorders is feasible and efficient in undergraduate medical students is unknown. Objective: The aim of this study was to compare the impact of a novel IM module with a conventional PPS module using M-TEL for emergent ORL-HNS disorders with regard to learning outcomes, satisfaction, and learning experience. Methods: This pilot study was conducted at an academic teaching hospital and included 24 undergraduate medical students who were novices in ORL-HNS. The cognitive style was determined using the Group Embedded Figures Test. The participants were randomly allocated (1:1) to one of the two groups matched by age, sex, and cognitive style: the IM group and the PPS group. During the 100-min learning period, the participants were unblinded to use the IM or PPS courseware on a 7-inch tablet. Pretests and posttests using multiple-choice questions to evaluate knowledge and multimedia situational tests to evaluate competence were administered. Participants evaluated their satisfaction and learning experience by the AttrakDiff2 questionnaire, and provided feedback about the modules. Results: Overall, the participants had significant gains in knowledge (median of percentage change 71, 95% CI 1-100, P<.001) and competence (median of percentage change 25, 95% CI 0-33, P=.007) after 100 min of learning. Although there was no significant difference in knowledge gain between the two groups (median of difference of percentage change 24, 95% CI −75 to 36; P=.55), competence gain was significantly lower in the IM group compared with the PPS group (median of difference of percentage change −41, 95% CI −67 to −20; P=.008). However, the IM group had significantly higher scores of satisfaction (difference 2, 95% CI 2-4; P=.01), pragmatic quality (difference 1.7, 95% CI 0.1-2.7; P=.03), and hedonic stimulation (difference 1.9, 95% CI 0.3-3.1; P=.01) compared with the PPS group. Qualitative feedback indicated that the various games in the IM module attracted the participants’ attention but that the nonlinearly arranged materials affected their learning. Conclusions: Using M-TEL for undergraduate medical education on emergent ORL-HNS disorders, an IM module seems to be useful for gaining knowledge, but competency may need to occur elsewhere. While the small sample size reduces the statistical power of our results, its design seems to be appropriate to determine the effects of M-TEL using a larger group. Trial Registration: ClinicalTrials.gov NCT02971735; https://clinicaltrials.gov/ct2/show/NCT02971735 (Archived by WebCite at http://www.webcitation.org/6waoOpCEV) %M 29519776 %R 10.2196/mededu.9237 %U http://mededu.jmir.org/2018/1/e8/ %U https://doi.org/10.2196/mededu.9237 %U http://www.ncbi.nlm.nih.gov/pubmed/29519776 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e56 %T Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial %A Lee,Li-Ang %A Chao,Yi-Ping %A Huang,Chung-Guei %A Fang,Ji-Tseng %A Wang,Shu-Ling %A Chuang,Cheng-Keng %A Kang,Chung-Jan %A Hsin,Li-Jen %A Lin,Wan-Ni %A Fang,Tuan-Jen %A Li,Hsueh-Yu %+ Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Guishan District, Taoyuan, 33305, Taiwan, 886 33281200 ext 3972, 5738@cgmh.org.tw %K cognitive style %K e-learning %K mobile technology %K randomized controlled trial %D 2018 %7 13.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic learning (e-learning) through mobile technology represents a novel way to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders to undergraduate medical students. Whether a cognitive style of education combined with learning modules can impact learning outcomes and satisfaction in millennial medical students is unknown. Objective: The aim of this study was to assess the impact of cognitive styles and learning modules using mobile e-learning on knowledge gain, competence gain, and satisfaction for emergent ORL-HNS disorders. Methods: This randomized controlled trial included 60 undergraduate medical students who were novices in ORL-HNS at an academic teaching hospital. The cognitive style of the participants was assessed using the group embedded figures test. The students were randomly assigned (1:1) to a novel interactive multimedia (IM) group and conventional Microsoft PowerPoint show (PPS) group matched by age, sex, and cognitive style. The content for the gamified IM module was derived from and corresponded to the textbook-based learning material of the PPS module (video lectures). The participants were unblinded and used fully automated courseware containing the IM or PPS module on a 7-inch tablet for 100 min. Knowledge and competence were assessed using multiple-choice questions and multimedia situation tests, respectively. Each participant also rated their global satisfaction. Results: All of the participants (median age 23 years, range 22-26 years; 36 males and 24 females) received the intended intervention after randomization. Overall, the participants had significant gains in knowledge (median 50%, interquartile range [IQR]=17%-80%, P<.001) and competence (median 13%, IQR=0%-33%, P=.006). There were no significant differences