[The following notes were generated by Thomas Thesen, Ph.D.]

Presenters: Teresa Chan MD (McMaster University, Canada), Satid Thammasitboon MD, MHPE (Baylor College of Medicine, USA) Eric Gantwerker MD, MS, MMSc(MedEd), FACS, AFAMEE (Zucker School of Medicine at Hofstra/Northwell, USA)

Card and Board Games for Health Professionals Education

The Winter 2023 IAMSE Webinar Seminar Series, titled “Not Just Fun & Games: Game-based Learning in Health Professions Education,” had its fourth session on Thursday, February 2. This series explores the benefits of using games in healthcare education and offers strategies for incorporating different types of games into the basic science curriculum. It covers existing literature on the theories behind using games in medical education and the results of recent research studies on the topic. The series also features speakers who will provide practical tips for implementing game-based learning in the classroom. The fifth session was presented by Dr. Teresa Chan, Dr. Eric Gantwerker and Dr. Satid Thammasitboon and was titled “Foresight, Insight & the Quest: Transforming Learning through Game-Based Learning”.

Drs. Chan, Gantwerker and Thammasitboon started by defining their definition of “Gamification”, a term that refers to the use of video game elements to improve user experience and engagement in non-gaming systems. With the rise of ‘gamified’ applications, there is a wealth of research on the heuristics, design patterns and dynamics of games and their positive impact on user experience. Gamification and serious games in education are similar in that both utilize elements of games to improve the learning experience, but they differ in their primary goal. Gamification involves adding game-like elements to non-gaming systems to increase user engagement and motivation, whereas serious games are specifically designed for educational or training purposes, using games as the primary medium to deliver content and achieve learning objectives. In other words, gamification takes a broader approach to using game elements in a variety of contexts, while serious games are specifically designed for educational outcomes. The presenters explain their approach to educational program activities by integrating faculty development, design thinking, best practices, evaluation tools, a community forum, research and a start-up arm.

The presenters stated that Game-Based Learning (GBL) has the potential to revolutionize medical science education. The idea that “gameful engagement is mostly entertainment today but it will evolve into the most powerful learning medium in history” suggests that GBL will have a future place in medical education. In medical science education, GBL offers several benefits, such as providing a more interactive and engaging way to learn complex concepts, allowing for simulation and practice in a safe environment, and promoting problem-solving skills and critical thinking. As technology continues to advance, the possibilities for GBL in medical science education will likely expand, allowing for more immersive and realistic simulations, and potentially even incorporating virtual and augmented reality elements. Overall, the presenters argue that the future of GBL in medical science education has the potential to greatly enhance the way medical professionals are trained and educated.  They also stated that game-based education has the potential to be the most effective way of learning and growing because it taps into our natural desire for interaction and engagement. By incorporating elements of play and competition, game-based learning can create a more dynamic and engaging educational experience. This approach can also foster collaboration, critical thinking, and problem-solving skills. They further prophesize that ““the psychology and technology from games will transform education at every level and across every industry.”

They further offer insight into the evolution of gamification in medical education As Game-Based Learning (GBL) becomes more prevalent in medical science education, there are also challenges to be considered. Challenges or threats include: Ensuring the quality and accuracy of the educational content within the game. Balancing the competitive aspect with the educational goals. The potential for distraction and oversimplification of complex medical concepts. The need for effective evaluation and assessment of learning outcomes.

Drs. Chan, Gantwerker and Thammasitboon proposed that teaching the tools of game designers to medical educators who are serious about games is seen as a crucial step in catalyzing personalization, motivation, and engagement in learning. By incorporating cognitive and technological elements used by game designers, educators can enhance the learning experience and foster more active and engaged learners. They believe that in order to optimize the potential of Game-Based Learning (GBL) in advancing medical science education, it is important to capitalize on the opportunities and address the challenges in four key areas: Innovation, Learning, Sustainability, and Well-being. This can involve utilizing the latest technology and game design techniques, fostering a learning-centered approach, ensuring sustainability and accessibility, and incorporating considerations for student well-being into the design This can involve utilizing the latest technology and game design techniques, fostering a learning-centered approach, ensuring sustainability and accessibility, and incorporating considerations for student well-being into the design. By approaching GBL in a strategic and holistic manner, it is possible to improve the overall learning experience for students and advance medical science education. By approaching GBL in a strategic and holistic manner, it is possible to improve the overall learning experience for students and advance medical science education. Drs. Chan, Gantwerker and Thammasitboon concluded their presentation by suggesting popular non-fiction books for those who are further interested in game psychology, design and application.

