GAMES FOR HEALTH JOURNAL: Research, Development, and Clinical Applications Volume 5, Number 1, 2016 ª Mary Ann Liebert, Inc. DOI: 10.1089/g4h.2015.0028

Gaming Preferences, Motivations, and Experiences of Pharmacy Students in Asia

Huan Ying Chang, BSc (Pharm), Li Lian Wong, PharmD, Kai Zhen Yap, PhD, and Kevin Yi-Lwern Yap, PhD, SRPharmS

Abstract

Objective: Serious games are becoming popular in various healthcare domains. However, they should be designed to cater toward learners’ perspectives, needs, and specifications in order to be used to their full potential in education. This study investigated the gaming experiences, motivations, and preferences of pharmacy students. Materials and Methods: An anonymous self-administered survey obtained participant demographics, gaming experiences (enjoyment level of different game genres, years of experience, gaming frequency and duration, and motivations), and gaming preferences (on in-game rewards, settings, storylines, perspectives, and styles). Descriptive statistics, t tests, analysis of variance, chi-squared tests, and Fisher’s exact tests were used for analysis. Results: The response rate was 69.1 percent (465/673 undergraduates). Role-playing games (RPGs) (4.12 –1.07) and massively multiplayer online RPGs (MMORPGs) (3.81 – 1.26) had the highest enjoyment ratings. Males enjoyed imagination games (e.g., RPGs, MMORPGs) more than females, whereas females enjoyed games more. Top motivating factors for respondents were progressing to the next level (3.63 – 1.19), excitement (3.33 – 1.33), and a feeling of efficacy when playing (3.02 – 1.16). Unlocking mechanisms (25.2 percent) and experience points (17.6 percent) were the most popular in-game reward systems. Most respondents preferred a fantasy/medieval/mythic setting (59.8 percent) and an adventurer storyline (41.3 percent), with similar proportions preferring competitive (35.3 percent), cooperative (33.3 percent), and collaborative (30.8 percent) game styles. Conclusions: Different groups of pharmacy students differ in their gaming experiences, motivating factors, and preferences. There is no ‘‘one size fits all’’ game that is suitable for all pharmacy education. Such differences should be considered when developing a pharmacy game in order to cater to the diverse student population.

Introduction Serious games (electronic games that have a purpose other than to entertain, such as train, instruct, or educate9) have n recent years there has been an increasing interest in become increasingly popular and have been applied to var- Ithe usage of technologies in higher education, due to the ious domains, including education and corporate training.9 shift toward experiential learning.1 Although tertiary students Serious games have also been applied to various healthcare vary widely in their technological proficiencies,2 they gen- domains. Examples include teaching of pediatric content,10 erally have a preference for technology-infused teaching geriatric house calls,11 insulin therapy,12 and team training13 approaches.3 One such approach being explored for higher to medical students and training life support14 and clinical education is ‘‘gamification,’’4 which is ‘‘the use of game skills15 to nursing students. They are not only naturally design elements in non-game contexts.’’5 An example is the motivating, but can also provide a safe, realistic environment Quest to Learn school in New York City, where motivation for students to learn from their mistakes without having to techniques derived from entertainment games are used to experience any negative consequences from their actions.16 stimulate students to solve problems and learn curricular Furthermore, games can also adapt to different learning content.6 Game-based learning, on the other hand, involves styles of students and better cater to their needs.17 the learning of educational objectives through the use of Despite the potential of serious games to enrich healthcare games.7 Besides being used for entertainment, games can students’ learning experiences, it has only been applied in potentially enhance learning through engagement, motiva- pharmacy education recently.18 Web-based , tion, and direct experiences as well.8 such as WebStudies19 and SimPharm,20 have been used in

Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.

