developing low cost game-like software simulations for the medical domain
Post on 19-Oct-2014
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As complexity in medicine increases and there is a need to improve education and reduce the number errors, simulation is being used to provide experiential learning in a risk-free environment. The typical approach is to use simulation wards with mannequin-based training to enhance patient safety through routine practice in high realism scenarios to obtain expert performance. Now this approach is being scaled up at large institutions such as MGH with the Learning Lab Simulation Center. In parallel a range of new game technologies have been developed that simplify the creation new applications at a lower cost. These technologies are beginning to be used in the medical domain. This include immersive environments (e.g. Second Life), multi-platform game development environments (e.g. Unity 3D) or new game devices (e.g. MS Kinect). We have created eAdventure an open source game platform that allows for the creation and maintenance of adventure games and simulations without any programming. We are interested in how this low-cost game technology and especially story-based game-like simulations can be used to improve the acquisition of procedural knowledge in medicine. Our current research focus is on how game-like simulations can be applied to represent, standardize and/or improve medical procedures (including the representation of the common errors or the capture of team tacit knowledge). We study how to use the description of medical procedures combined with representative teaching cases to produce game-like simulations that provide students with the opportunity to enhance knowledge and skill acquisition in a safe environment. We have applied this approach to create several simulations in the medical domain (e.g. teaching basic first aid procedures to high-school students, preparing for the first visit to the operating room, representation of the supra-hospital transplant procedures in Spain, improving application of the WHO Surgical Check-list). We are also researching how learning analytics can be applied to the evaluation of simulations.TRANSCRIPT
Baltasar [email protected]
@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: [email protected]
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.