Playing and Affective and Behavioral Symptoms in Children and Adolescents [Playing and Mental Health]

Introduction: Pediatric mental problems have been increasing, especially after COVID-19, which led to reduced active play. In childhood and adolescence, active play has been recognized as a protective factor against psychopathology. Objective(s): To determine the association between gambling and internalizing or externalizing symptoms in children and adolescents. Material(s) and Method(s): Cross-sectional analytical observational study, with a sample of 1533 children and adolescents, between six and 18 years of age in the city of Manizales, during the second semester of 2021. The Child Behavior Checklist 6-18 (CBCL/6-18) and inquired about hobbies and active play, where bivariate analyzes were performed. Result(s): 69.4% of those surveyed are fond of art and 12.0% of sports. 46.37% presented significant symptoms in the CBCL. Statistically significant negative correlations were found between active gaming and the presence of symptoms in all CBCL domains, as well as a positive correlation between alterations in mental health and the use of video games. Conclusion(s): Active play is a behavior related to child and adolescent mental health, which is why it should be investigated and promoted from the first levels of health care.Copyright © 2023 Asociacion Colombiana de Psiquiatria

How much did it cost to develop and implement an eHealth intervention for a minority children population that overlapped with the COVID-19 pandemic.

BACKGROUND: eHealth interventions using active video games (AVGs) offer an alternative method to help children exercise, especially during a pandemic where options are limited. There is limited data on costs associated with developing and implementing such interventions. OBJECTIVES: We quantified the costs of delivering an eHealth RCT intervention among minority children during COVID-19. METHODS: We categorized the total trial cost into five subcategories: intervention material development, advertising and recruitment, intervention delivery, personnel salaries, and COVID-19-related equipment costs. RESULTS: The total RCT cost was $1,927,807 (Direct: $1,227,903; Indirect: $699,904) with three visits required for each participant. The average cost per participant completing the RCT (79 participants/237 visits) was $24,403 (Direct: $15,543; Indirect: $8860). Due to no-shows and cancellations (198 visits) and dropouts before study completion (61 visits; 56 participants), 496 visits had to be scheduled to ensure complete data collection on 79 participants. If all 496 visits were from participants completing the three-visit protocol, that would correspond to 165 participants, bringing the average cost per participant down to $11,684 (Direct: $7442; Indirect: $4242). Of the subcategories, intervention material development accounted for the largest portion, followed by personnel salaries. While the direct COVID-19-specific cost constituted <1% of the entire budget, the indirect effects were much larger and significantly impacted the trial. CONCLUSION: RCTs typically involve significant resources, even more so during a pandemic. Future eHealth intervention investigators should budget and plan accordingly to prepare for unexpected costs such as recruitment challenges to increase flexibility while maximizing the intervention efficacy.

University membership through immersive virtual environments and a sense of belongingness

In this work, we study the feeling of membership in undergraduate students who interact with their higher education institution through a virtual environment. We explore the Centro de Investigaciones en Diseño Industrial (CIDI) case, in which a virtual environment was built using the Roblox platform to enhance the online experience that students were having during the COVID-19 pandemic. Through the application of the Psychological Sense of School Membership scale, we show that it is possible to evoke a sense of belonging in a physical space with a virtual representation. We achieved this by virtually replicating the physicality of the original CIDI and by promoting social behaviors using three modalities of social interaction. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

University membership through immersive virtual environments and a sense of belongingness

In this work, we study the feeling of membership in undergraduate students who interact with their higher education institution through a virtual environment. We explore the Centro de Investigaciones en Diseño Industrial (CIDI) case, in which a virtual environment was built using the Roblox platform to enhance the online experience that students were having during the COVID-19 pandemic. Through the application of the Psychological Sense of School Membership scale, we show that it is possible to evoke a sense of belonging in a physical space with a virtual representation. We achieved this by virtually replicating the physicality of the original CIDI and by promoting social behaviors using three modalities of social interaction. [ FROM AUTHOR]

Prediction of problem gambling by demographics, gaming behavior and psychological correlates among gacha gamers: A cross-sectional online survey in Chinese young adults.

