Educational games for health professionals

  • Review
  • Intervention

Authors


Abstract

Background

The use of games as an educational strategy has the potential to improve health professionals' performance (e.g. adherence to standards of care) through improving their knowledge, skills and attitudes.

Objectives

The objective was to assess the effect of educational games on health professionals' performance, knowledge, skills, attitude and satisfaction, and on patient outcomes.

Search methods

We searched the following databases in January 2012: MEDLINE, AMED, CINAHL, Cochrane Central Database of Controlled Trials, EMBASE, EPOC Register, ERIC, Proquest Dissertations & Theses Database, and PsycINFO. Related reviews were sought in DARE and the above named databases. Database searches identified 1546 citations. We also screened the reference lists of included studies in relevant reviews, contacted authors of relevant papers and reviews, and searched ISI Web of Science for papers citing studies included in the review. These search methods identified an additional 62 unique citations for a total of 1608 for this update.

Selection criteria

We included randomized controlled trials (RCT), controlled clinical trials (CCT), controlled before and after (CBA) and interrupted time-series analysis (ITS). Study participants were qualified health professionals or in postgraduate training. The intervention was an educational game with "a form of competitive activity or sport played according to rules".

Data collection and analysis

Using a standardized data form we extracted data on methodological quality, participants, interventions and outcomes of interest that included patient outcomes, professional behavior (process of care outcomes), and professional's knowledge, skills, attitude and satisfaction.

Main results

The search strategy identified a total of 2079 unique citations. Out of 84 potentially eligible citations, we included two RCTs. The game evaluated in the first study used as a reinforcement technique, was based on the television game show "Family Feud" and focused on infection control. The study did not assess any patient or process of care outcomes. The group that was randomized to the game had statistically higher scores on the knowledge test (P = 0.02). The second study compared game-based learning ("Snakes and Ladders" board game) with traditional case-based learning of stroke prevention and management. The effect on knowledge was not statistically different between the two groups immediately and 3 months after the intervention. The level of reported enjoyment was higher in the game-based group.

Authors' conclusions

The findings of this systematic review neither confirm nor refute the utility of games as a teaching strategy for health professionals. There is a need for additional high-quality research to explore the impact of educational games on patient and performance outcomes.

Résumé scientifique

Jeux éducatifs pour les professionnels de santé

Contexte

L'utilisation de jeux en tant que stratégie éducative peut potentiellement améliorer les performances des professionnels de santé (ex. : respect des normes de soins) en améliorant leurs connaissances, leurs compétences et leurs comportements.

Objectifs

L'objectif était d'évaluer les effets des jeux éducatifs sur les performances, les connaissances, les compétences, le comportement et la satisfaction des professionnels de santé ainsi que sur les résultats des patients.

Stratégie de recherche documentaire

Nous avons utilisé une stratégie de recherche documentaire exhaustive incluant une recherche électronique dans les bases de données suivantes : DARE, registre EPOC, CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, ERIC et Dissertation Abstracts Online (date de la recherche : janvier 2007). Nous avons également étudié les références bibliographiques des études incluses et des revues pertinentes, contacté les auteurs des revues et articles appropriés et consulté ISI Web of Science pour identifier les articles qui citaient les études incluses dans la revue.

Critères de sélection

Nous avons inclus des essais contrôlés randomisés (ECR), des essais cliniques comparatifs (ECC), des études contrôlées avant-après et des analyses de séries chronologiques interrompues. Les participants étaient des professionnels de santé qualifiés ou des stagiaires de troisième cycle. L'intervention était un jeu éducatif offrant « une forme d'activité compétitive ou sportive impliquant le respect de certaines règles ».

Recueil et analyse des données

À l'aide d'un formulaire de données standardisé, nous avons extrait les données relatives à la qualité méthodologique, aux participants, aux interventions et aux résultats d'intérêt, qui incluaient les résultats des patients, le comportement professionnel (résultats du processus de soins), ainsi que les connaissances, les compétences, l'attitude et la satisfaction des professionnels.

