Interprofessional Healthcare Informatics is a graduate-level, hands-on interactive exploration of real informatics tools and techniques offered by the University of Minnesota and the University of Minnesota's National Center for Interprofessional Practice and Education. We will be incorporating technology-enabled educational innovations to bring the subject matter to life. Over the 10 modules, we will create a vital online learning community and a working healthcare informatics network. We will explore perspectives of clinicians like dentists, physical therapists, nurses, and physicians in all sorts of practice settings worldwide. Emerging technologies, telehealth, gaming, simulations, and eScience are just some of the topics that we will consider. Throughout the course, we’ll focus on creativity, controversy, and collaboration - as we collectively imagine and create the future within the rapidly evolving healthcare informatics milieu. All healthcare professionals and IT geeks are welcome!
Game Based Teaching and Computer Simulation
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Interprofessional Healthcare Informatics
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Informatics, Gaming, and Simulation
This module describes applications of gaming, simulation, and virtual reality tools in healthcare. By the end of this module, learners will be able to: analyze informatics and gaming in relationship to health and healthcare and describe use of simulations and informatics to improve healthcare quality.
Rencontrer les enseignants
Karen Monsen, Ph.D., RN, FAANAssistant Professor
School of Nursing
Hi, my name is Tom Clancy and currently I serve as a Clinical Professor and an
Assistant Dean in the School of Nursing at the University of Minnesota.
And today's presentation is on game-based teaching and computer simulation.
the objectives today are to first, to describe some of the unique learning
methods provided by simulation and game-based teaching.
And we'll talk briefly about experiential and reflective learning, one of the
unique aspects of gaming. Hope you'll understand some of the key
components of good game design. And then, to review the game building
methods that we use when we construct a game.
We'd like to start off with a little bit of history about how we ended up using
games in teaching nurses and nursing students in today's health care
environment. When I went to school, 30 plus years ago,
traditional models of hospitalized nursing education.
Really we're immersed in nurses practicing within health care settings
such as a hospital generally for a two to three year period.
And the concept then was really to learn by doing through what we call task-based
education. As nursing education became more academic
in the last 20 years, task-based education really has been replaced by
more. What I would call didactic learning
methods, such as lecture, seminars, readings and so forth.
And this has really moved nursing into a field of its own.
But there were some disadvantages here in that we lost much of the deep.
What I would call experiential learning opportunities that presented themselves
when we were in the clinical setting. So through the work of Donald Schon and
Pat Benner, through their theory of Reflective Practice, we've seen a
reemergence of experiential learning. Not so much back into the clinic setting,
but in simulated environments such as in, simulation labs and through computer
simulation. And with these methods of teaching we are
again emphasizing the experiential learning, where people learn best through
doing. And it's a very good adjunct to what we
have seen in the last 10 to 15 years as a compliment to didactic lecture, and so
forth. Experiential Learning learning consists
if what we call context specific, and socially situated cycles of meaningful
action and reflection. And if we take that definition and we
break it apart, context specific might mean in a situation, for example,
medication management. Socially situated would be where that
medication management takes place, let's say in a hospital environment.
Meaningful action might be to ask the nursing student to administer the five
rights of medication and administration. Right dose, right person, right place,
right time, and so forth. And finally, once those actions take
place we reflect what went well and what did not go well.
And this is actually where learning takes place.
When and individual has the opportunity to look at their actions and the actions
that they were trying to achieve, and the gap is where the learning takes place.
And it's this reflective learning that where game theory really starts to help
us in teaching students. Now, there's two types of reflective
learning. One is what we call reflection on action.
And this takes place after an action or when a person ends an action to stop and
think. So, if we go back to our medication
management example, after a nurse has gone through an exercise where they need
to administer medications. And then, stop and go over their exercise
with their instructor, it's at that time they actually reflect on how they did and
learning takes place. But there's also reflection in action.
And that actually is when you have to think in the moment during the time when
the nurse actually has to administer the medication.
If they're doing it say for example, the first time when they're not certain
exactly how to do it. They have to experiment.
And that experimentation, having to think on your feet, is actually a form of
learning, and it serves to reshape what we're doing while we're doing it.
So, both reflection on and reflection in action are very important.
And game-based teaching and simulation really focuses on experiential and
reflective learning. And it differentiates game-based teaching
from other forms of learning. Games offer us the ability to experiment
with action and solutions. But, in a very safe place where the
consequences of failure are lessened but success is rewarded.
So today, what we are seeing in the evolution of teaching methods in nursing
schools is that early in nursing school, the curriculum is redundant and
repetitive. With much didactic content which would
consist of lectures and seminars and examinations.
And within the first year or two then, nursing students try to master that
clinical content through traditional forms of teaching.
And then, there's a gradual transition or a hand-off to the clinical experiences at
their various onsite practicums. But it's between where they master the
clinical content through traditional education.
And when they transition into actually having to do hands-on care in a hospital,
that simulation and gaming really has become an opportunity.
To enhance traditional methods before nurses actually go into the clinical
environment. And this is where we see exponential and
reflective learning most applicable. What we see now is that by allowing
nurses to work in an environment that's controlled.