Objective: The objective of this study is to explore the association of problem gambling with demographics, psychological distress, and gaming behavior in young adult gacha gamers in Hong Kong. Materials and methods: Cross-sectional data was collected in the first and fifth waves of COVID-19 pandemic in Hong Kong online. Participants who aged 18-25 years and had been playing gacha games over the past 12 months were recruited. Stepwise multiple regression was used to explore the association among risk of problem gambling, gaming behavior, participation in gaming activities and psychological distress. A two-sided p-value <0.05 was considered as statistical significance. Results: Three hundred and thirty-seven completed questionnaires were received with no missing data. 34.7% (n = 117) of the participants had non/low-risk of problem gambling. About 40% (n = 136) of them had moderate-risk and the remaining 25% (n = 84) were at high risk of problem gambling. A higher proportion of female participants (78.6%) were found in high-risk group as compared to 39.7% and 55.6% only in the non/low-risk and moderate-risk groups, respectively. The regression model (R 2 = 0.513, F = 71.895, p < 0.001) showed that 51.3% of the variance of the total problem gambling score could be explained by stress, anxiety, monthly expenses on gacha purchases, number of motives for gacha purchase and number of gambling activities engaged. Conclusion: The present study provides empirical evidence to support the association between problem gambling and microtransaction especially for gacha which is the most popular type of video game microtransaction in Asia. The established regression model suggests that gacha gamers with higher risk of problem gambling tend to have greater stress, higher anxiety level, spend more on gacha purchase, have more motives for gacha purchases and engage in more gambling activities. In contrast to the extant literature, higher proportion of female participants in high-risk group indicates that female gacha gamers are also at very high risk of becoming problem gamblers.

Relational Victimization and Video Game Addiction among Female College Students during COVID-19 Pandemic: The Roles of Social Anxiety and Parasocial Relationship.

Video game addiction, a common behavioral problem among college students, has been more prominent during the COVID-19 pandemic; at the same time, females' video game usage has also attracted considerable research attention. Against this background and under the perspective of social interaction, this study aimed to examine the relationship between relational victimization and video game addiction among female college students, as well as its underlying mechanism-the mediating roles of social anxiety and parasocial relationships with virtual characters. Female college students (N = 437) were recruited to complete a set of questionnaires voluntarily in June 2022. Through the mediating effect analysis, the results found that (1) relational victimization was positively associated with female college students' video game addiction; (2) social anxiety and parasocial relationships with virtual characters could independently mediate this relation; (3) social anxiety and parasocial relationships with virtual characters were also the serial mediators in this association. These findings not only expand previous studies by revealing the social motivation of video game usage and the underlying mechanism accounting for video game addiction, but also provide basis and guidance for the prevention and intervention of video game addiction in the current context of the COVID-19 pandemic.

Risk and protective factors for (internet) gaming disorder: A meta-analysis of pre-COVID studies.

This large-scale meta-analysis aimed to provide the most comprehensive synthesis to date of the available evidence from the pre-COVID period on risk and protective factors for (internet) gaming disorder (as defined in the DSM-5 or ICD-11) across all studied populations. The risk/protective factors included demographic characteristics, psychological, psychopathological, social, and gaming-related factors. In total, we have included 1,586 effects from 253 different studies, summarizing data from 210,557 participants. Apart from estimating these predictive associations and relevant moderating effects, we implemented state-of-the-art adjustments for publication bias, psychometric artifacts, and other forms of bias arising from the publication process. Additionally, we carried out an in-depth assessment of the quality of underlying evidence by examining indications of selective reporting, statistical inconsistencies, the typical power of utilized study designs to detect theoretically relevant effects, and performed various sensitivity analyses. The available evidence suggests the existence of numerous moderately strong and highly heterogeneous risk factors (e.g., male gender, depression, impulsivity, anxiety, stress, gaming time, escape motivation, or excessive use of social networks) but only a few empirically robust protective factors (self-esteem, intelligence, life satisfaction, and education; all having markedly smaller effect sizes). We discuss the theoretical implications of our results for prominent theoretical models of gaming disorder and for the existing and future prevention strategies. The impact of various examined biasing factors on the available evidence seemed to be modest, yet we identified shortcomings in the measurement and reporting practices.