40 GAMING PREFERENCES OF PHARMACY STUDENTS 41 pharmacy education. However, these Web-based simulations tivation statements (from 1 = disagree, 2 = slightly disagree, differ from serious games in many aspects, such as the 3 = neutral, 4 = slightly agree, to 5 = agree), and interest level in presence of rules, goals, competition, and other game-like playing a pharmacy-related (from 1 = not inter- elements.21,22 As educators embrace technology-enhanced ested at all, 2 = slightly interested, 3 = moderately interested, education, serious games can potentially be a platform for 4 = very interested, to 5 = extremely interested). Open-ended the education of students. However, serious games cannot be feedback about their gaming preferences were also obtained. used to their full potential in education if they are not de- The survey questions were designed by the study team, and the signed to cater to the target learners’ perspectives, needs, and survey was pretested on a small group of students from the specifications.23,24 Research has shown that prior experience Science Faculty who were not enrolled in the pharmacy of playing videogames is a predictor of the effectiveness of course, to ensure that the questions were understandable by the game-based learning,23 and students’ degree of motivation undergraduate students. can affect learning outcomes.25 Enjoyment and interest also E-mails were sent to the lecturers-in-charge to seek sup- affect motivation and, in turn, learner outcomes.22 It is thus port and permission before the surveys were conducted. The important to consider what students’ experiences, motiva- surveys were then administered in print form by the first tions, and preferences are with regard to videogaming if a author to students between October 2013 and January 2014 game-based learning platform is to be used for education. after their lectures. The rationale of the study was explained As part of the technology-enhanced education initiative before the surveys were distributed. A collection box was advocated at our university, the pharmacy department is placed in front of the lecture hall near the exit for students to considering this form of learning for our students. This study return their surveys when they were leaving the lecture hall. aimed to investigate the gaming experiences, motivations, Participation was voluntary, and students’ completion of the and preferences of pharmacy students. Our hypothesis was survey was considered consent to their participation in the that different cohorts of students would have different study. It was made known to the students that they could gaming experiences, motivating factors, and preferences. withdraw at any point in time. Approval was obtained from the University’s Institutional Review Board. Materials and Methods Statistical analysis Study design The survey results were directly transcribed from the This was a cross-sectional census study involving an anon- hardcopy form into Statistical Package for the Social Sci- ymous self-administered survey to pharmacy undergraduates ences (SPSS) Statistics version 21 software (IBM Corp., at our university. All full-time pharmacy undergraduates were Armonk, NY) by the first author. In order to prevent any eligible. Part-time students, postgraduates, nonpharmacy un- transcribing errors, all the SPSS entries were vetted through dergraduates, and undergraduates not enrolled at our univer- by the transcriber (first author) for the first time and then by sity were excluded. another senior author to ensure that the entries tallied with The survey consisted of 22 questions split into three sec- the hardcopy results. tions. The first section obtained demographic information on Descriptive statistics were used to analyze the data. The gender, race, religion, year of undergraduate study, and pre- respondents were regrouped into categories based on their university education. race, religion, year of study, and pre-university education The second section consisted of questions on gaming ex- before analysis (Fig. 1). The analyses of the Likert-type scale periences, level of enjoyment on different game genres, years questions (level of enjoyment of different game genres, de- of gaming experience, gameplay frequency and duration in the gree of agreement to motivation statements, and level of past 6 months, and gaming motivations. The classification of interest in a pharmacy game) were done using t tests and one- game genres was adapted and modified from the list provided way analysis of variance, using Tukey’s test as the post hoc by Lucas and Sherry.26 Additionally, Wikipedia and online 27–32 test. Chi-squared and Fisher’s exact tests were used to ana- gaming forums were consulted to include other genres, so lyze the associations between demographics and categorical as to provide a comprehensive list of game genres to the gaming variables (e.g., gaming preferences). A confidence survey participants (Supplementary Table S1; Supplementary level of 95 percent was used for all analyses. Data are available online at www.liebertonline.com/g4h). In the analysis of the level of enjoyment of different game The third section obtained respondents’ preferences on genres, respondents who indicated ‘‘0’’ (never played before) in-game reward systems, game settings, storylines, gameplay were excluded from the analysis for that specific game genre. perspectives, and game styles. The competitive game style Participants who had never played games before were also requires players to form strategies against each another, in excluded from the analysis of motivating factors. Respondents contrast to the cooperative and collaborative styles, in which who answered ‘‘did not play videogames in the last 6 months’’ the players work together as a team. However, the players in a were excluded from the analysis of questions regarding their collaborative game style win and lose together as a team, frequency and duration of gameplay in the last 6 months. sharing their payoffs and outcomes, whereas players in a co- However, their responses were included in other analyses that operative game style may not necessary reap equal benefits or did not involve gameplay frequency and duration. suffer equal losses, even though they work together to achieve a win–win condition.33 Respondents were also asked for their Results level of interest in playing a pharmacy-related serious game. Respondents Five-point Likert-type questions were used for questions on their enjoyment level of different game genres (from 1 = The response rate was 69.1 percent (465/673 undergrad- do not enjoy to 5 = enjoy a lot), degree of agreement to mo- uates). Mean age was 21.1 – 3.9 years (range, 19–25 years). 42 CHANG ET AL.