Résultats principaux

La stratégie de recherche documentaire a permis d'identifier 1 156 citations. Sur 55 citations potentiellement admissibles, un ECR a été inclus. La qualité méthodologique était acceptable. Le jeu, utilisé comme technique de renforcement, était basé sur le jeu télévisé « Une famille en or » et portait sur la prévention de l'infection. L'étude n'évaluait pas les résultats des patients et des processus de soins. Le groupe randomisé pour le jeu obtenait des scores statistiquement supérieurs lors de l'examen des connaissances (P = 0,02).

Conclusions des auteurs

Les résultats de cette revue systématique ne sont pas suffisants pour étayer ou réfuter l'utilité des jeux en tant que stratégie éducative pour les professionnels de santé. D'autres recherches de haute qualité sont nécessaires pour étudier l'impact des jeux éducatifs sur les résultats des patients et des performances.

Plain language summary

Educational games to improve health care professional practice and care for patients

There have been many ways developed to improve how health care professionals care for their patients. One way is to use games to improve their knowledge and skills, and change their attitudes and performance. This review found two eligible studies. The first study evaluated a game based on the TV show Family Feud and taught about infection control. The second study evaluated the use of a "Snakes and Ladders" board game in continuing medical education on stroke prevention and management. The two studies did not consistently show a beneficial effect on knowledge. We are therefore very uncertain whether games improve health care professional practice or patient care.

Résumé simplifié

Des jeux éducatifs pour améliorer les pratiques des professionnels de santé et les soins des patients

De nombreuses méthodes ont été développées pour améliorer les soins offerts par les professionnels de santé. Cela consiste notamment à utiliser des jeux pour améliorer leurs connaissances et leurs compétences et modifier leurs comportements et leurs performances. Cette revue n'a identifié qu'une seule étude admissible qui évaluait un jeu portant sur la prévention de l'infection créé sur le modèle du jeu télévisé Une famille en or. Nous ignorons donc si les jeux peuvent améliorer les pratiques des professionnels de santé ou les soins des patients.

Notes de traduction

Traduit par: French Cochrane Centre 5th March, 2013
Traduction financée par: Ministère du Travail, de l'Emploi et de la Santé Français

எளியமொழிச் சுருக்கம்

ஆரோக்கிய பராமரிப்பு வல்லுநர் பயிற்சிமுறை மற்றும் நோயாளிகளுக்கான பராமரிப்பை மேம்படுத்துவதற்கு கல்வியியல் விளையாட்டுகள்

ஆரோக்கிய பராமரிப்பு வல்லுநர்கள் எவ்வாறு அவர்களின் நோயாளிகளின் பராமரிப்பை மேம்படுத்தலாம் என்பதற்கு பல வழிகள் உருவாக்கப்பட்டுள்ளன. அவர்களின் அறிவு மற்றும் திறன்களை மேம்படுத்த மற்றும் அவர்களின் மனப்பான்மை மற்றும் செயல்திறனை மாற்றுவதற்கு விளையாட்டுகளை பயன்படுத்துவது ஒரு வழியாகும். இரண்டு தகுதியுடைய ஆய்வுகளை இந்த திறனாய்வு கண்டது. முதல் ஆய்வு, பேமிலி பாய்ட் என்ற ஒரு தொலைக்காட்சி நிகழ்ச்சியை அடிப்படையாக கொண்டு நோய் தொற்று கட்டுப்பாட்டை பயிற்றுவித்த ஒரு விளையாட்டை மதிப்பிட்டது. இரண்டாவது ஆய்வு, "பாம்புகள் மற்றும் ஏணிகள்" (பரமபதம்) அட்டை விளையாட்டை பக்கவாத தடுப்பு மற்றும் மேலாண்மைக்கான தொடர் மருத்துவ கல்விக்கு பயன்படுத்தியதை மதிப்பிட்டது. இரண்டு ஆய்வுகளும், அறிவின் மேல் ஒரு நிலைப்பட்ட நன்மையான விளைவை காட்டவில்லை. ஆதலால், ஆரோக்கிய பராமரிப்பு வல்லுநர் பயிற்சிமுறை அல்லது நோயாளி பராமரிப்பை கல்வியியல் விளையாட்டுகள் மேம்படுத்துமா என்பது பற்றி நாங்கள் வெகுவாக நிச்சயமற்று உள்ளோம்.