Gaming Activities during the Covid-19 Pandemic Era: A Systematic Literature Review

The Covid-19 outbreak, which has been declared a pandemic since March 2020, has been causing problems worldwide. As a result, many countries have implemented lockdown policies to control the spread of the Covid-19 virus. In addition, time spent on gaming activity has increased by 52% since video game engagement was thought to be essential in improving players' vitality, reducing psychological suffering, and helping combat stress. This literature review was conducted as a systematic literature review based on the 15 primary studies between 2020 and March 2022. Analysis of the selected primary studies revealed that the authors conducted studies of gaming activities in the Covid-19 pandemic era for four reasons: To determine the factors of play intention, factors of purchase intention, factors of gaming disorder, and to investigate the impact of the gaming activities itself. Physical health issues, family interactions, social interactions, fear of missing out, psychological distress, and time and location flexibility are the six determinants for people to continue to play video games. Meanwhile, the expectation of performance and effort were the factors that influenced purchase intention in mobile games. And from these determinant factors, it seemed that psychological distress and fear of missing out were the causes of someone experiencing a gaming disorder. As for the method employed, Structural Equation Modeling (SEM) was the most extensively used statistical tool in conducting quantitative research. Six of the eleven quantitative research in the primary studies utilized SEM, and the others employed other statistical tools. Although, in the selected primary studies, we also have four studies conducted qualitative research using interviews and open-ended surveys. Ten different countries were identified as the origin country of the respondents for the primary studies, with Finland and the United States as the most research object. However, we also found three studies that did not specifically mention the origin countries of the respondents. © 2022 IEEE.

Coping with the Child During COVID-19

More than 10 months have passed since the COVID-19 pandemic in the world. Parents have complained about the behavioral and emotional changes in their children and feel it is diffcult for them to manage these changes. Parents must consider these important tips: 1- Re-establishment of previous routines of life and letting children know that they are supposed to behave according to these routines (for example, waking up early and eating breakfast before the online classes start);2- Re-establishment of physical activity for their children. There may be restrictions on going to the gym and other public places for physical activity, but there is no justifcation for stopping these activities (conditions can be provided safely);3- The child does not have the cognitive capacity to analyze some of these global issues, so parents should be careful not to allow the child to be exposed to all the catastrophic events of the environment in these critical conditions. These issues can be easily overlooked and can cause great harm to the child;4- Considering the danger of Cyber addiction and Game addiction, during the COVID- 19 pandemic, children spend hours at the computer, and in addition to losing opportunities for socializing and physical activity, there is the risk of pathological dependence on cyber content and computer games, and encountering immoral content that is inappropriate for age, leading to changes in their child's mood and behavior and occurrence of psychiatric disorders.

Trauma 2021

The proceedings contain 65 papers. The topics discussed include: blended learning using augmented reality glasses during the COVID-19 pandemic: the present and the future;training in soft-tissue resection using real-time visual computer navigation feedback from the surgery tutor: A randomized controlled trial;activating emotions enhance surgical simulation performance: A cluster analysis;SonoGames: delivering a point of care ultrasound curriculum through gamification;portable, adjustable simulator for cardiac surgical skills;teaching heart valve surgery techniques using simulators: A review;design and validity evidence for a unique endoscopy simulator using a commercial video game;comparison of a novel silicone flexor tendon repair model to a porcine tendon repair model;and challenges addressed with solutions, simulation in undergraduate and postgraduate surgical education, innovative education or research in surgical education.

Journalists and communicators on Twitch: media beyond social networks

Journalists and communicators discovered Twitch in mid-2020, during the months of quarantine imposed by Covid-19, during which a large part of the population used the Internet to seek communication with the outside world that confinement prevented. Given its content, dedicated to e-sports, and the youth of its followers, this specialized social network had gone unnoticed by the general public for years. Having initially been a platform for broadcasting video games, thanks to the arrival of journalists it started to become a space for information and entertainment, with the creation of new channels aimed at a more adult audience. The aim of this paper is to analyse the presence of journalists and communicators on Twitch, how they structure their channels, the use they make of this platform compared to other similar platforms, the differences and similarities in their use of the platform compared to the streamers already present on Twitch and, finally, to evaluate whether Twitch meets the necessary conditions to become an appropriate medium for news communication. By looking at the content generated on Twitch by five journalists and communicators, we study how they adapt their channels to the common characteristics of the platform, which can be seen in the behaviours and content generated by video game creators. © 2022. Analisi. All Rights Reserved.