FIG. 1. Summary of the study procedures. ANOVA, analysis of variance; SPSS, Statistical Package for the Social Sciences.

Most were females (63.0 percent) and Chinese (92.7 per- Gaming experiences cent). Most were free thinkers/had no religion (35.1 percent), Of the over three-quarters of the respondents (85.8 per- Buddhists (29.9 percent), and Christians (22.4 percent). cent) who had videogame experiences, half of them (50.9 More respondents were from their lower years (61.9 per- percent) had 9 or more years of experience (Table 2). Over cent). Around two-thirds were from the traditional ‘‘O’’ one-fifth (23.1 percent) played videogames less than six Levels route (69.2 percent), whereas the rest were from the times in the last 6 months, and nearly a third (30.6 percent) Integrated Program (IP) (28.6 percent) (Table 1). Students in had less than 1 hour of gameplay. the traditional ‘‘O’’ Levels route undertake the Singapore- In general, each game genre had been played before by at Cambridge General Certificate of Education (Ordinary Lev- least half of the respondents with videogame experiences. el) (i.e., GCE ‘‘O’’ Level) examination at the end of their Puzzle (97.0 percent) and real-time strategy (57.9 percent) secondary education and can apply to various polytechnics or games had the highest and lowest proportions of respondents pre-university institutions (i.e., junior colleges) in Singapore (Supplementary Tables S2 and S3). Role-playing games based on their results. In contrast, IP students are considered (RPGs) (4.12 – 1.07) and massively multiplayer online RPGs academically stronger and thus follow a 6-year independent (MMORPGs) (3.81 – 1.26) had the highest enjoyment rat- and less-structured program that prepares them for the pre- ings, but card/dice games had the lowest enjoyment rating university examinations at the end of the 6 years.34 (2.35 – 1.24) (Supplementary Tables S4 and S5). GAMING PREFERENCES OF PHARMACY STUDENTS 43

Table 1. Participant Demographics such as for fighter (3.26 – 1.23 versus 2.90 – 1.09; P = 0.006), first-person shooter (3.53 – 1.29 versus 2.84 – 1.24; P < 0.001), Frequency and third-person shooter (3.25 – 1.33 versus 2.62 – 1.18; Demographic parameter ( 465) (%)a n = P < 0.001) games. On the other hand, females enjoyed simula- Gender tion games more (3.63 – 1.21 versus 3.01 – 1.38; P < 0.001) as Male 170 (36.6%) well as social and traditional games (Supplementary Table S3). Female 293 (63.0%) Race Analysis by race Chinese 431 (92.7%) The percentage of Chinese respondents (64.6 percent) who Malay 11 (2.4%) played videogames for 1 hour or more each time in the past 6 Indian 12 (2.6%) months was more than that of non-Chinese respondents (34.8 Others 11 (2.4%) percent) (P = 0.004) (Table 3). Chinese were more likely than Religion non-Chinese to have played games that involved role- No religion/free thinker 163 (35.1%) playing (RPG, 88.4 percent versus 60.7 percent [P < 0.001]; Buddhism 139 (29.9%) MMORPG, 69.5 percent versus 50.0 percent [P = 0.033]) and Christian 104 (22.4%) Minority religions 55 (11.8%) fighting (81.9 percent versus 57.1 percent [P = 0.001]) Catholic 23 (4.9%) (Supplementary Table S2). However, non-Chinese enjoyed Hinduism 2 (0.4%) fighter games more (3.81 – 1.17 versus 3.03 – 1.16; P = 0.009) Islam 16 (3.4%) (Supplementary Table S3). Taoism 13 (2.8%) Other 1 (0.2%) Analysis by religion Current educational level Respondents professing a religion were more likely than free Lower years 288 (61.9%) thinkers to have played simulation games before (84.7 percent Undergraduate Year 1 143 (30.8%) versus 75.7 percent; P = 0.028) (Supplementary Table S4). Undergraduate Year 2 145 (31.2%) Upper years 177 (38.1%) Undergraduate Year 3 81 (17.4%) Table 2. Gaming Experiences Undergraduate Year 4 96 (20.6%) and Habits of Participants Educational track before entering university Traditional GCE ‘‘O’’ Levels route 322 (69.2%) Frequency Gaming parameter (n = 465) (%)a

