Systematic review of serious games for medical education and surgical skills training

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Abstract

The application of digital games for training medical professionals is on the rise. So-called 'serious' games form training tools that provide a challenging simulated environment, ideal for future surgical training. Ultimately, serious games are directed at reducing medical error and subsequent healthcare costs. The aim was to review current serious games for training medical professionals and to evaluate the validity testing of such games. PubMed, Embase, the Cochrane Database of Systematic Reviews, PsychInfo and CINAHL were searched using predefined inclusion criteria for available studies up to April 2012. The primary endpoint was validation according to current criteria. A total of 25 articles were identified, describing a total of 30 serious games. The games were divided into two categories: those developed for specific educational purposes (17) and commercial games also useful for developing skills relevant to medical personnel (13). Pooling of data was not performed owing to the heterogeneity of study designs and serious games. Six serious games were identified that had a process of validation. Of these six, three games were developed for team training in critical care and triage, and three were commercially available games applied to train laparoscopic psychomotor skills. None of the serious games had completed a full validation process for the purpose of use. Blended and interactive learning by means of serious games may be applied to train both technical and non-technical skills relevant to the surgical field. Games developed or used for this purpose need validation before integration into surgical teaching curricula. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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Technology-enhanced simulation for health professions education: a systematic review and meta-analysis.

David A. Cook, Rose Hatala, Ryan Brydges … (2011)

Although technology-enhanced simulation has widespread appeal, its effectiveness remains uncertain. A comprehensive synthesis of evidence may inform the use of simulation in health professions education. To summarize the outcomes of technology-enhanced simulation training for health professions learners in comparison with no intervention. Systematic search of MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011. Original research in any language evaluating simulation compared with no intervention for training practicing and student physicians, nurses, dentists, and other health care professionals. Reviewers working in duplicate evaluated quality and abstracted information on learners, instructional design (curricular integration, distributing training over multiple days, feedback, mastery learning, and repetitive practice), and outcomes. We coded skills (performance in a test setting) separately for time, process, and product measures, and similarly classified patient care behaviors. From a pool of 10,903 articles, we identified 609 eligible studies enrolling 35,226 trainees. Of these, 137 were randomized studies, 67 were nonrandomized studies with 2 or more groups, and 405 used a single-group pretest-posttest design. We pooled effect sizes using random effects. Heterogeneity was large (I(2)>50%) in all main analyses. In comparison with no intervention, pooled effect sizes were 1.20 (95% CI, 1.04-1.35) for knowledge outcomes (n = 118 studies), 1.14 (95% CI, 1.03-1.25) for time skills (n = 210), 1.09 (95% CI, 1.03-1.16) for process skills (n = 426), 1.18 (95% CI, 0.98-1.37) for product skills (n = 54), 0.79 (95% CI, 0.47-1.10) for time behaviors (n = 20), 0.81 (95% CI, 0.66-0.96) for other behaviors (n = 50), and 0.50 (95% CI, 0.34-0.66) for direct effects on patients (n = 32). Subgroup analyses revealed no consistent statistically significant interactions between simulation training and instructional design features or study quality. In comparison with no intervention, technology-enhanced simulation training in health professions education is consistently associated with large effects for outcomes of knowledge, skills, and behaviors and moderate effects for patient-related outcomes.

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Walter Boot, Arthur Kramer, Daniel Simons … (2008)

Expert video game players often outperform non-players on measures of basic attention and performance. Such differences might result from exposure to video games or they might reflect other group differences between those people who do or do not play video games. Recent research has suggested a causal relationship between playing action video games and improvements in a variety of visual and attentional skills (e.g., [Green, C. S., & Bavelier, D. (2003). Action video game modifies visual selective attention. Nature, 423, 534-537]). The current research sought to replicate and extend these results by examining both expert/non-gamer differences and the effects of video game playing on tasks tapping a wider range of cognitive abilities, including attention, memory, and executive control. Non-gamers played 20+ h of an action video game, a puzzle game, or a real-time strategy game. Expert gamers and non-gamers differed on a number of basic cognitive skills: experts could track objects moving at greater speeds, better detected changes to objects stored in visual short-term memory, switched more quickly from one task to another, and mentally rotated objects more efficiently. Strikingly, extensive video game practice did not substantially enhance performance for non-gamers on most cognitive tasks, although they did improve somewhat in mental rotation performance. Our results suggest that at least some differences between video game experts and non-gamers in basic cognitive performance result either from far more extensive video game experience or from pre-existing group differences in abilities that result in a self-selection effect.