Hidden pandemic: Handling behavioral addiction during COVID-19 chaos in Low Middle-Income Countries

Symposium summary: Over the last few decades, the medical concept of addiction disorders has undergone tremendous development. Addictive disorders are currently considered a multifactorial chronic disease and have become a significant cause of global health problems and other psychiatric disorders. Not only drug addiction but also the number of behavioral addiction patients continues to increase. The outbreak of Coronavirus Disease 2019 (COVID-19) spread across the entire world has curtailed most individuals' daily activities and movements. In response, the COVID-19 pandemic lets individuals engage more with technology use, providing escapism to several activities (e.g., shopping, eating, gambling, gaming, doing physical exercise, watching pornography). These activities allow them to find some acute emotional relief, albeit pathologically. These behaviors happened by accessibility, availability, and the absence of prevention and management programs for excess use. The COVID-19 pandemic and the lockdown policies in several countries have created a new paradigm regarding the prevention of specific strategies for behavioral addiction, primarily due to the increase in internet use that leads to addiction. A standard is needed to manage behavioral addiction, both pharmacological and non-pharmacological, in a holistic and comprehensive manner. Besides, an instrument is needed to distinguish healthy gamers, problematic gamers, and gaming disorders in order to prevent overdiagnosis. Notably, the symposium will highlight the emerging issue of behavioral addiction such as gambling, gaming, and pornography in Low Middle-Income Countries during the pandemic, exploring global solutions to international problems in the field of addiction medicine. In this symposium, there will be one chair and four speakers.

Online gaming and prolonged self-isolation: Evidence from Italian gamers during the COVID-19 outbreak

Objective: The self-isolation measures employed during the COVID-19 pandemic made it difficult for basic needs to be met, thus increasing emotional distress. It has been suggested that socially meaningful online gaming buffered emotional distress during the lockdown. This study aimed to test the protective effect of online gaming during the lockdown and to investigate the differences between highly involved gamers (those who play videogames intensely without adverse consequences) and problematic gamers in this regard. Method: Capitalizing on a data collection that started before the pandemic, we adopted a cross-sectional between-groups study design in which gaming patterns, gaming-related variables and levels of emotional distress were compared between a pre-COVID group (N=298) and a COVID group (N=366). Results: Compared to the pre-COVID group, high involvement in gaming was more prominent and emotional distress was decreased in the COVID group. Moderated regression analyses further revealed that the interaction between social compensation via gaming and highly involved gaming was associated with lower levels of emotional distress in the COVID-19 group. In contrast, the interaction between gaming-related relaxation and problematic gaming predicted higher emotional distress in the COVID-19 group. Conclusions: This study suggests that gaming for social compensation might mitigate the experienced emotional distress during pandemic related self-isolation, whereas maladaptive gaming patterns could constitute a vulnerability factor deserving clinical attention.

Gaming disorder: current research directions

Research into gaming disorder (GD) is dynamic and growing, generating multiple new research directions. The present narrative review covers important recent studies of GD between 2019 and 2021, and addresses the following topics: (1) conceptualization, assessment, and prevalence, (2) comparison of GD frameworks proposed by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases 11th Revision, (3) clinical studies, (4) neurobiological studies, (5) gambling elements in video games, and (6) impacts of the COVID-19 pandemic on gaming and GD. The most important findings in these areas and study limitations are discussed, and future research directions are proposed.

Mental models, meaning, & games: An interpretative phenomenological analysis of player meaning making in a complex STEM themed video game

This research addressed increasing understanding of how players make meaning during play of a complex STEM game and explores to what extent player mental models of STEM concepts shift as a result of interacting with the game simulation. Game based learning is attracting increased attention and interest as a novel platform for experiential learning, especially during the COVID-19 pandemic. The affordances of real-time interactive simulations in video games are being leveraged to create complex games for learning, designed with components arranged to reflect models of real-world systems in physical, biological, and social sciences. To build these models, designers use the complex multimedia nature of video games to encode and represent information in an array of game components with key attributes and relationships with one another, to provide a system that players can interact with to achieve game goals. Much work has been done to study outcomes of learning games in terms of post-intervention knowledge assessments, but relatively little has been done to explore the process of player mental model construction and adaptation at the level of specific interactions with components over time. This research aims to expand understanding of how players make meaning during gameplay in the STEM themed game Oxygen not Included, specifically through their interaction with game objects and their relationships. Using the approach of interpretative phenomenological analysis, in conjunction with formal analysis of gameplay and continuous think-aloud interview techniques, this work endeavored to collect rich qualitative data on player meaning-making processes during gameplay to address the following research questions: What major themes of interpretation can be identified for youth meaning making of knowledge structures in games for learning? To what extent do player mental models of STEM phenomena that are modeled in game shift during play? What are design implications and recommendations for learning game designers based on these results? (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Ukucha: a video game for teaching experimental psychology