மொழிபெயர்ப்பு குறிப்புகள்

மொழி பெயர்ப்பாளர்கள்: சிந்தியா ஸ்வர்ணலதா ஸ்ரீகேசவன், தங்கமணி ராமலிங்கம், ப்ளசிங்டா விஜய், ஸ்ரீகேசவன் சபாபதி.

Summary of findings(Explanation)

Summary of findings for the main comparison. 
  1. 1 Downgraded for risk of bias due to concerns about lack of reporting about concealment and blinding.

    2 Downgraded for risk of bias due to lack of reporting about concealment, randomization and blinding of outcome assessors.

    3 Downgraded for small sample size despite the statistically significant results.

Educational games compared with no educational games for health professionals

Patient or population: Health professionals

Settings: Independent practice or postgraduate training

Intervention: Educational games

Comparison: No educational games

OutcomesImpactNo of Participants
(studies)
Quality of the evidence
(GRADE)
Patient outcome-No data-
Professional behavior (process of care outcomes)-No data-
Knowledge

One study found a statistically significant increase in main effect of knowledge retention (delayed post-test score) in the gaming reinforcement group compared with the control group (p=0.02)

In another study, the game-based group scored 0.3 points (out of 40) lower than the case-based group (P = 0.83; lower limit of 95% CI -2.5) three months post intervention

308 (2)⊕⊕⊝⊝1
low due to risk of bias and imprecision
SatisfactionStatistically significant higher proportions of participants in the game-based group compared to the case-based group strongly agreed that the event was enjoyable (94% vs. 53%; p = 0.02), that their attention was high throughout the event (88% vs. 41%; p = 0.012), and that they would register for a similar event in the future (82% vs. 41%; p = .034).35 (1)

⊕⊕⊝⊝2,3
low

due to risk of bias and imprecision

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Background

Description of the intervention

An educational game is "an instructional method requiring the learner to participate in a competitive activity with preset rules" (Fitzgerald 1997). It is a type of experiential learning where the learner "engages in some activity, looks back at the activity critically, abstracts some useful insight from the analysis and puts the results to work" (Pfeiffer 1980). It differs from other educational interventions in its competitive nature and the use of prescribed settings constrained by rules and procedures (Allery 2004). Furthermore, the use of educational games includes a variety of activities including teaching, training, practicing skills, long-range planning, research, operational analysis, entertainment, and theory building (Gordon 1970; Shubik 1989).

How the intervention might work

With educational games, the learners have an opportunity to experiment with decision-making and problem-solving in a risk-free, active learning environment (Clark 1976; Taylor 1972; Walljasper 1982). They learn through their own actions and through their interactions with others (Corbett 1982; Joyce 1986). They benefit both from participating in the game and from discussions that follow (Boocock 1968; Hankinson 1987; Thatcher 1990).

By allowing active learning experiences, educational games stimulate higher thinking such as analysis, synthesis, and evaluation (Bonwell 1991). They make the learning process fun and exciting and reduce stress and anxiety (Calliari 1991; Gruending 1991), which in turn may increase retention (Stern 1989). They also can generate useful points of departure for discussion (Walljasper 1982).

The use of educational games is supported by the four principles of Knowles' theory of adult learning (Knowles 1970).

  1. Adults are autonomous and self-directed; games give the learner active control of learning which can promote learner's independence.

