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Gamification and Multimedia for Medical Education: a Landscape Review Lise Mccoy, Edd Joy H

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Gamification and Multimedia for Medical Education: a Landscape Review Lise Mccoy, Edd Joy H MEDICAL EDUCATION Gamification and Multimedia for Medical Education: A Landscape Review Lise McCoy, EdD Joy H. Lewis, DO, PhD David Dalton, DO From the A.T. Still Background: Medical education is rapidly evolving. Students enter medical school University–School of with a high level of technological literacy and an expectation for instructional Osteopathic Medicine in Arizona (Mesa). variety in the curriculum. In response, many medical schools now incorporate tech- nology-enhanced active learning and multimedia education applications. Education Financial Disclosures: None reported. games, medical mobile applications, and virtual patient simulations are together termed gamified training platforms. Support: This project was funded in part by Objective: To review available literature for the benefits of using gamified training a grant from the platforms for medical education (both preclinical and clinical) and training. Also, Health Resources and Services Administration to identify platforms suitable for these purposes with links to multimedia content. (D54HP20674). Methods: Peer-reviewed literature, commercially published media, and grey litera- Address correspondence to ture were searched to compile an archive of recently published scientific evaluations Lise McCoy, EdD, of gamified training platforms for medical education. Specific educational games, A.T. Still University– School of Osteopathic mobile applications, and virtual simulations useful for preclinical and clinical train- Medicine in Arizona, ing were identified and categorized. Available evidence was summarized as it related 5850 E Still Cir, Mesa, to potential educational advantages of the identified platforms for medical education. AZ 85206-3618. E-mail: [email protected] Results: Overall, improved learning outcomes have been demonstrated with vir- tual patient simulations. Games have the potential to promote learning, increase Submitted March 9, 2015; engagement, allow for real-word application, and enhance collaboration. They can final revision received also provide opportunities for risk-free clinical decision making, distance training, August 19, 2015; learning analytics, and swift feedback. A total of 5 electronic games and 4 mobile ap- accepted plications were identified for preclinical training, and 5 electronic games, 10 mobile August 25, 2015. applications, and 12 virtual patient simulation tools were identified for clinical train- ing. Nine additional gamified, virtual environment training tools not commercially available were also identified. Conclusion: Many published studies suggest possible benefits from using gamified media in medical curriculum. This is a rapidly growing field. More research is required to rigorously evaluate the specific educational benefits of these interventions. This archive of hyperlinked tools can be used as a resource for all levels of medical trainees, providers, and educators. J Am Osteopath Assoc. 2016;116(1):22-34 doi:10.7556/jaoa.2016.003 22 The Journal of the American Osteopathic Association January 2016 | Vol 116 | No. 1 MEDICAL EDUCATION amification is “the process of game-thinking landscape of resources, including those designed specifi- and game mechanics to engage users and cally for osteopathic medical training, we hope to iden- Gsolve problems.”1(p.xiv) Advances in education tify a body of gamified learning resources useful as a of preclinical sciences, distance education, gamifica- foundation for an expanding, sharable resource archive tion, and classroom technologies have contributed of new media. to increased emphasis on multiple learning media in higher education.2-4 As a result, over the past 15 years, there have been developments in technology-enhanced Methods active learning and multimedia applications for medical We searched the available literature for scientific evalua- education. Organizations such as the American Asso- tions, reviews, and rigorous validation studies of gami- ciation of Colleges of Osteopathic Medicine and the fied training platforms for medical education. Platforms Association of American Medical Colleges support the were defined as follows: scholarly exchange of ideas regarding gamification for health care training.5,6 ■ Electronic games are “instructional method[s] To meet the needs of the Internet generation,4,5 both requiring the learner to participate in a competitive preclinical and clinical medical training need to evolve activity with preset rules”11(p16) presented in beyond traditional approaches to infuse new tools and electronic formats. media into curriculum.7,8 According to the Horizon re- ■ Medical mobile applications are medical software port,3 the current generation of students must have var- applications used on handheld devices such as ious skill sets to be successful. These skills include personal digital assistants, cell phones, or tablet digital literacy, complex thinking, and creativity. Other devices. Mobile applications are increasingly education experts9 recommend learner-centered ap- used by clinicians as part of medical practice.12 proaches including adaptive, differentiated environments We included those applications particularly useful tailored to individual student needs. Medical students during training exercises. enter their programs with previous experience with video ■ Virtual patient simulations are interactive computer games and Web 2.0 technologies such as mobile applica- simulations of real-life clinical scenarios for tions (often called apps), podcasting, instant messaging, medical training, education, or assessment.13 blogs, wikis, media sharing, and social networking.7,8 These learning exercises provide “situated Educational games, mobile applications, and electronic learning,”14 a process whereby trainees gain simulations may be useful for this generation of medical orientation to a professional culture by participating students.8,10 in activities of the practice through a limited, The current review is a descriptive study of current mentored apprenticeship, gradually assuming gaming resources available for use in medical education. responsibility over time. First, we discuss the potential educational advantages of gamified learning strategies and tools. Second, we To identify education advantages of gamified training present current, established, or published electronic platforms, we used a landscape review methodology medical education games, mobile applications, and vir- used by education innovators to describe the large pic- tual patient simulations (together termed gamified ture and current products available.15 The present study training platforms) suitable for general preclinical and drew upon a range of publicly available literature, in- clinical medical education. By exploring the current cluding independent research, published systematic re- The Journal of the American Osteopathic Association January 2016 | Vol 116 | No. 1 23 MEDICAL EDUCATION views, textbooks on education game instruction, and terials are plentiful and are often used in medical educa- Internet resources. PsychInfo, Ovid, and Medline tion and patient care, bedside care, and point-of-care, searches were conducted using the key words serious mobile applications and programs without gamified ele- games or gamification with medical education or med- ments were excluded. We reviewed each resource and ical students for articles published between 2005 and identified any available evidence related to potential edu- 2015. In addition, we reviewed grey literature such as cational advantages. We independently reviewed each game database websites, webzine articles, executive re- training resource and identified which potential educa- ports, video resources, and material presented at health tional advantage could apply. When there was literature care game conferences. Internet Google searches using to support or document the educational advantages for the terms virtual patient simulation, medical education specific tools, the literature was cited. Additionally, we simulation, medical education games, healthcare educa- identified links to multimedia content so readers may tion games, mobile apps for medical education, and sample gamified learning exercise formats. healthcare apps were conducted to identify additional Using the review techniques described, pilot studies or gamified training platforms. Articles and other materials innovations were also identified. These sources were were included in this landscape review if they presented journal articles that described the development of new valid methods and offered evidence toward the potential media for health care training, but the software or hardware benefits of games for medical education. platforms were not commercially available. These types of Available evidence was summarized as it relates to articles were included to provide a thorough landscape re- potential educational advantages of gamified training view and a glimpse into possibilities for the future. tools for medical education. Potential educational advan- tages were identified as the ability to identify learning outcomes through increased engagement and enhanced Results collaboration. Additional potential educational advan- The field of gamification for medical education is inno- tages included real-world application, clinical decision vative and dynamic. Publication and rigorous validation making, distance training, learning analytics, and swift studies are not yet available for many gamified training feedback. Symbols were chosen to represent each poten-
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