The COVID-19 pandemic has forced educational institutions to find a way to meet educational needs, within these those for experimentation. This article implements a video game for teaching experimental psychology in a private university. The research is of an applied type and experimental design. For the development of the software, the SUM methodology was used for the development of the video game and the OOHDM methodology for the development of the web page according to the video game. Additionally, cutting-edge tools have been considered to be able to make a scalable and robust application such as the use of Unreal Engine 4 in its version 4.27 for the development of the video game, Blender in its version 3.0 for 3D modeling and character animation, Django as a framework Python for web development in conjunction with PostgreSQL for the elaboration of the database through the software architecture Model Vista Template (MVT). © 2022 IEEE Computer Society. All rights reserved.

Video game streaming: how poor licensing undermines creators*

This article tackles the phenomenon of video game streaming amidst a regulatory shift in the European Union towards the DSM Directive framework. The article offers a new perspective on a specific and economically significant industry fuelled by the growing exploitation of copyright-protected content amplified by the COVID-19 pandemic and global lockdowns. European scholars have previously studied video game streaming, however, this article offers a new approach focused on the licensing aspects. The article, thus, presents an attempt to capture the unique characteristics of the European digital market framed by the video game industry. The article discusses three separate topics, Article 17 of the DSM Directive, authorization practices, and the impacts of the DSM Directive framework on the video game streaming industry. First, the article analyses the legal shift and its implications on the video game streaming industry. Secondly, it seeks to identify broader ten-dencies in the video game streaming industry and particularly licensing practices. Finally, it analyses the position of video game streamers and possible room for improvement. The presented conclusions focus predominantly on identified licensing insufficiencies in the video game industry that put creators in a vulnerable position. Article 17 of the DSM Directive, subsequently, could bring about improvements to licence terms due to a shift in enforce-ment consequences from take-down to stay-down. © 2022, Edward Elgar Publishing Ltd.

SCREEN TIME AND SLEEP IN YOUNG ADOLESCENTS BEFORE AND ACROSS THE FIRST YEAR OF THE COVID-19 PANDEMIC

Introduction: The COVID-19 pandemic has been associated with profound biopsychosocial changes for children, potentially affecting their health and wellbeing. Among these changes are altered sleep patterns and screen time use, however, no work has examined interactions between these two behaviors in the context of the pandemic. Here, we used longitudinal data from the Adolescent Brain Cognitive Development (ABCD) Study® to investigate changes in both sleep and screen time, and their relationship, from before and across the first year of the COVID-19 pandemic in young adolescents. Methods: More than 5000 adolescents (11-14 years;48% girls) completed digital surveys about their sleep and daily screen time use before the pandemic and across six timepoints during 2020- 2021, as part of the ongoing ABCD Study®. Random intercept linear mixed effect models (LMMs) were used to examine longitudinal associations between bedtime, wake-up time, and daily screen time use (social media, gaming), considering age, sex, and school effects. Results: Adolescents' wake up time was delayed (R2 = 0.51;~1.5 hour) during May-August 2020 relative to the pre-pandemic assessment (p<0.01), which was partially related to the summer break (p<0.01), before advancing to earlier times in October 2020. Bedtimes also delayed at all pandemic assessments (R2=0.62;~1 hour), even after starting the new school year (p<0.01), particularly in older adolescents (p<0.01) and girls (p<0.01). Recreational screen time was dramatically higher across the first year of the pandemic, relative to pre-pandemic (p<0.01;~45min social media, ~20min video gaming). More time spent with screen related activities was associated with later bedtimes and wake up times (p<0.01), across the pandemic, with effects being evident in male and female adolescents. Conclusion: Our findings show profound changes in sleep timing and screen time use across the pandemic in young adolescents, and critically, that excessive screen time negatively impacts sleep. As adolescents increasingly turn to more screen usage, these data highlight the need to promote their balanced and informed use of social media platforms, video games, and other digital technology to ensure adequate opportunity to sleep and maintain other healthy behaviors during this critical period of developmental change.