Integrated Program 133 (28.6%) Leading to GCE ‘‘A’’ Levels 111 (23.9%) Had experience in playing 399 (85.8) Leading to International Baccalaureate 10 (2.2%) videogames Leading to NUS high school diploma 12 (2.6%) Years of experience in playing videogames (n = 399) aPercentages may not add up to 100% due to missing responses. Less than 1 year 34 (8.5%) GCE, General Certificate of Education; NUS, National University 1 year to less than 3 years 44 (11.0%) of Singapore. 3 years to less than 6 years 57 (14.3%) 6 years to less than 9 years 61 (15.3%) 9 years or more 203 (50.9%) Analysis by gender Frequency of videogame playing in the past 6 months Males (93.5 percent) were more likely than females (81.2 (n = 399) percent) to have played videogames before (P < 0.001) (Table 3). Did not play in the last 6 months 68 (17.0%) There were more males (82.4 percent) than females (55.0 Less than 6 times in the last 92 (23.1%) percent) with 6 or more years of gaming experience (P < 0.001). 6 months Similarly, the percentage of males (89.2 percent) who had 1–3 times every month 58 (14.5%) 1–3 times every week 76 (19.0%) played videogames in the past 6 months was higher than that of 4–6 times every week 27 (6.8%) females (78.1 percent) (P = 0.004), as was their frequency (60.8 Once daily 35 (8.8%) percent versus 33.0 percent; P < 0.001) and duration (77.3 More than once daily 37 (9.3%) percent versus 51.1 percent; P < 0.001) of gameplay. Males Duration of videogame playing in the past 6 months were more likely to have played game genres from the physical (n = 399) enactment and imagination categories (P < 0.05 each), with the Did not play in the last 6 months 68 (17.0%) exception of simulation games (P = 0.199) (Supplementary Less than 1 hour 122 (30.6%) Table S2). However, the proportions of male and female re- 1 hour or more, but less than 110 (27.6%) spondents who had played games from the traditional category 3 hours were comparable. 3 hours or more, but less than 52 (13.0%) The top game genres enjoyed by both genders were imagi- 5 hours nation games, of which males (4.44 – 0.87) enjoyed RPGs more 5 hours or more, but less than 15 (3.8%) than females (3.85 – 1.15; P < 0.001). Males also enjoyed sev- 7 hours 7 hours or more, but less than 7 (1.8%) eral other genres of imagination games more, such as action- 9 hours adventure, MMORPGs, real-time strategy, and turn-based 9 hours or more 19 (4.8%) strategy games (Supplementary Table S3). Their enjoyment ratings for physical enactment games were significantly higher, aPercentages may not add up to 100% due to missing responses. 44 CHANG ET AL.

Table 3. Gaming Experiences of Study Participants, Categorized Based on Various Participant Characteristics

Participant characteristics Gender Gaming experience parameter Number of males (%) Number of females (%) P value Played videogames before 159 (93.5%) 238 (81.2%) <0.001 Have 6 or more years of videogaming 131 (82.4%) 131 (55.0%) <0.001 experience Played videogames in the last 6 months 141 (89.2%) 182 (78.1%) 0.004 Played videogames for at least once a 96 (60.8%) 77 (33.0%) <0.001 week or more in the last 6 months Played videogames for 1 hour or more 109 (77.3%) 93 (51.1%) <0.001 each time in the last 6 months

Race Chinese Non-Chinese

Played videogames for 1 hour or more 195 (64.6%) 8 (34.8%) 0.004 each time in the last 6 months

Educational level Lower years Upper years

Played videogames before 258 (89.6%) 141 (79.7%) 0.003

Educational track before entering university Traditional route Integrated program