  2. Adult's past experiences become a resource for learning; games facilitate this process as feedback is given to learners by peers based on their past experiences (Crancer 1980).

  3. Adults are goal-oriented; organized games with clearly defined elements help adults attain their learning goals.

  4. Adult learning is problem-centred rather than content-oriented; games allow students to apply their knowledge in a situation that resembles real life problems.

School teachers have been creating and using educational games to teach different content areas to students of different grade levels (e.g. math, arts, languages) (Ormiston 2001). Similarly, business and management education has a long history with educational gaming (Wolfe 1993). The 2006 Horizon Report identified educational gaming as an emerging technology likely to have a large impact on teaching, learning, or creative expression within higher education over the next 2-3 years (Horizon Report 2006).

Health educators have also been using educational games to confer knowledge and improve skills of their learners. Ogershok et al used the board game format to further students learning during a paediatric clerkship. The game included 400 questions derived from core paediatric textbooks. The results of a post game survey showed positive feedback from medical students, paediatric residents and faculty (Ogershok 2004). In a paediatric residency training program, D'Alessandro et al. used the format of the television game show "Jeopardy!" and questions derived from concurrent paediatric journals issues (D'Alessandro 2002). Residents reported an increase in the time they spend reading and evaluated the educational intervention positively. Kenny reported on the "six hats game" to aid nursing students in critical thinking and reflection in palliative care (Kenny 2003). After reviewing a case study, the student discusses the case from the perspective of the hat she is wearing (each hat is associated with a way of thinking such as information, benefits, caution, etc.).

Why it is important to do this review

The 2004 Games for Health Conference highlighted the potential applications of educational games to patient care, health education, health policy, and health management fields. (Howell 2005). Specifically, educational games have the potential to improve health professionals' performance (e.g. adherence to clinical practice guidelines) through improving their knowledge, skills and attitudes.

Objectives

The objective was to assess the effect of educational games on health professionals' performance, knowledge, skills, attitude and satisfaction, and on patient outcomes.

Methods

Criteria for considering studies for this review

Types of studies

We included randomized controlled trials (RCT), controlled clinical trials (CCT), controlled before and after studies (CBA) and interrupted time-series analyses (ITS).

Types of participants

Study participants were qualified health professionals, graduated or enrolled in additional postgraduate training.

Types of interventions

The main intervention was an educational game defined as "an instructional method requiring the learner to participate in a competitive activity with preset rules". Commonly known types of educational games are the social and cooperative games such as board games (e.g. Trivial Pursuit®) and games based on television game shows (e.g. Jeopardy!©). Our review did not cover role playing interventions or simulations, which are strategies to replicate real situations with guided experiences in a fully interactive way (e.g. endoscopy or CPR simulation).

The control group could have received any of the following:

  1. no intervention;

  2. standard educational activity;

  3. untargeted activity;

  4. other (e.g. another intervention).

Types of outcome measures

Primary outcomes

Patient outcomes, professional behavior (process of care outcomes).

Secondary outcomes

Professional's knowledge, skills, attitude and satisfaction.

Search methods for identification of studies

Related systematic reviews were identified by searching the Database of Abstracts of Reviews of Effectiveness (DARE) and the databases listed below. Studies were identified using the following bibliographic databases, sources, and approaches. We searched databases from their start date to January 3, 2012. We did not limit by language. For this update database searches identified 1546 unique citations; reference list and cited reference searching identified an additional 62 citations for a total of 1608 citations. For the original review we identified and screened 1019 citations. In total we have identified and screened 2087 (1608 +1019) citations for this review.

