Educational Game Development in Healthcare

Baltasar Fernandez-Manjonbalta@fdi.ucm.es @BaltaFM

e-UCM research groupVisiting Scientist MGH-LCS

MGH – Laboratory of Computer Science, Boston, 13/08/2013

e-UCM Research Group

• CS Professor at Complutense U.– Director of e-UCM

• e-UCM research group about Learning technologies– 15 researcher– Serious games

• Application to the medical domain

– European projects– www.e-ucm.es

• Collab. with C. Blesius MGH

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Can be the games used as a didactic tools in Healthcare?

• What is the potential of videogames in education and healthcare?

• Other questions– How to use videogames?– What can be teach using videogames?– When to use videogames?– Where videogames will be played?

• Videogames are very expensive. It is cost-effective the use of educational videogames?

• Is there any methodology that simplify the creation of games in healthcare?

Serious games and gamification

• Serious game is “any meaningful use of computerized game/game industry resources whose chief mission is not entertainment”

• Sawyer, B. (2007). The "Serious Games" Landscape. Presented at the Instructional & Research Technology Symposium for Arts, Humanities and Social Sciences, Camden, USA.

• “The word “gamification” has emerged in recent years as a way to describe interactive online design that plays on people’s competitive instincts and often incorporates the use of rewards to drive action—these include virtual rewards such as points, payments, badges, discounts, and “free” gifts; and status indicators such as friend counts, retweets, leader boards, achievement data, progress bars, and the ability to “level up.”

• Anderson J. , Rainie L. (2012) The Future of Gamification, Pew Internet.

Videogames as educational tools

• Video games can be instrumental in acquiring abilities and skills like– Spatial perception and recognition– Development of visual discernment and separation of visual

attention– Development of inductive logic– Cognitive development in scientific/technical aspects– Development of complex skills– Spatial representation– Inductive discovery– Iconic code construction– Gender construction

Aguilera M de, Mendiz A. Video games and education. Computers in Entertainment. 2003;1(1):10

Who is playing games?

• Pew Internet report. Adults and Video Games 2008

• 53% of American adults (>= 18) play video games• 97% of teens play video games• men (55%) are slightly more likely than women (50%) to

play any kind of digital game• 76% of students report playing games, compared with 49%

of non-students• computers are the most popular gaming device, but young

adults prefer gaming consoles• Virtual worlds only draw a small crowdhttp://www.pewinternet.org/~/media//Files/Reports/2008/PIP_Adult_gaming_memo.pdf.pdf

Use of games in residency programs in USA (2010)

Akl EA, Gunukula S, Mustafa R, et al. Support for and aspects of use of educational games in family medicine and internal medicine residency programs in the US: a survey. BMC medical education. 2010;10:26.

Alinier G. A typology of educationally focused medical simulation tools. Medical teacher. 2007;29(8):e243–50. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18236268.

Effects of different types of simulations

Arnold, J. J., Johnson, L. M., Tucker, S. J., Chesak, S. S., & Dierkhising, R. A. (2013). Comparison of Three Simulation-Based Teaching Methodologies for Emergency Response. Clinical Simulation in Nursing, 9(3), e85–e93.

“to compare the effects of 3 simulation methodologies (low-fidelity, computer-based, and full-scale) on the outcomes of emergency response knowledge, confidence, satisfaction and self-confidence with learning, and performance.”

“the statistical findings did not support the hypothesis that RNs who receive full-scale simulation training will score higher in knowledge, confidence, and performance than those receiving computer-based simulation or low-fidelity simulation”

Note: only 28 participants

Triage Trainer SGI Coventry (de Freitas) Resuscitation 81 (2010) 1175–1179

Educational videogames challenges

• Identification of more large success cases • including scientific and formal evaluation

• Scalability and maintainability • reducing initial cost and TCO

• Taking into account curriculum and involving educators

• Including student evaluation into games• Learning analytics

• Actual application in educational settings• Taking into account current technical infrastructure

Games characteristics

• Basically, a game is an abstract world where some goals should be obtained following some rules

• Fun elements– Conflict and challenge– Fantasy and curiosity– Perception of the advance– Progressive difficulty– Feedback

MGH – Laboratory of Computer Science, Boston, 13/08/2013

Flow in games

Chen J. Flow in games (and everything else). Communications of the ACM. 2007;50(4):31.

