developing low cost game-like software simulations for the medical domain

Baltasar Fernandez-Manjonbalta@fdi.ucm.es

@BaltaFM

Developing low-cost game-like software simulations for the

medical domain

06/08/2013, Institute of Medical Engineering & Science,

Harvard -Massachusetts Institute of Technology

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Context: about me

Baltasar Fernández Manjón Catedrático de Universidad, Facultad de

Informática Universidad Complutense de Madrid Director of the e-UCM e-learning research group http://www.e-ucm.es/people/balta E-mail: balta@fdi.ucm.es

Now visiting scientist at LCS-MGH

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Context: e-UCM group

e-UCM research group Learning tecnologies About 15 researcher Serious games

European projects Application to the medical

domain

www.e-ucm.es

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Medicine: new requirements

Medicine needs continous education Reduce the number of errors Knowledge duplicating every 5 years Time-limited certification

Traditionally master-apprentice Now moving to mannenquin-based simulation

Deliverate practice (Ander Ericsson) Clear learning objective Adequate and increasing level of difficulty Repetitive practice with informative feedback

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MGH Learning Laboratory

MGH has created a Learning Lab to include simulation in the MGH learning flow Regular opportunities for dedicated clinical

practice and feedback in a risk-free environment Fully integrate clinical simulation as a quality

and safety tool in health care practice Enhance patient safety through routine practice

for expert performance Residents and medical personnel

http://www.massgeneral.org/learninglab/

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MGH Learning Laboratory

7/46 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.

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Simulations: fligh simulator

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Serious games: A Learning Technology on the Rise

Serious Games

Game designed for learning or training

Game-based learning, educational simulations, etc

It is being used in different contexts Military (America´s Army, www.americasarmy.com) Medicine (Re-mission, www.re-mission.net)

Some of the advantages “Learning by doing” principles Enhance students’ motivations Involve students in their own learning

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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.

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

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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

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Serious Games

Characteristics of games Backstory or Story line Rules and game mechanics Graphical enviroment Interactivity and reactivity Challenge /competition

Flow – user engaged, focussed, committed Clear goals, attainable challenge, feedback

Gamification Use of game characteristics to increase user

engagement

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Serious Games: Open Issues

At the DESIGN Stage

Balance between entertainment and educational value

Involve instructors in the process to guarantee a high educational value!

Choose an appropriate game genre

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Serious Games: Open Issues

At the PRODUCTION Stage

The Cost! Developing a whole game is expensive

usually between 5k and 5M $

Reusability is SCARCE

games as closed products

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Serious games: Open Issues

At the DEPLOYMENT stage Games are an extra burden for the instructor

Games usually need to be installedGames usually need to be handed out in CDs

or DVDsGames usually require controlled

environmentsGames usually demand up-to-date

computersEducators do not always have the

preparation to install and execute the gamesThere is not always time in the curricula to

arrange play sessions

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Serious Games: Open Issues

How do instructors evaluate students’ performance?Plan and elaborate de-briefing sessions,

post-tests, debates, etc.

Very difficult to prove the effectivity of the serious games Even if some correlation has been found

between using games and fewer errors in practice (e.g. laparoscopic surgery)

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eAdventure

eAdventure platform development Simplify the creation of educational games and

simulations Educationcal characteristics (evaluation,

accesibility, deployment, etc)

Free, open source http://e-adventure.e-ucm.es

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Two applications: an editor to create the games, and an engine, to run the

games

¿What is eAdventure?

eAventure: A tool to simplify the creation and maintenance of educational games

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eAdventure’s goals

• Simplify the creation of games• Reduce of the cost of the resources needed for creating a game

• Simplify the use and deployment of games

Cost reduction

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eAdventure goals

• Involve teaching experts in the creation of the games

• Include educational characteristics

Increase the educational value

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eAdventure

Increase the educational value, reduce the development costs

Game genre: Point-and-click 2D adventure games (like Myst™ or Monkey Island™)High educational value

Promotes reflection instead of actionResolution of complex puzzlesThe story is important!

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eAdventure

Increase the educational value, reduce the development costs

Development methodology that involves instructorsInstructors add educational value to the

productsIncreases game acceptance by the instructorsA good story never becomes a bad game

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<e-Adventure>

Increase the educational value, reduce the development costs

Game patterns (from experience)Third-person games => Concepts. Subjects like

HistoryFirst-person photo-based games =>

Procedural knowledge. Contexts like medicine, engineering, etc.

Third-person games

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Educational Game Development Methodology

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eAdventure in Medical education:´First attemps

Central Venous Catheter (CVC) MGH Simulation to teach the whole procedure (over

90 steps) Problem:

Key and high risk procedureVery expensive and limited time

Professional timeLab equipment

Ensure that students known the procedure before doing a practical exam

Proof of concept

Work by Carl Blesius, Paul Courier, Pablo Moreno, Baltasar Fdez

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eAdventure in Medical education: evaluation of knowledge

HazMat Training Massachusetts General Hospital 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 2012Reduce certification time & costThe game is part of the final grade

Done by Carl Blesius, Pablo Moreno

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eAdventure in Medical education: better formalization of knowledge

Transplants: Evaluation, distribution, and logistics of organ donation National Transplant Organization (Spain) Training new staff (management and clinical) Problem: pre-existing situation

Tacit knowledge, non-formalized proceduresNot a predefined set of teaching cases

Other outcomes of the game creationBetter 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

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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.

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eAdventure in Medical Education

CPR 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

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Evaluation

Simultaneous sessions with same timeOne with game

Other with 2 emergency medical doctors

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CPR game Results

Pre-test and post-test for evaluating knowlege

game

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Now: Surgical Safety Checklist

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Surgical Safety Checklist

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Surgical Safety Checklist

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Improving evaluation: eAdventure + Learning Analytics

Game Engine

Communication

API

Logic

Input

Input

Logic

Input

{ type: 'input', timeStamp: some_timestamp, device: 'some_device', action: 'some_action', target: 'target_id', data: { key1: value, ...}}

{ type: 'logic', timeStamp: some_timestamp, event: 'some_event', target: 'some_id', data: { key1: value, ...}}

LA Database

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Raw data can feed several systems An LRS A Learning Analytics System

eAdventure + Learning Analytics with xAPI

Logic

Input

Logic

Input

Input

Input

Raw data

LRS

Learning Analytics System

StatementsAnalyzer

StatementsAnalyzer

EXPERIENCEAPI

EXPERIENCE

API

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Other experiences with xAPI

Laboratory of Computer Science MGH Integration medical maniquin simulation data in

a LMS

LRS THE HUB

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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)

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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.