Databases

AMED (Allied & Complementary Medicine), OVID [1985-]

The Cochrane Central Register of Controlled Trials (CENTRAL) 2011, Issue 12, part of the The Cochrane Library. www.thecochranelibrary.com

Cumulative Index to Nursing and Allied Health Literature CINAHL, EbscoHost [1980-]

Dissertations and Theses, ProQuest [1861-]

ERIC (Educational Resources Information Center), Proquest [1966-]

EPOC Specialised Register, Reference Manager

EMBASE, OVID [1947-]

MEDLINE, OVID [1948-, In-Process]

PsycInfo, OVID [1806-]

Additional studies were identified as follows:

Electronic searches

We revised search strategies for this update to broaden the scope of our search for evidence. To test the efficacy of the revised search strategy we created a gold standard set of relevant studies, using the included and excluded studies from the original review. The revised strategy identified all citations in the gold standard set and, as such, was considered valid. The revised strategy was written for OVID Medline and then translated for other databases. Revised strategies are available in Appendix 1 and original search strategies used in the 2008 review are in Appendix 2.

For the period 2007 to January 3, 2012 we ran the revised search strategies without methodological filters; we did this to increase the sensitivity of our search for the most recent evidence. For the retrospective, pre-2007, search, however, we applied methodological filters (Appendix 3). We made this decision in order to finish this update in a reasonable time frame. The remaining, unfiltered results from the retrospective search will be screened for the next update of this review. If we find no relevant studies in the unfiltered search results, we will use methodological filters for subsequent searching.

The terms used in our search strategies include controlled vocabulary such as MeSH "play and playthings" and "games, experiential," and a reasonably comprehensive set of game show and game names such as: Jeopardy, Family Feud, and Wheel of Fortune. Although our population of interest is the practicing or post-graduate health professional, we included terms for students and undergraduate health education in order to cast as wide a net as possible in our search for studies.  

Searching other resources

We also used the following approaches:

  • Reviewed reference lists of relevant systematic reviews or other publications.

  • Contacted authors of relevant studies or reviews to clarify reported published information or seek unpublished results/data.

  • Contacted researchers with expertise relevant to the review topic or EPOC interventions. 

  • Conducted cited reference searches on studies selected for inclusion in this review, studies cited in related reviews, and other relevant citations in ISI Web of Science/Web of Knowledge.

Data collection and analysis

Selection of studies

Two reviewers independently screened the title and abstract of identified articles for potential eligibility. We retrieved the full text of articles judged potentially eligible by at least one reviewer. Two reviewers then independently screened the full text article for eligibility. The two reviewers resolved their disagreements by discussion. We excluded duplicate reports. We included abstracts only if investigators supplied us with full reports of their methods and results. As mentioned above, we also identified studies involving students but did not include them in this review

Data extraction and management

We developed a data extraction form as a modified version of the EPOC data checklist.

We extracted the following information about the game under investigation: type (e.g. alternative reality game, social and cooperative play), whether rules were clearly described, material needed (e.g. audiovisual), educational content (subject, source of information, quality of information), context and location, duration, intensity, costs (both human resource and financial), challenges to implementation, and whether or not the authors stated clearly the learning objectives. We extracted similar information about the intervention in the control group. Two reviewers independently extracted the data from each study and resolved their disagreements by discussion or by consulting a third reviewer. We contacted the authors for incompletely reported data. We included abstracts only if investigators supplied us with full reports of their methods and results.

Assessment of risk of bias in included studies

Two reviewers independently assessed the methodological quality of each study and resolved their disagreements by discussion. We followed EPOC quality criteria for RCT, CCT, CBA and ITS. We also used five quality domains identified by Beach et al, (Beach 2004) recommended for educational interventions (Reed 2005):

  • representativeness of targeted health care providers or patients or both;

  • potential for bias and confounding;

  • description of interventions;

  • outcomes assessment;

  • analytic approach.

Data synthesis

We did not conduct any meta-analyses because we included only two studies reporting on different types of games in this systematic review. We do, however, report the relevant quantitative analyses of both papers.

Our plan for data analysis for future updates is as follows:

In the primary analyses we will analyse dichotomous process measures. Where studies report more than one measure for each endpoint, we will abstract data for the primary measure as defined by the authors of the study. If the authors do not define any variable as the primary one, we would rank the effect sizes for the five variables and take the median value.