in knowledge gain (40%, IQR=13%-76% vs 60%, IQR=20%-100%, P=.42) and competence gain (0%, IQR= −21% to 38% vs 25%, IQR=0%-33%, P=.16) between the IM and PPS groups. However, the IM group had a higher satisfaction score (8, IQR=6-9 vs 6, IQR=4-7, P=.01) compared with the PPS group. Using Friedman’s two-way nonparametric analysis of variance, cognitive styles (field-independent, field-intermediate, or field-dependent classification) and learning modules (IM or PPS) had significant effects on both knowledge gain (both adjusted P<.001) and satisfaction (both adjusted P<.001). Conclusions: Mobile e-learning is an effective modality to improve knowledge of emergent ORL-HNS in millennial undergraduate medical students. Our findings suggest the necessity of developing various modules for undergraduate medical students with different cognitive styles. Trial Registration: Clinicaltrials.gov NCT02971735; https://clinicaltrials.gov/ct2/show/NCT02971735 (Archived by WebCite at http://www.webcitation.org/6waoOpCEV) %M 29439943 %R 10.2196/jmir.8987 %U http://www.jmir.org/2018/2/e56/ %U https://doi.org/10.2196/jmir.8987 %U http://www.ncbi.nlm.nih.gov/pubmed/29439943 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 2 %P e11 %T Medical Student Evaluation With a Serious Game Compared to Multiple Choice Questions Assessment %A Adjedj,Julien %A Ducrocq,Gregory %A Bouleti,Claire %A Reinhart,Louise %A Fabbro,Eleonora %A Elbez,Yedid %A Fischer,Quentin %A Tesniere,Antoine %A Feldman,Laurent %A Varenne,Olivier %+ AP-HP, Hôpital Cochin, Cardiology, 27 rue du Faubourg Saint Jacques, Paris,, France, 33 158412750, olivier.varenne@aphp.fr %K serious game %K multiple choice questions %K medical student %K student evaluation %D 2017 %7 16.05.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: The gold standard for evaluating medical students’ knowledge is by multiple choice question (MCQs) tests: an objective and effective means of restituting book-based knowledge. However, concerns have been raised regarding their effectiveness to evaluate global medical skills. Furthermore, MCQs of unequal difficulty can generate frustration and may also lead to a sizable proportion of close results with low score variability. Serious games (SG) have recently been introduced to better evaluate students’ medical skills. Objectives: The study aimed to compare MCQs with SG for medical student evaluation. Methods: We designed a cross-over randomized study including volunteer medical students from two medical schools in Paris (France) from January to September 2016. The students were randomized into two groups and evaluated either by the SG first and then the MCQs, or vice-versa, for a cardiology clinical case. The primary endpoint was score variability evaluated by variance comparison. Secondary endpoints were differences in and correlation between the MCQ and SG results, and student satisfaction. Results: A total of 68 medical students were included. The score variability was significantly higher in the SG group (σ2 =265.4) than the MCQs group (σ2=140.2; P=.009). The mean score was significantly lower for the SG than the MCQs at 66.1 (SD 16.3) and 75.7 (SD 11.8) points out of 100, respectively (P<.001). No correlation was found between the two test results (R2=0.04, P=.58). The self-reported satisfaction was significantly higher for SG (P<.001). Conclusions: Our study suggests that SGs are more effective in terms of score variability than MCQs. In addition, they are associated with a higher student satisfaction rate. SGs could represent a new evaluation modality for medical students. %M 28512082 %R 10.2196/games.7033 %U http://games.jmir.org/2017/2/e11/ %U https://doi.org/10.2196/games.7033 %U http://www.ncbi.nlm.nih.gov/pubmed/28512082 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 2 %P e9 %T Using Computer Simulations for Investigating a Sex Education Intervention: An Exploratory Study %A Eleftheriou,Anastasia %A Bullock,Seth %A Graham,Cynthia A %A Ingham,Roger %+ Institute for Complex Systems Simulation, Electronics and Computer Science, University of Southampton, Highfield Campus, Southampton,, United Kingdom, 44 07564035077, eleftheriouanastasia@gmail.com %K sex education %K personality %K STI %K gender %K computer simulation %D 2017 %7 03.05.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: Sexually transmitted infections (STIs) are ongoing concerns. The best method for preventing the transmission of these infections is the correct and consistent use of condoms. Few studies have explored the use of games in interventions for increasing condom use by challenging the false sense of security associated with judging the presence of an STI based on attractiveness. Objectives: The primary purpose of this study was to explore the potential use of computer simulation as a serious game for sex education. Specific aims were to (1) study the influence of a newly designed serious game on self-rated confidence for assessing STI risk and (2) examine whether this varied by gender, age, and scores on sexuality-related personality trait