Have 3 or more years of videogaming 212 (77.7%) 102 (87.9%) 0.019 experience Played videogames in the last 6 months 214 (79.6%) 103 (90.4%) 0.011

However, there were fewer Christians who played arcade (89.1 (Table 3). The IP respondents also had more recent gameplay percent) and platformer (84.8 percent) games (Supplementary experience within the past 6 months (90.4 percent versus Table S2). Free thinkers rated their enjoyment of racing/speed, 79.6 percent; P = 0.011). In general, respondents from the sports, and platformer games with lower scores compared to traditional ‘‘O’’ Levels route enjoyed shooter games better, those professing a religion (Supplementary Table S5), but they whereas those from the IP route enjoyed role-playing–type gave higher enjoyment ratings for classic board games instead games better (Supplementary Table S5). In fact, third-person (2.68– 1.32 versus 2.38– 1.23; P = 0.037). shooter games were preferred more by respondents from the traditional route (3.07 – 1.26 versus 2.71 – 1.34; P = 0.044), Analysis by year of study whereas MMORPGs were preferred more by the IP re- spondents (4.14 – 1.06 versus 3.67 – 1.31; P = 0.002). There were more respondents from the lower years than upper years with videogaming experiences (89.6 percent versus 79.7 percent; P = 0.003) (Table 3). In particular, they played Motivating factors imagination games more than their upper year counterparts, The top three motivating factors for respondents were especially adventure (81.4 percent versus 72.3 percent; P = progressing to the next level (3.63 – 1.19), excitement from 0.036), action-adventure (76.0 percent versus 63.1 percent; the game (3.33 – 1.33), and a feeling of efficacy when playing P = 0.007), and turn-based strategy (68.1 percent versus 56.7 (3.02 – 1.16) (Supplementary Tables S6 and S7). Male re- percent; P = 0.024) games (Supplementary Table S4). They spondents showed a higher level of agreement with most of also rated RPGs (4.20 – 1.05 versus 3.96 – 1.10; P = 0.044) and the motivating factors, except finding it rewarding to MMORPGs (3.91 – 1.24 versus 3.59 – 1.27; P = 0.045) higher progress to the next level (P = 0.964), which was equally in terms of enjoyment (Supplementary Table S5). motivating for both genders (Supplementary Table S6). The motivating factors for males (ratings >3.00), but Analysis by pre-university educational track not females (ratings p3.00), were experiencing a feeling The proportion of IP respondents (87.9 percent) who had 3 of efficacy (P < 0.001), experiencing a lot of freedom or more years of videogaming experience was higher than (P = 0.001), feeling capable and effective (P < 0.001), those from the traditional route (77.7 percent) (P = 0.019) spending time with friends (P < 0.001), and finding it GAMING PREFERENCES OF PHARMACY STUDENTS 45 rewarding to help other players in the game (P = 0.001). systems less (6.2 percent versus 13.0 percent; P = 0.032) Males were generally more motivated than females by the (Supplementary Table S10). The former group also preferred a excitement of videogaming (3.73 – 1.14 versus 3.06 – 1.37; historical game setting (10.2 percent versus 4.9 percent; P < 0.001). P = 0.033). Among the different religions, there were more Christians (17.6 percent) who preferred science fiction settings Gaming preferences than free thinkers (7.6 percent) (P = 0.014) and Buddhists (6.7 percent) (P = 0.008) (Supplementary Table S9). In terms of gaming parameters (Supplementary Table S8), unlocking mechanisms (25.2 percent) and experience points Analysis by year of study (17.6 percent) were the most popular in-game reward sys- and pre-university educational track tems (Supplementary Table S9). Most respondents preferred a fantasy/medieval/mythic setting (59.8 percent) and an ad- The interest level for playing a pharmacy game was higher venturer storyline (41.3 percent). Similar proportions pre- among respondents in their lower years than those in their ferred three-dimensional third person (34.8 percent) and upper years (mean scores, 3.18 – 1.20 versus 2.68 – 1.23; two-dimensional side-scrolling (34.0 percent) perspectives. P < 0.001). Students from the traditional ‘‘O’’ Levels (38.9 There was no preference for game styles, with a third pre- percent) also preferred a competitive game style compared ferring competitive (35.3 percent), cooperative (33.3 per- with IP students (27.1 percent) (P = 0.017). cent), and collaborative (30.8 percent) game styles. A moderate level of interest existed among the respondents for Discussion playing a pharmacy game (mean score, 2.99). This study has managed to identify the gaming experi- ences, motivations, and preferences of pharmacy students in Analysis by gender Singapore. The majority had at least 3 years of videogaming A higher percentage of males than females preferred ex- experience. The common reason given by those who did not perience points (27.1 percent versus 15.7 percent; P = 0.005) play videogames was due to lack of interest. Not surpris- and item grants (11.0 percent versus 4.7 percent; P = 0.017) ingly, those with gaming experience had only played inter- as their in-game reward systems (Supplementary Table S9). mittently and for short durations in the 6 months prior to On the other hand, the most preferred reward system among doing the survey. The reason given was lack of time due to females was unlocking mechanisms (36.2 percent versus schoolwork because this period had coincided with the uni- 16.1 percent; P < 0.001). versity’s academic semester. The most preferred game setting and storyline for both A gender divide existed among pharmacy students in terms