[The following notes were generated by Thomas Thesen, Ph.D.]

Presenter: Sarah Edwards, BMBS FHEA MSc(MedEd) MSc(PEM) (University Hospitals of Derby and Burton NHS Trust, UK) and Michael Cosimini, MD FAAP (Oregon Health and Science University, USA)

Card and Board Games for Health Professionals Education

The Winter 2023 IAMSE Webinar Seminar Series, titled “Not Just Fun & Games: Game-based Learning in Health Professions Education,” had its fourth session on Thursday, January 26. This series explores the benefits of using games in healthcare education and offers strategies for incorporating different types of games into the basic science curriculum. It covers existing literature on the theories behind using games in medical education and the results of recent research studies on the topic. The series also features speakers who will provide practical tips for implementing game-based learning in the classroom. The third session was presented by Dr. Sarah Edwards and Dr. Michael Cosimini and was titled “Card and board games for health professional education”.

Drs. Edwards and Cosimini started by explaining that Gamification is a technique that incorporates game-like elements in non-game contexts to impact learning behaviors or attitudes. It leverages the motivational and engagement factors found in games to drive desired behaviors and improve the learning experience. Researchers in medical education can use gamification to enhance the effectiveness of traditional educational methods and make learning more interactive and enjoyable. By incorporating game mechanics like points, feedback, competition, and storytelling, medical education researchers can increase engagement, motivation, and retention of information in learners.

They then introduced a theory of gamified learning developed by Landers et al., which states that gamified learning defines gamification as the use of game attributes outside of the context of a game to influence learning-related behaviors or attitudes. These behaviors or attitudes then impact learning through either strengthening the relationship between instructional design quality and outcomes or influencing learning directly. This differs from serious games, where game attributes are used to directly affect learning. The Bedwell taxonomy provides categories of game attributes and examples of how they might be applied in gamification. Recommendations are given for conducting rigorous and scientific studies of gamification. Next, the presenters discuss “Serious Games” by Abt CC, published in 1970, which defines serious games as games with a specific educational purpose and not primarily intended for entertainment. Abt asserts that these games have a well-thought-out educational purpose. They also presented an input-process-output model of instructional games and learning (Garris et al., 2022), which covers the crucial aspects of games from an educational viewpoint, the game cycle of user feedback, behavior, and judgments that define engagement in gameplay, and the resulting learning outcomes. They examine the significance of this model for the creation and implementation of effective instructional games. The presenters highlight that a game is a suitable choice for a medical education session when it enhances learner engagement, changes motivation, provides low-stakes trial and error, has game mechanics that align with learning goals, and showcases how systems work.

Drs. Edwards and Cosiminicontinued their presentation by showcasing various examples of board games currently used in health professions education, including ‘Cards Against Peds Ortho’, ‘Game of Stools’, and ‘Gridlock ED’. The presenters then summarized the results of a survey on a card game used to educate on antibiotic use. The survey was conducted among online groups interested in educational games and healthcare education. Of the 390 participants who completed the survey, 55 were excluded as they were not in healthcare. The majority (56%) were physicians, residents, or medical students, 33% were pharmacists, residents, or students. 53% of participants were from the US, and 70% were downloading the game for their own education. In addition, the optimal length of board games for education is recommended to be around 20 minutes and educators are not encouraged to go above 40 minutes based on survey data. The most often cited barriers for using games for education are the lack of appropriate games and the concern for content accuracy, followed by cost.  They also briefly discussed the potential lack of credibility of games in educational contexts. The presenters then offered some game design tips, starting with the maxim that “game complexity game complexity shouldn’t be harder than the information its providing. The point is to learn, not to understand the game.”. The presenters concluded their presentation by highlighting the uniqueness of card and board games as a social environment for active learning. Currently, not many such games are available, but there is a demand for short and simple 2-4 player games. If you think about creating a game for your specific educational setting, they recommend starting by recycling mechanics from known games.

[The following notes were generated by Thomas Thesen, Ph.D.]