measures. Methods: This paper undertook a Web-based questionnaire study employing between and within subject analyses. A Web-based platform hosted in the United Kingdom was used to deliver male and female stimuli (facial photographs) and collect data. A convenience sample group of 66 participants (64%, 42/66) male, mean age 22.5 years) completed the Term on the Tides, a computer simulation developed for this study. Participants also completed questionnaires on demographics, sexual preferences, sexual risk evaluations, the Sexual Sensation Seeking Scale (SSS), and the Sexual Inhibition Subscale 2 (SIS2) of the Sexual Inhibition/Sexual Excitation Scales-Short Form (SIS/SES - SF). Results: The overall confidence of participants to evaluate sexual risks reduced after playing the game (P<.005). Age and personality trait measures did not predict the change in confidence of evaluating risk. Women demonstrated larger shifts in confidence than did men (P=.03). Conclusions: This study extends the literature by investigating the potential of computer simulations as a serious game for sex education. Engaging in the Term on the Tides game had an impact on participants’ confidence in evaluating sexual risks. %M 28468747 %R 10.2196/games.6598 %U http://games.jmir.org/2017/2/e9/ %U https://doi.org/10.2196/games.6598 %U http://www.ncbi.nlm.nih.gov/pubmed/28468747 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 1 %P e1 %T Development of an Educational Game to Set Up Surgical Instruments on the Mayo Stand or Back Table: Applied Research in Production Technology %A Paim,Crislaine Pires Padilha %A Goldmeier,Silvia %+ Institute of Cardiology of Rio Grande do Sul, University Foundation of Cardiology, 395 Princesa Isabel Avenue, Porto Alegre, 90620-001, Brazil, 55 51 32303600, sgoldmeier@gmail.com %K nursing education research %K educational technology %K perioperative nursing %D 2017 %7 10.01.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: Existing research suggests that digital games can be used effectively for educational purposes at any level of training. Perioperative nursing educators can use games to complement curricula, in guidance and staff development programs, to foster team collaboration, and to give support to critical thinking in nursing practice because it is a complex environment. Objective: To describe the process of developing an educational game to set up surgical instruments on the Mayo stand or back table as a resource to assist the instructor in surgical instrumentation training for students and nursing health professionals in continued education. Methods: The study was characterized by applied research in production technology. It included the phases of analysis and design, development, and evaluation. The objectives of the educational game were developed through Bloom’s taxonomy. Parallel to the physical development of the educational game, a proposed model for the use of digital elements in educational game activities was applied to develop the game content. Results: The development of the game called “Playing with Tweezers” was carried out in 3 phases and was evaluated by 15 participants, comprising students and professional experts in various areas of knowledge such as nursing, information technology, and education. An environment was created with an initial screen, menu buttons containing the rules of the game, and virtual tour modes for learning and assessment. Conclusions: The “digital” nursing student needs engagement, stimulation, reality, and entertainment, not just readings. “Playing with Tweezers” is an example of educational gaming as an innovative teaching strategy in nursing that encourages the strategy of involving the use of educational games to support theoretical or practical classroom teaching. Thus, the teacher does not work with only 1 type of teaching methodology, but with a combination of different methodologies. In addition, we cannot forget that skill training in an educational game does not replace curricular practice, but helps. %M 28073736 %R 10.2196/games.6048 %U http://games.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/games.6048 %U http://www.ncbi.nlm.nih.gov/pubmed/28073736 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 4 %N 2 %P e22 %T Cardiopulmonary Resuscitation Training by Avatars: A Qualitative Study of Medical Students’ Experiences Using a Multiplayer Virtual World %A Creutzfeldt,Johan %A Hedman,Leif %A Felländer-Tsai,Li %+ Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, K32, Karolinska University Hospital, Stockholm, 14186, Sweden, 46 8 585 82102, johan.creutzfeldt@ki.se %K avatars %K cardiopulmonary resuscitation %K educational technology %K medical students %K experiences %K multiplayer virtual worlds %K patient simulation %K virtual learning environments %D 2016 %7 16.12.