genders were a fantasy/medieval/mythic setting (60.9–63.9 of gaming experiences. Our results showed that males had percent) and an adventurer storyline (36.5–45.9 percent). higher gameplay frequency and duration, which concurred However, more males preferred a historical setting (10.8 with the literature.35–37 Furthermore, as with previous stud- percent versus 4.6 percent; P = 0.012) and war-themed ies,26,38 male respondents in our study were also more moti- (24.6 percent versus 4.2 percent; P < 0.001) or heroic/sav- vated to play videogames than females. An equally high ing humanity (20.4 percent versus 12.0 percent; P = 0.017) proportion of both genders found it rewarding to progress to storyline, in contrast to females who preferred a modern the next level, suggesting that they were equally motivated by setting (23.8 percent versus 11.4 percent; P = 0.001) and challenge.26 However, social interaction was a top motivating spy/secret agent storyline (35.7 percent versus 15.0 percent; factor for males, but not females, probably because males P < 0.001). Half of the males preferred a three-dimensional perceived videogaming as an appropriate activity39 and thus third person game perspective (55.6 percent versus 22.9 were more likely to engage in gaming as a social activity.26 percent; P < 0.001), whereas a similar proportion of females Our results also identified that female students did not prefer preferred a two-dimensional side-scrolling perspective traditional games more than other game genres, even though (48.1 percent versus 10.1 percent; P < 0.001). Females were they enjoyed traditional games more than males.26,40 In fact, more open to competitive game styles (39.0 percent versus the top game genres enjoyed by females were games from the 29.6 percent; P = 0.041) compared with males, who pre- imagination category, such as RPGs/MMORPGs, adventure ferred to play more cooperatively (39.6 percent versus 30.1 games, and simulation games. They could have been more percent; P = 0.037). technologically savvy and exposed more widely to different genres of videogames because Singapore has a well-built Analysis by race digital infrastructure with the majority of households having Internet access.41 Furthermore, females preferred a two- Fantasy/medieval/mythic settings were preferred more by dimensional side-scrolling perspective, probably because such Chinese (63.8 percent) than non-Chinese respondents (38.7 games do not have confusing or complex views or mecha- percent) (P = 0.005). An equal proportion of non-Chinese nisms42–44 and thus are generally easier to see and control. also liked modern settings for the pharmacy game (38.7 per- Interestingly, Chinese respondents preferred games with cent), which was double that of Chinese respondents (17.7 fantasy/medieval/mythic settings, but non-Chinese respon- percent) (P = 0.004) (Supplementary Table S9). dents preferred games with modern settings. Furthermore, there were several differences in the gaming preferences of Analysis by religion respondents professing various religions. The Chinese re- Free thinkers (35.9 percent) preferred an unlocking mech- spondents’ preference for fantasy games could be influenced anism reward system more than respondents professing a by the rich Chinese culture of folklore and mythology, which religion (24.9 percent) (P = 0.019) but preferred achievement includes mythical creatures such as dragons.45 Our results 46 CHANG ET AL. also concur with other studies that showed differences in demic and enrichment activities,48,49 of which these charac- gaming preferences and emotional experiences of people teristics are also reflected in multiplayer role-playing–type from different religious groups.46,47 However, caution games. should be taken when extrapolating these results to other The results of this survey have enabled our team to design populations, as there was an under-representation of non- a longitudinal pharmacy-related serious game for students Chinese and certain religions in our respondent pool. entering the pharmacy course (i.e., lower year undergradu- Lastly, IP students enjoyed role-playing–type games more ates) at our institution. We are currently in the process of than students from the traditional route, of whom the latter designing the game storyboards, which will be a multiplayer enjoyed shooter games more. The competitive nature of the online strategy RPG that students will play as part of their traditional route, where students sit for the national GCE curriculum. The intended duration of gameplay will stretch ‘‘O’’ Levels examination to determine their postsecondary over several weeks, and students can play both at home and education,34 may have influenced the respondents’ prefer- as part of their module. ence for the more individualistic shooter games, as well as a In the RPG, students will play as pharmacist avatars in a more competitive game style. In contrast, the more inde- three-dimensional environment in order to save humankind pendent and less-structured nature of the integrated program from a man-eating superbug (i.e., adventurer/saving hu- implies that IP students are more exposed to collaboration, manity storyline). The game is set in a futuristic postapoc- teamwork, and interactions through their engagement in aca- alyptic world (i.e., modern setting with a fantasy element)