Where possible we will use a standard method of presentation of results for all comparisons. For comparisons of RCTs, CCTs, CBAs we will report (separately for each study design):

  • Median effect size across included studies

  • Inter-quartile ranges of effect sizes across included studies

  • Range of effect sizes across included studies

Reanalysis of RCTs, quasi-RCTs and CBAs with potential unit of analysis errors: comparisons that randomise or allocate clusters (professionals or health care organisations) but do not account for clustering during analysis have 'potential unit of analysis errors' resulting in artificially extreme p-values and over narrow confidence intervals (Ukoumunne 1999). We will attempt to reanalyze studies with potential unit of analysis errors if information is available on the size/number of clusters and the value of the intra cluster correlation coefficient in addition to the outcome data ignoring the cluster design. If a comparison is re-analysed then the p-value will be quoted and annotated with 'reanalyzed'. If this is not possible, we will report only the point estimate.

Reanalysis of ITS comparisons with inappropriate analysis: we will use time series regression to re analyse each comparison (where possible). We will estimate the best fit pre-intervention and post-intervention lines using linear regression and autocorrelation adjusted for using an appropriate method (Draper 1981). First order autocorrelation will be tested for statistically using the Durbin-Watson statistic and higher order autocorrelations will be investigated using the autocorrelation and partial autocorrelation function.

In the secondary analyses, we will explore consistency of primary analyses with other types of endpoints (for example continuous process of care measures; dichotomous outcome of care measures and continuous outcome of care measures). We will calculate standardised effect sizes for continuous measures by dividing the difference in mean scores between the intervention and comparison group in each study by an estimate of the (pooled) standard deviation. This results in a "scale free" estimate of the effect for each study, which can be interpreted and pooled across studies regardless of the original scale of measurement used in each study (Laird 1990).

In order to explore heterogeneity, we will prepare tables and bubble plots comparing effect sizes of studies grouped according to potential effect modifiers (characteristics of the educational game, complexity of behaviour and quality of comparisons).

We will calculate the agreement between the two reviewers for the assessment of eligibility, and methodological quality using a weighted κ statistic.

Results

Description of studies

See: Characteristics of included studies; Characteristics of excluded studies.

Results of the search

For this update, we screened 1608, excluded 1524 during title/abstract screening and assessed the remaining 84 in full-text. After full-text screening, we identified one new study, Telner 2010, for inclusion. For the original review , we screened 1019 citations and identified one study, Burke 2001 for inclusion. See Figure 1.

Figure 1.

PRISMA flow diagram.

Included studies

The first included study (Burke 2001) compared training strategies in the setting of an infection control educational program. The author used a factorial design to compare a self-learning module to video tape as the initial training strategy and gaming (intervention) to no intervention as the reinforcement strategy one month later.

The participants included 273 healthcare workers (excluding office staff and administrators) in a small community acute care hospital in the US. The mean age of participants was 39.7 years (SD=11.0) and 82% were females.

The intervention consisted of a self-learning module developed by a hospital safety committee. The videotapes were commercially prepared. The educational content included topics such as blood borne pathogens, proper handwashing techniques and isolation precautions. The game was based on the television game show "Family Feud", a social and cooperative game. The television game show that puts two families against each other in a contest to name the most popular responses to a survey-type question posed of 100 people. Team members discuss the question amongst them before answering it. The game has elements of fun and competition. The author provided a clear and detailed description of the game's rules. The study author served as facilitator for both the intervention and the control groups. The "winning team" received no monetary or other reward. Running the game required two tables, two bells, an overhead projector and a large projection screen. The educational content focused on infection control but the author did not report the source of information. Although not clearly reported, it is likely that the intervention took place in the hospital. The game was played once. The author did not report the duration of the game, the training needed for the teacher, its specific learning objectives, its costs or any challenges to its implementation.