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Emergency medical practices are often team efforts. Training for various tasks and collaborations may be carried out in virtual environments. Although promising results exist from studies of serious games, little is known about the subjective reactions of learners when using multiplayer virtual world (MVW) training in medicine. Objective: The objective of this study was to reach a better understanding of the learners’ reactions and experiences when using an MVW for team training of cardiopulmonary resuscitation (CPR). Methods: Twelve Swedish medical students participated in semistructured focus group discussions after CPR training in an MVW with partially preset options. The students’ perceptions and feelings related to use of this educational tool were investigated. Using qualitative methodology, discussions were analyzed by a phenomenological data-driven approach. Quality measures included negotiations, back-and-forth reading, triangulation, and validation with the informants. Results: Four categories characterizing the students’ experiences could be defined: (1) Focused Mental Training, (2) Interface Diverting Focus From Training, (3) Benefits of Practicing in a Group, and (4) Easy Loss of Focus When Passive. We interpreted the results, compared them to findings of others, and propose advantages and risks of using virtual worlds for learning. Conclusions: Beneficial aspects of learning CPR in a virtual world were confirmed. To achieve high participant engagement and create good conditions for training, well-established procedures should be practiced. Furthermore, students should be kept in an active mode and frequent feedback should be utilized. It cannot be completely ruled out that the use of virtual training may contribute to erroneous self-beliefs that can affect later clinical performance. %M 27986645 %R 10.2196/games.6448 %U http://games.jmir.org/2016/2/e22/ %U https://doi.org/10.2196/games.6448 %U http://www.ncbi.nlm.nih.gov/pubmed/27986645 %0 Journal Article %@ 2369-3762 %I JMIR Publications Inc. %V 1 %N 2 %P e6 %T Digital Literacy in the Medical Curriculum: A Course With Social Media Tools and Gamification %A Mesko,Bertalan %A Győrffy,Zsuzsanna %A Kollár,János %+ Institute of Behavioural Sciences, Semmelweis University, H-1089, Budapest, Nagyvárad tér 4, Hungary, 36 (1) 459 1500, berci@medicalfuturist.com %K medical education %K social media %K digital literacy %D 2015 %7 01.10.2015 %9 Original Paper %J JMIR Medical Education %G English %X Background: The profession of practicing medicine is based on communication, and as social media and other digital technologies play a major role in today’s communication, digital literacy must be included in the medical curriculum. The value of social media has been demonstrated several times in medicine and health care, therefore it is time to prepare medical students for the conditions they will have to face when they graduate. Objective: The aim of our study was to design a new e-learning-based curriculum and test it with medical students. Method: An elective course was designed to teach students how to use the Internet, with a special emphasis on social media. An e-learning platform was also made available and students could access material about using digital technologies on the online platforms they utilized the most. All students filled in online surveys before and after the course in order to provide feedback about the curriculum. Results: Over a 3-year period, 932 students completed the course. The course did not increase the number of hours spent online but aimed at making that time more efficient and useful. Based on the responses of students, they found the information provided by the curriculum useful for their studies and future practices. Conclusions: A well-designed course, improved by constant evaluation-based feedback, can be suitable for preparing students for the massive use of the Internet, social media platforms, and digital technologies. New approaches must be applied in modern medical education in order to teach students new skills. Such curriculums that put emphasis on reaching students on the online channels they use in their studies and everyday lives introduce them to the world of empowered patients and prepare them to deal with the digital world. %M 27731856 %R 10.2196/mededu.4411 %U http://mededu.jmir.org/2015/2/e6/ %U https://doi.org/10.2196/mededu.4411 %U http://www.ncbi.nlm.nih.gov/pubmed/27731856 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e114 %T Using Video Games to Enhance Motivation States in Online Education: Protocol for a Team-Based Digital Game %A Janssen,Anna %A Shaw,Tim %A Goodyear,Peter %+ Sydney Medical School, University of Sydney, Level 2, Charles Perkins Centre D17, University of Sydney, Sydney, 2006, Australia, 61 02 9036 9406, anna.janssen@sydney.edu.au %K digital games %K medical education %K online learning %D 2015 %7 28.09.