Presenter: Amy Beresheim, PhD and Adam WilsonPhD (Rush University, USA)

Escape Rooms: Breaking Away from the Lull of Lackluster Curricula

The Winter 2023 IAMSE Webinar Seminar Series, titled “Not Just Fun & Games: Game-based Learning in Health Professions Education,” had its third session on Thursday, January 19. This series explores the benefits of using games in healthcare education and offers strategies for incorporating different types of games into the basic science curriculum. It covers existing literature on the theories behind using games in medical education and the results of recent research studies on the topic. The series also features speakers who will provide practical tips for implementing game-based learning in the classroom. The third session was presented by Dr. Amy Beresheim, Ph.D. and Dr. Adam Wilson, Ph.D. and was titled “Escape Rooms: Breaking away from the lull of lackluster curricula”.

Drs. Beresheim and Wilson started by explaining that Gamification is a field of educational science that aims to make learning more engaging and motivating using game-related mechanisms. They further highlighted that game-based learning typically includes a system with pre-defined rules, which allows individuals or groups to track their progress and receive incentives as they advance. They also emphasized that immediate incentives could enhance learning and promote engagement with the learning process. The presenters continued by giving an overview of the current literature on gamification in education. They cited several meta-analyses that support the effectiveness of gamification in enhancing student performance. According to one study, students exposed to educational games had higher performance outcomes than non-gaming control groups. Another meta-analysis found that gamification had small positive effects on cognitive, motivational, and behavioral learning outcomes. A third study reported a moderately positive effect of gamification on student achievement.

Drs. Beresheim and Wilson then shifted to the main topic of their talk, the concept of escape rooms, explaining that the goal is to escape a theme room using a series of clues within a specific time frame, usually 60 minutes. They went on to describe the mechanics of an escape room game, saying that it typically begins with a storyline to provide context for the environmental setting and the need for escape. Participants then search for clues and solve puzzles throughout the room in hopes of activating something, such as unlocking a combination device to reveal another clue. At first, the search may feel aimless but as more clues are decoded, it becomes easier to anticipate what additional steps are needed to complete the escape. They also mentioned additional features, such as the common use of distractors and the creation of time pressure to escape the room before the clock runs out.

Next, they discussed how escape rooms can be utilized in a medical education setting. The presenters stated that the primary objective should be to review or practice new educational content through an interactive and collaborative approach. The secondary goal should be to solve the puzzles and escape the room within a given time frame. They mentioned that the medical education escape room still begins with a storyline to establish the context and objectives and tie everything together. They also noted that there are still elements that can distract from the main objective (i.e. distractors), but the key difference in an educational escape room is that the puzzles and clues are designed to test the application of knowledge rather than just finding them. When knowledge is applied correctly, it will either reveal a new clue or help solve parallel ones that will eventually lead to the escape.

Drs. Beresheim and Wilson then delved into the topic of group size and dynamics in escape rooms. They

mentioned that groups can range in size, but generally have around 5 participants. They also emphasized that the ideal environment is usually fast paced, generating a high rate of communication among team members. Additionally, they pointed out that there is evidence that older and more educated players tend to speak for longer during the game. Furthermore, the prior strength of relationships within the group is linked to the intensity of collaboration and problem-solving interactions.

Next, the team discussed the difference between in-person and virtual escape rooms in educational settings. The majority of escape rooms used in education contexts are occurring in-person, and much smaller percentage constitute digital games or hybrid formats. They also mentioned that there are few comparative studies that have examined the effectiveness of in-person vs virtual/digital educational escape rooms. He cited one study that suggests that remote educational escape rooms can be as engaging as their face-to-face counterparts, but their learning effectiveness may be lower. As we now all know, virtual escape rooms offer logistical advantages such as being able to use them in case of COVID-19, saving space and time, reducing resource costs and allowing for reproducibility. The cost of running escape rooms is low and logistical issues are similar to small group sessions already common in medical education. They emphasized that educators must ensure that all participants have the dexterity and motor skills required for in-person puzzles, and think about the overall challenges that some individual students with extra challenges may encounter. They then went on to describe various escape room implementations with a focus on anatomy at the University of Alabama and Rush University, including the ‘Anatomy Escape Room’ and ‘Who am I?’. To make it easier for viewers to implement their own virtual escape rooms, they provided a list of tools and provided an extensive list of other potential examples that could be used in the medical education setting. Lastly, they shared with us links to escape room instructor guides that can be used by the audience as inspiration to build their own educational escape rooms.

After the conclusion of the presentation, the audience had the chance to ask questions from Drs. Beresheim and Wilson. Questions that were discussed included, “Would you consider running a step-by-step course in the future where participants can construct their own escape room games?”, “Do students have a preference between in-person and virtual?”, followed by an ensuing discussion about the use of distractors in medical education escape room games.