The study outcome was the retention of knowledge (knowledge test with 20 true-false and multiple choice questions administered 3 times in the following sequence: pre-test; initial training; post-test; reinforcement; delayed post-test). The author assessed no patient or process of care outcomes.

The second included study (Telner 2010) was an equivalence trial with a cluster randomized design.

The study subjects consisted of three senior family medicine residents and thirty-two family physicians participating in a continuing medical education event during the annual meeting of the Ontario College of Family Physicians in Toronto in Ontario, Canada. The event focused on the prevention and the management of stroke.

The intervention consisted of a one-hour session during which a team of six physicians (total of three teams participated in the study) played a game based on the "Snakes and Ladders" board game. Each team read and discussed the questions. A neurologist was available to answer questions and a trained moderator facilitated the game by keeping the time and answering to the game related questions. The investigators developed 22 true-or-false and multiple-choice questions from the "Changing Dynamics of Stroke Prevention and Management", a nationally accredited educational workshop.

The comparison group received one hour session during which a team of five to six physicians (total of three teams participated in the study) received conventional case-based learning. A neurologist was available to answer questions and a trained facilitator was involved. Both groups viewed a 30-minute videotaped lecture by a neurologist on stroke prevention and management before receiving the one hour session.

The first outcome was a knowledge test administered immediately after the learning activity and three months later. The test contained 40-item multiple-choice knowledge questions, including 20 free-standing questions and four clinical vignettes. All questions were reviewed by a group of family physicians and a neurologist, and covered the content of the game-based and case-based sessions. The three month posttest contained the same questions and answer options but presented in different order.

The second outcome was a satisfaction questionnaire administered immediately after the learning activity. The questionnaire which included 11 statements, each rated on a 5 point scale, evaluated participants' enjoyment of the event, subjective educative experiences, and whether they would attend similar learning events in the future.

Excluded studies

We excluded 82 studies for the following reasons: no description of the game (1), population composed of students and not professionals (11), not about a specific game (3), review (12) including 2 reviews of gaming theory and 1 review of creative teaching strategies), abstract (9), not appropriate study design (46). We provide an additional table (Table 1) for illustrative examples of games used in 25 of these excluded studies.

Table 1. Illustrative examples of games used in health professions education
StudyGame description
Boreham 1989"The Phenytoin Game". A computer game for teaching phenytoin dosage to medical students
Cessario 1987"Cessario's Board Game". Board game for teaching medical students about conceptual models of nursing
D'Alessandro 2002"Pediatric jeopardy". Jeopardy!© style game for paediatric residents with questions derived from current issues of paediatric journals
Durman 2002Cards game with messages to stimulate considerations and group discussions among nurses about therapeutic communication in clinical settings
Ford 1996"Jeopardy". Jeopardy!© style game for teaching surgical services nursing staff basic safety information
French 1980"Guts". Card game for teaching psychiatric nursing students about the digestive system
Girardi 2006"T- and B-Cell Ontogeny Game". A board game for teaching medical students about T/B-cell ontogeny and medical immunology
Gordon 1995"The Neonatal Emergency Trivia Game". A trivia game for teaching newborn caregivers material related to neonatal emergency care decisions
Harding 2001"Lego® Activity". Interactive game using Lego® blocks for teaching medical students interview techniques and how to improve patient/doctor relationship
Ingram 1998"Let's Hypothesize". A board game for teaching nursing students hypothesis generation and problem solving
Jones 2000"Cranial Nerve Wheel of Competencies". Game for testing cranial nerve competencies of intensive care unit nursing staff
LeCroy 2006"Who Wants To Be Incontinent?". Game based on "Who Wants To Be A Millionaire?©" TV show for teaching urologic nurses and nurse educators about overactive bladder.
"Survivor: BPH". Game based on the "Survivor©" television show for teaching urologic nurses and nurse educators about BPH
Leidy 1992"Not So Trivial ... Protective Pursuit". Game based on "Trivial Pursuit®" game for hospital staff education sessions
Montpas 2004"Jeopardy". Jeopardy!© style game for teaching nursing students geriatric nursing concepts
Morton 2001"Pain Game". Game for assisting nursing staff in maintaining up-to-date knowledge of pain assessment and management
Ogershok 2004"The paediatric board game". A board game for paediatric residents an medical students using content from core paediatric textbooks
Parker 2005"Road Map to Preparedness". A game for teaching public health workers the US Centers for Disease Control and Prevention's nine core competencies for all public health workers and for facilitating the workers understanding and acceptance of their emergency response roles
Regan 2000"Nurse-Patient Communication Game ". A board game for teaching nursing students about empathic communication
Roubidoux 2002"Breast Cancer Detective". Web-based board game for teaching 4th-year medical students about breast imaging
Saethang 1998A game using a caricature case study for teaching non-critical care nurses the use of critical cardiovascular drugs
Schmitz 1991"Emergency Pursuit game". A game based on "Trivial Pursuit®" game for teaching nursing emergency decision-making skills
Skinner 2000"Sexual Dysfunction Trivia game". A game based on "Trivial Pursuit®" game for teaching staff nurses about sexual dysfunction and the aging process
Udin 1985"Smile". A board game for sensitizing dental students to children with special needs
Wargo 2000"Blood Clot". A board game for reinforcing nurses learning about disseminated intravascular coagulation
White 1985"Rights: Helter Skelter". A game for teaching nursing students to tolerate high levels of uncertainty while they analyze ethical dilemmas