FIG. 2. Summary of the game design process. 3D, three-dimensional. GAMING PREFERENCES OF PHARMACY STUDENTS 47 where students will face various simulated encounters at a females preferred a two-dimensional side-scrolling per- mock pharmacy, where they have to assess patients (auto- spective with an unlocking mechanism reward. There is no mated nonplayer avatars) subjectively and objectively ‘‘one size fits all’’ game that is suitable for all pharmacy through visual and audio cues, as well as communicate students. Differences in gaming motivations, experiences, through a series of questions in the attempt to find out and preferences should be taken into account when devel- more about the patients’ medical conditions. They will then oping a pharmacy game, so that it can better cater to the provide an appropriate assessment of the patients and ther- diverse student population. apeutically sound management plans—through a pharma- cotherapeutic approach taught in our curriculum known as Acknowledgments SOAP (subjective, objective, assessment, plan). In order to provide an authentic learning experience that will fulfill the The authors would like to thank the lecturers (Ms. Mui module objectives, the patient (nonplayer) avatars will react Ling Tan, Dr. Nancy Ko, and Prof. Paul Ho) and the de- dynamically to the questions posed by the student pharma- partment administration manager (Ms. Ying Ying Chew) for cists throughout the patient encounters. In the simulations, their help and permission to administer the surveys to the students will also be able to pick, pack, and dispense med- pharmacy undergraduates. The printing of surveys in this ications or to collect suitable ingredients to prepare ex- project was sponsored by the Final Year Project fund by the temporaneous preparations, with the aid of the visual and Department of Pharmacy, Faculty of Science, National motion capture sensors. University of Singapore. This project is part of a larger study Students play the game in groups of 8–10, where they have supported by the Learning Innovation Fund–Technology to work cooperatively, collaboratively, and competitively (as (grants C-148-000-038-001 and C-051-000-028-511) awarded individuals and in teams) in order to complete the patient by the National University of Singapore for enabling encounters and solve various ‘‘mini-tasks’’ throughout the technology-enhanced learning at the university. game. Students will be able to select their player avatars from a total of six characters. In order to encourage teamwork, Author Disclosure Statement each of the characters has a ‘‘special ability’’ (e.g., super speed, ability to operate certain equipment) to aid his or her No competing financial interests exist. team in certain tasks during gameplay. On the other hand, each character also has a ‘‘weakness’’ (e.g., decreased vi- References tality, more easily seen by enemies) that will require him or 1. De Freitas S, Rebolledo-Mendez G, Liarokapis F, et al. her to depend on other members of the team to complete the Learning as immersive experiences: Using the four- tasks. Other gaming elements to be incorporated into this dimensional framework for designing and evaluating im- game also follow the student preferences obtained from this mersive learning experiences in a virtual world. Br J Educ study, such as including experience points, unlocking Technol 2010; 41:69–85. mechanisms (e.g., new areas to explore), and item grants 2. Jones C, Shao B. 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