Laws of Learning For Games’ Linked to ‘Game Design’ (Murphy 2011)

Law of Learning Idea Game Design TechniquesMotivation Motivated students learn Flow is the fundamental attraction of games. Games are

(Law of Readiness) more fun and require moment-by-moment choices. This leads

to extremely motivating experiences.Feedback Feedback is how Feedback is an essential part of games and a

(Law of Exercise)learners correlate actions requirement for flow. The simplicity of games helps the

with outcomes learner correlate actions to outcomes.Practice Practice is necessary for Games use practice to promote mastery. They use(Law of Exercise) learning and mastery increasing difficulty to keep players in flow and promote

the learning of virtual or real skills needed to progress.Positive Feelings Learning is increased Games are supposed to be fun - defined as the positive

(Law of Effect) when associated with feelings associated with compelling flow experiences.positive feelings The simplicity and involvement of games encourages

feelings of accomplishment and mastery.Intensity Intense experiences A person in flow is intensely focused on an activity. The

(Law of Intensity) increase learning, feedback loop intensifies the relationship between actioninterest, and retention and outcome. Games use a combination of immersion

and engagement to create intense experiences.

Choice/InvolvementInvolvement and decision Games simplify the world to a series of interesting and

(Laws of Intensity, making can increase meaningful decisions. From moment to moment, players

Readiness, Effect) motivation, intensity, and are actively engaged in the process of learning through

positive feelings experience.

Evaluation Questionsfor “Serious Games” (in Medicine)

• Does it work? (beta-testing)• Is the content accurate and appropriate for target audience?

(content review)• Is it easy to use and easy to learn to use? (usability-navigation)• Is it compelling/engaging for the target audience? (realism,

satisfaction)• What are the learning goals? (learning)• How well do the learners achieve those goals? (learning)• What else are they learning? (learning)• Does it track the learner’s performance? (learning

management system)http://simworkshops.stanford.edu/06_0626/pdf/Evaluating_serious_games.pdf

Educational Game Development Approach in Healthcare (EGDA)

EGDA Methodology

• Teaching procedural knowledge in healthcare• game-like simulations created from

– description of medical procedures – representative teaching cases

• Close collaboration with of game designer with medical experts– Minimal requirement for medical experts

• Rapid prototyping using eAdventure– Early validation by experts

eAdventure: creating videogames without programming

• Environment to create point and click adventure games

• Open code (java)• Multilingual• Games as Learning Objects (for LMS)• Support for Learning AnalyticsNow working on …

Support for tablets, multidevice (HTML5)• http://e-adventure.e-ucm.es

eAdventure,

eAdventure game platformAuthoring environment for the production of point-and-click adventure games & immersive learning simulations

e-Adventure game platform

eAdventure: main characteristics

• Reduce the development and maintenance costs• Involve the instructors in the design and development• Focus on adventure videogames

– Story is more important than action• First person and third person games• Games are packed as a Learning Objects using the “de facto”

e-learning standards– IMS Content Packaging & IEEE Learning Object Metadata

• Videogames can be automatically deployed in an e-learning platform (e.g. Moodle, LAMS, BlackBoard)

• Easy to include support for Learning Analytics

eAdventure educational features

• User tracking and assessment– the relevant situations can be detected and included in a

report that can be used for auto evaluation or assessment purposes

• Adaptive games– The designer can include an adaptation profile for changing

the behaviour of the game (e.g. initial state)• Produced games can be stored in a repository of

educational contents– AGREGA Spanish Ministry of Education central repository for

learning contents• Very simple to include Learning Analytics with eA games

eAdventure in Medical Education

• CPR game – First-aid game– Centro de Tecnologias Educativas de Aragon

(Spain)– Identify a cardiac arrest and teach how to do a

cardiopulmonary resuscitation– Oriented to middle and high school students– Includes how to use a automatic defribilator– Tested in schools with 340 students

Marchiori EJ, Ferrer G, Fernández-Manjón B, Povar Marco J, Suberviola González JF, Giménez Valverde A. Video-game instruction in basic life support maneuvers. Emergencias. 2012;24:433-7.