EVOLUTION OF BODY COMPOSITION DURING A INTRADIALYSIS EXERCISE PROGRAM USING VIRTUAL REALITY

BACKGROUND AND AIMS: There are few follow-up studies on the composition body by bioimpedance in exercise programs in different population. It is necessary to know if the body composition measured by bioimpedance change during a intradialysis exercise program using virtual reality. The aim is to determine evolution of body composition of patients on intradialysis exercise program using virtual reality. METHOD: This is a subanalysis in a clinical trial with intradialysis exercise intervention. Intradialysis exercise consists in a video game adapted to dialysis: Treasure hunting. It is a nonimmersive virtual reality game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise lasts from 20 to 40 min. Intensity was checked through the rate of perceived exertion. The body composition is determined by multi-frequency stereoscopic bioimpedance . The study started in September 2019 (Baseline) but due to the COVID-19 pandemic it was paused for 1 year and started again in March 2021 (Restart). Body composition was determined basal, at 3th and 6th month in program. This study is funding from Programa Estatal de I + D + i Orientada a los Retos de la Sociedad, del Plan Estatal de Investigación Científica y Técnica y de Innovación 2017-2020 del Gobierno de España. RESULTS: This is an open recruitment study, 49 patients have been recruited as of September 2021, mean (SD) age 72 (13) years, females 18. About 17 patients dropped out (16 of them don't return after the pandemic start). To date, 32 patients are in exercise program. Paired data analysis showed no difference in normohydrated weight, lean tissue index, or overhydration. The fat tissue index increased significantly (P 0.04) during the pause period in the first year of the pandemic. At the time of this communication, only 12 patients have completed 6 months of the program. We await the evolution of all included patients to report results at 6 months. CONCLUSION: The evolution of body composition measured by bioimpedance during an intradialysis exercise program by virtual reality did not show relevant changes. Considering our results and those of previous studies, it's possible that bioimpedance is not a very sensitive test to evaluate an intradialysis exercise program in the short to medium term. Longer and larger studies are needed.

Gamification for Infectious Diseases Medical Education: Creating a Videogame to Teach COVID 19 Diagnosis and Treatment to Medical Students

Background. Brazillian authorities reported a total of 16.3 million cases and 454. 000 deaths during COVID-19 pandemic in Brazil by may 2021. It became necessary to educate healthcare professionals on diagnosis and treatment of the syndrome. Game based learning surfaced as an effective alternative, since it promotes critical thinking and problem solving skills. A team of Brazilian and Peruvian students, physicians, designers and programmers gathered to create a decision based computer game that simulates a hospital scenario and allows medical students to analise, make decisions and receive feedback. This work describes the creative process and showcase the initial version of the software. Methods. Professors and students of Medicine, Information Technology (IT), Design and Architecture from Brazil and Peru assembled a team in order to develop the computer game. Clinical cases were created by the medical students and professors, comprising medical procedures for the treatment and management of COVID 19, and a video game script was developed exploring gamification principles of challenge, objectivity, persistence, failure, reward and feedback. Algorithms (image 1) were created, under supervision of professors of Medicine, to define possible courses of action and outcomes (e.g. gain or loss of points, improvement or worsening of the patient). Students of Design created artistic elements, and IT students programmed with a game engine software. This fluxogram, written in portuguese, describes in detail all the possible courses of actions that can be exercised by the player. It is created by a team of Professors of Medicine and medical students, in accordance with evidence-based guidelines. Primarily, this document guides the programmers and designers throughout the development phase of the game. Results. Initially, an expandable minimum viable product was obtained. The game, visualized on image 2, consists in a non-playable character and a playable character (i.e. doctor), with a scenario and a dialogue script simulating a clinical examination of a COVID 19 patient. The player can interact with certain elements within the game, e.g. the computer and other characters, to retrieve test results or start dialogues with relevant information. Hospital scenario and dialogue window between doctor (player in black) and patient (non playable character) are displayer in the game engine software (Unity 2D). On the bottom half of the screen, the dialogue box allows the player to collect the patient's medical history. The player can interact with certain elements to obtain relevant information to make decision and progress in the game. Conclusion. The game allows medical students to practice diagnosis and treatment of COVID 19. Future versions will include assessment reports of player's actions, and a new score system will be implemented. New diseases will be incorporated in the gameplay to match the variety of scenarios offered by real hospitals and patients. Artificial intelligence will be employed to optimize gameplay, feedback and learning.