Serious Gaming and Gamification Education in Health Professions: Systematic Review.

BACKGROUND: There is a worldwide shortage of health workers, and this issue requires innovative education solutions. Serious gaming and gamification education have the potential to provide a quality, cost-effective, novel approach that is flexible, portable, and enjoyable and allow interaction with tutors and peers. OBJECTIVE: The aim of this systematic review was to evaluate the effectiveness of serious gaming/gamification for health professions education compared with traditional learning, other types of digital education, or other serious gaming/gamification interventions in terms of patient outcomes, knowledge, skills, professional attitudes, and satisfaction (primary outcomes) as well as economic outcomes of education and adverse events (secondary outcomes). METHODS: A comprehensive search of MEDLINE, EMBASE, Web of Knowledge, Educational Resources Information Centre, Cochrane Central Register of Controlled Trials, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature was conducted from 1990 to August 2017. Randomized controlled trials (RCTs) and cluster RCTs were eligible for inclusion. Two reviewers independently searched, screened, and assessed the study quality and extracted data. A meta-analysis was not deemed appropriate due to the heterogeneity of populations, interventions, comparisons, and outcomes. Therefore, a narrative synthesis is presented. RESULTS: A total of 27 RCTs and 3 cluster RCTs with 3634 participants were included. Two studies evaluated gamification interventions, and the remaining evaluated serious gaming interventions. One study reported a small statistically significant difference between serious gaming and digital education of primary care physicians in the time to control blood pressure in a subgroup of their patients already taking antihypertensive medications. There was evidence of a moderate-to-large magnitude of effect from five studies evaluating individually delivered interventions for objectively measured knowledge compared with traditional learning. There was also evidence of a small-to-large magnitude of effect from 10 studies for improved skills compared with traditional learning. Two and four studies suggested equivalence between interventions and controls for knowledge and skills, respectively. Evidence suggested that serious gaming was at least as effective as other digital education modalities for these outcomes. There was insufficient evidence to conclude whether one type of serious gaming/gamification intervention is more effective than any other. There was limited evidence for the effects of serious gaming/gamification on professional attitudes. Serious gaming/gamification may improve satisfaction, but the evidence was limited. Evidence was of low or very low quality for all outcomes. Quality of evidence was downgraded due to the imprecision, inconsistency, and limitations of the study. CONCLUSIONS: Serious gaming/gamification appears to be at least as effective as controls, and in many studies, more effective for improving knowledge, skills, and satisfaction. However, the available evidence is mostly of low quality and calls for further rigorous, theory-driven research.

Impact of a Video Intervention for Rural Peruvian Women With Cervical Neoplasia Before Loop Excisional Procedures.

OBJECTIVE: Indigenous Peruvian women have very high rates of cervical cancer. This study assessed the impact of an educational video on impoverished rural Peruvian women seeking loop excision surgery. MATERIALS AND METHODS: Women completed baseline, postvideo and postsurgery questionnaires that assessed knowledge and attitudes about the procedure. Differences between groups were examined using repeated measures analysis of variance. RESULTS: Women who watched the video were significantly more calm (2.6, 2.6, and 2.3, respectively; P = 0.04), relaxed (2.5, 2.5, and 2.1, respectively; P = 0.02), and content (3.4, 3.4, and 2.4, respectively, P < 0.01) at postvideo and postsurgery assessments compared with mean results at the baseline assessment. The same women were also significantly more tense (2.5, 2.0, and 2.0, respectively; P = 0.01), upset (1.6, 1.1, and 1.1, respectively; P = 0.01), and worried (3.0, 2.0, and 2.0, respectively; P = 0.01) at baseline compared with postvideo and postsurgery results. Approximately 93% of women believed that other women scheduled to have loop excision surgery should also watch the video. CONCLUSIONS: Dissemination of culturally sensitive video information minimizes adverse emotional responses associated with loop excision procedures before surgery. Such an intervention quickly improves the psychological well-being of women eventually subjected to surgical management of cervical neoplasia.

Design of Mobile Augmented Reality in Health Care Education: A Theory-Driven Framework.

BACKGROUND: Augmented reality (AR) is increasingly used across a range of subject areas in health care education as health care settings partner to bridge the gap between knowledge and practice. As the first contact with patients, general practitioners (GPs) are important in the battle against a global health threat, the spread of antibiotic resistance. AR has potential as a practical tool for GPs to combine learning and practice in the rational use of antibiotics. OBJECTIVE: This paper was driven by learning theory to develop a mobile augmented reality education (MARE) design framework. The primary goal of the framework is to guide the development of AR educational apps. This study focuses on (1) identifying suitable learning theories for guiding the design of AR education apps, (2) integrating learning outcomes and learning theories to support health care education through AR, and (3) applying the design framework in the context of improving GPs' rational use of antibiotics. METHODS: The design framework was first constructed with the conceptual framework analysis method. Data were collected from multidisciplinary publications and reference materials and were analyzed with directed content analysis to identify key concepts and their relationships. Then the design framework was applied to a health care educational challenge. RESULTS: The proposed MARE framework consists of three hierarchical layers: the foundation, function, and outcome layers. Three learning theories-situated, experiential, and transformative learning-provide foundational support based on differing views of the relationships among learning, practice, and the environment. The function layer depends upon the learners' personal paradigms and indicates how health care learning could be achieved with MARE. The outcome layer analyzes different learning abilities, from knowledge to the practice level, to clarify learning objectives and expectations and to avoid teaching pitched at the wrong level. Suggestions for learning activities and the requirements of the learning environment form the foundation for AR to fill the gap between learning outcomes and medical learners' personal paradigms. With the design framework, the expected rational use of antibiotics by GPs is described and is easy to execute and evaluate. The comparison of specific expected abilities with the GP personal paradigm helps solidify the GP practical learning objectives and helps design the learning environment and activities. The learning environment and activities were supported by learning theories. CONCLUSIONS: This paper describes a framework for guiding the design, development, and application of mobile AR for medical education in the health care setting. The framework is theory driven with an understanding of the characteristics of AR and specific medical disciplines toward helping medical education improve professional development from knowledge to practice. Future research will use the framework as a guide for developing AR apps in practice to validate and improve the design framework.