Simulated, where they experience all of these different events that they may or
mo, may not experience in the in their clinical site.
They're better prepared to go out and start taking care of patients in their,
in their various clinical sites. So, let's talk a little bit about game
design. Games simulate the real world.
They're not the real world, they simulate it.
And so, we start off with game design by actually looking at the environment.
And if you look at this slide on the left, you see the inside of an ambulance.
And in gaming, we have to transition the design of the real world into a game.
The slide picture on the right and this is a gaming environment of a patient in
an ambulance. And as you can see the, the gaming
environment has a lot of information on the screen.
It provides the nurse with the ability to select specific types of tools like a
stethoscope, or blood pressure cuff or defibrillator.
It allows nurses to get information about the patient through asking for their
medical record. It provides, in this case, their
electrocardiograms so they can see their heart rate.
It tries to mimic real life in as much as possible.
But there are some unique things on this screen that you wouldn't necessarily have
in real life. And that is that there is actually a
point total that is actually generating as you do things within the game.
You're under time pressure. You have to make decisions in a
relatively quick period of time, or else the patient starts to be compromised.
So game design is really where you start with game theory [COUGH] to develop a
good game you need to start with a well ordered problem.
So, it's important to find the appropriate skill level.
In this particular game, we are looking at a patient that is suffering a heart
attack or a myocardial infarction. So, our audience is going to be Emergency
Care Unit nurses. The game must be able to test the
knowledge of the nurses by themselves, because there's not a facilitator or a
faculty present during the game. So, the game has to be structured in a
way that they can actually go through it without being facilitated.
And it must encourage the players to engage in knowledgeable reflection in and
on action. And in this particular case here, you
have plenty of opportunities with a patient who is suffering a heart attack.
Where you have to make decisions quickly, but you also have the opportunity to
reflect on the decisions you made earlier in the game.
The game has to have meaningful goals. They have to be clearly defined.
They need to be able to motivate the player to achieve success through
problem-solving. And they need to reward the player after
the achievement is made. So for example, a typical goal for this
game might be, by the conclusion of training of the training simulation, the
learner will demonstrate competency. By conducting an accurate and complete
head-to-toe assessment. The learner will then demonstrate
competency by demonstrating appropriate utilization of a physical assessment
tool. So, the nurse knows specifically what
they need to achieve to be successful in the game.
Another unique quality of games is what we call possibility of spaces.
In other words, there is no necessarily right answer or right way to get to a
successful outcome. In this particular game, where we're
treating a patient who's suffering a heart attack, the choices and how you get
them can vary. For example do you check the airway
first? Do you check the pulse first?
Do you check the armband first? What happens if you do review the medical
records first? You are the person having to make the
choice. And based upon the choices you make
really determines the outcome of the game.
And if you make the wrong sequence of choices, the outcome can be such that the
patient becomes unstable and in the worse case scenario, dies.
One of the things that this allows then in games is that you being to compete
against yourself. Because the first time you go through a
game, you may have a certain point total. And if you do the game again, you will
learn through reflective learning what to improve and improve your point total.
So, games build in redundancy which is excellent for learning.
Games need to have immediate feedback and information.
So in this particular game if you look at the two components of experiential
learning, reflection in time. What happens when an unexpected event
happens? In this particular case, this patient may
have trouble breathing. And based upon actions that you performed
in the past, such as fitting the mask on properly they may impact future
decisions. So, if you look at the dialogue occurring
in this game, the nurse asks are you having trouble breathing?
An immediate feedback that you get is, yes, it seems like I'm not getting any
oxygen through my mask. This sets up an opportunity for learning,
where you can be empowered and rewarded. If we continue the dialogue, you see that
the nurse responds with, I see your mask is not fitting well, let me adjust it.
As soon as you do that, and the patient responds, thank you, I'm breathing much
better, you receive achievement points. And this allows for empowerment and
reward. So, games have unique characteristics
that you might not find in other forms of learning that are more passive.
Finally game development is a is a very challenging but exciting endeavor.
The usual process starts with, as we mentioned before, identify the audience
that you want to focus on. Clearly defining what your objectives
are, but determining how you're going to evaluate students after the game is over.
You need to be very clear on what a successful game is.
In our cases, we develop a pretest before a game.
They do the game and then they do a post test, and we measure if they improved
between the pre and the post test. It's important to determine your
resources. we develop our games with another company
that works closely with us that has experience in the gaming field.
And the combination of nurses who can developed the content and gaming
company's who can program that makes a very nice union for the ultimate creation
of games. Developing the storyline is probably the
most difficult part of creating a game. You essentially have to create a film,
not unlike creating the story line to a plot, and then you have to develop a
series of protocols based upon decisions within the plot that the player makes.
So, the outcomes can be very different. And this can be very time consuming.
Games are developed in a step wise fashion.
You develop your initial game, you show it to a group of nurses, you get their
feedback in terms of usability, function ability and so forth.
And then, make changes to it, and then send it out for feedback again.
You then finally test the game, and then ultimately are able to begin the game for
training. So this concludes our brief lecture on
gaming. Thank you very much.
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