Available at http://first-aid-game.e-ucm.es

http://first-aid-game.e-ucm.es

Evaluation of the first-aid game

• 342 high school students• Control group with emergency medical

doctors

Experiment

• After a short introduction of the game students play for 50 minutes

Control group

• Control group expend the same time with 2 emergency medical doctors and a medical maniquin

CPR game ResultsPre-test and post-test for evaluating knowlege

game

Marchiori EJ, Ferrer G, Fernández-Manjón B, Povar Marco J, Suberviola González JF, Giménez Valverde A. Video-game instruction in basic life support maneuvers. Emergencias. 2012;24:433-7.

eAdventure in Medical education: evaluation

• HazMat Training (Massachusetts General Hospital)– Use of the game for evaluate students– Staff certification for handling Hazardous Material

(HazMat) shipments– Problem

• Moving face-to-face training to online training• The training includes a game packing evaluation

– Deployed from 2009 to 2012• Reduce certification time & cost• The outcome of the game is part of the final grade

Done by Carl Blesius, Pablo Moreno

Educ@ONT : Evaluation, distribution and logistics of transplants

– National Transplant Organization (Spain)– Training new staff in the transplant suprahospital

procedures– Problem: pre-existing situation

• Tacit knowledge, no fully represented in the existing description of the procedures

• Not a predefined set of teaching cases

– Other outcomes of the game creation• Better formalization of procedures that can be tested and

refined by the medical personnel• Creation of 10 representative teaching cases

Done by Blanca Borro, Baltasar Fernandez, ONT

a) Main scene corresponding to a real picture of ONT central office b) Action of evaluating the organs.

c) Documentation available for the player. The player is opening the zone distribution document.

d) Character of the simulation representing the liver transplant coordinator.

Now: Surgical Safety Checklist

Surgical Safety Checklist

Surgical Safety Checklist

Improving evaluation: eAdventure + Learning Analytics (LA)

• eAdventure games can include a learning analytic module without modifiying the game

• LA information can be used to improve evaluation

Game Engine

CommunicationAPI

Logic

Input

Input

Logic

Input

LA Database

• Raw data can feed several systems– A Learning Record Store (LRS using xAPI)– A Learning Analytics System

eAdventure + Learning Analytics (xAPI)

Logic

Input

Logic

Input

Input

Input

Raw data

LRS

Learning Analytics System

StatementsAnalyzer

StatementsAnalyzer

EXPERIENCEAPI

EX

PE

RIE

NC

EA

PI

Other experiences with xAPI (MGH)

– Integration of different user information• Heterogeneus systems• Medical mannequin simulation data in LMS (The Hub)

LRS THE HUB

Conclusions

• Many opportunities of serious games in the medical domain

• Need to do more evaluation of the effect of the serious game application in real settings

• Cost and integration in the learning flow are identified issues

• New oportunities with Learning Analytics and new e-learning specifications – Experience API (xAPI)

References•eAdventure. http://e-adventure.e-ucm.es/•MGH Learning Lab. http://www.massgeneral.org/learninglab/•First Aid Game. http://first-aid-game.e-ucm.es/• Marchiori EJ, Ferrer G, Fernández-Manjón B, Povar Marco J, Suberviola González JF, Giménez Valverde A. Video-game instruction in basic life support maneuvers. Emergencias. 2012;24:433-7•Pablo Moreno-Ger, Javier Torrente, Julián Bustamante, Carmen Fernández-Galaz, Baltasar Fernández-Manjón, María Dolores Comas-Rengifo (2010). Application of a low-cost web-based simulation to improve students’ practical skills in medical education. International Journal of Medical Informatics 79(6), 459-467 (doi:10.1016/j.ijmedinf.2010.01.017).•Brian Johnston, Liz Boyle, Ewan MacArthur, Baltasar Fernández-Manjón (2013). The role of technology and digital gaming in nurse education. Nursing Standard, Vol 27, No 28, pp 35-38, March•Ángel del Blanco, Baltasar Fernández-Manjón, Pedro Ruiz, Manuel Giner (2013). Using videogames facilitates the first visit to the operating theatre. Medical Education. Vol 47, Issue 5, pp. 519-520 (short contribution to the really good stuff section).•Borro-Escribano B., Martínez-Alpuente I., del Blanco A., Torrente J., Fernández-Manjón B., Matesanz R. (in press) Application of Game-Like Simulations in the Spanish National Transplant Organization. Transplantation Proceedings Journal.