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Video and computer games for education have been of interest to researchers for several decades. Over the last half decade, researchers in the health sector have also begun exploring the value of this medium. However, there are still many gaps in the literature regarding the effective use of video and computer games in medical education, particularly in relation to how learners interact with the platform, and how the games can be used to enhance collaboration. Objective: The objective of the study is to evaluate a team-based digital game as an educational tool for engaging learners and supporting knowledge consolidation in postgraduate medical education. Methods: A mixed methodology will be used in order to establish efficacy and level of motivation provided by a team-based digital game. Second-year medical students will be recruited as participants to complete 3 matches of the game at spaced intervals, in 2 evenly distributed teams. Prior to playing the game, participants will complete an Internet survey to establish baseline data. After playing the game, participants will voluntarily complete a semistructured interview to establish motivation and player engagement. Additionally, metrics collected from the game platform will be analyzed to determine efficacy. Results: The research is in the preliminary stages, but thus far a total of 54 participants have been recruited into the study. Additionally, a content development group has been convened to develop appropriate content for the platform. Conclusions: Video and computer games have been demonstrated to have value for educational purposes. Significantly less research has addressed how the medium can be effectively utilized in the health sector. Preliminary data from this study would suggest there is an interest in games for learning in the medical student body. As such, it is beneficial to undertake further research into how these games teach and engage learners in order to evaluate their role in tertiary and postgraduate medical education in the future. %M 26416522 %R 10.2196/resprot.4016 %U http://www.researchprotocols.org/2002/3/e114/ %U https://doi.org/10.2196/resprot.4016 %U http://www.ncbi.nlm.nih.gov/pubmed/26416522 %0 Journal Article %@ 2369-3762 %I JMIR Publications Inc. %V 1 %N 1 %P e2 %T Student Preferences on Gaming Aspects for a Serious Game in Pharmacy Practice Education: A Cross-Sectional Study %A Chang,Huan Ying %A Poh,David Yan Hong %A Wong,Li Lian %A Yap,John Yin Gwee %A Yap,Kevin Yi-Lwern %+ National University of Singapore, Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, 18 Science Drive 4, Singapore, , Singapore, 65 6601 3253, kevinyap.ehealth@gmail.com %K gaming aspects %K pharmacy-related serious game %K pharmacy practice education %K reward systems %K game settings %K storylines %K viewing perspectives %K gaming styles %D 2015 %7 11.05.2015 %9 Original Paper %J JMIR Medical Education %G English %X Background: Serious games are motivating and provide a safe environment for students to learn from their mistakes without experiencing any negative consequences from their actions. However, little is known about students’ gaming preferences and the types of serious games they like to play for education. Objective: This study aims to determine the types of gaming aspects that students would like to play in a pharmacy-related serious game. Methods: A cross-sectional study was conducted using a self-administered survey, which obtained students’ responses on their preferences regarding various gaming aspects (reward systems, game settings, storylines, viewing perspectives, and gaming styles) and for a hypothetical gaming scenario (authentic simulation or post-apocalyptic fantasy). Descriptive statistics, chi-square, and Fisher’s exact tests were used for statistical analyses. Results: Response rate was 72.7% (497/684 undergraduates). The most popular game reward systems were unlocking mechanisms (112/497, 22.5%) and experience points (90/497, 18.1%). Most students preferred fantasy/medieval/mythic (253/497, 50.9%) and modern (117/497, 23.5%) settings, but lower year undergraduates preferred modern settings less than upper year seniors (47/236, 19.9% vs 70/242, 28.9%, P=.022). Almost one-third (147/497, 29.6%) preferred an adventurer storyline or an authentic pharmacy-related plot (119/497, 23.9%), and a collaborative game style was most preferred by the students (182/497, 36.6%). Three-dimensional game perspectives (270/497, 54.3%) were more popular than two-dimensional perspectives (221/497, 44.5%), especially among males than females (126/185, 68.1% vs 142/303, 46.9%, P<.001). In terms of choice for a pharmacy-related serious game, a post-apocalyptic fantasy game (scenario B, 287/497, 57.7%) was more popular than an authentic simulation game (scenario A, 209/497, 42.1%). More males preferred the post-apocalyptic fantasy scenario than females (129/187, 69.0% vs 155/306, 50.7%, P<.001). Conclusions: In general, students want a three-dimensional, fantasy/medieval/mythic post-apocalyptic game, based on an adventurer storyline with an unlocking mechanism reward system. A balance between real-life and fantasy elements needs to be struck in order for the game to cater students towards health care practices. %M 27731304 %R 10.2196/mededu.3754 %U http://mededu.jmir.org/2015/1/e2/ %U https://doi.org/10.2196/mededu.3754 %U http://www.ncbi.nlm.nih.gov/pubmed/27731304