Risk of bias in included studies

The first included study had a factorial RCT design (Burke 2001). The author did not report whether the assessors of the primary outcome were blinded and whether there was an attempt to protect against contamination. Allocation was not concealed. The study included a baseline measurement but the author reported no data in relation to the reliability of the measure of the primary outcome (knowledge questionnaire).

Considering the five quality domains (Beach 2004): the health care providers are representative mainly of US community acute care hospitals; there is a potential for bias and confounding as allocation was not concealed nor adequately randomized (based on the badge number) and contamination might have occurred; the intervention was fairly described; the author did not report any evaluation of the reliability and validity of the knowledge test; and the analytic approach was not transparent nor complete.

The second included study also had a cluster randomized design (Telner 2010). The author did not report blinding the outcome assessors or attempting to protect against contamination. It was not clear whether allocation was concealed. The study did not include a baseline measurement and the author reported no data on the reliability of the knowledge questionnaire. Furthermore, the sample size was smaller than the target sample size due to recruitment challenges. Considering the five quality domains (Beach 2004): the health care providers are representative mainly of Canadian family physicians; there is a potential for bias as it was not reported how randomization was done and outcome assessors were not blinded; the intervention was well described; the author did not report any evaluation of the reliability and validity of the knowledge test; and the analytic approach was described.

Effects of interventions

See: Summary of findings for the main comparison

The first included study found a statistically significant difference in main effect of knowledge retention (delayed post-test score) in the gaming reinforcement group compared with the control group (p=0.02). There was a significant interaction effect between gaming reinforcement and type of instruction suggesting that in the group of patients exposed to the videotape, gaming reinforcement was associated with a statistically higher score than the control group (mean = 16.6 versus mean = 15.5) whereas in patients exposed to the self learning module, gaming reinforcement was not associated with a statistically higher score (mean = 17.0 versus 16.9). The author reported no qualitative data.

In the second study, the effects on the knowledge test were as follows: the game-based group scored 1.6 points (out of 40) lower than the case based group (P = 0.24; lower limit of 95% CI -3.8) on the immediate posttest; the game-based group scored 0.3 points lower than the case-based group (P = 0.83; lower limit of 95% CI -2.5) three months post intervention.

Statistically significant higher proportions of participants in the game-based group compared to the case-based group strongly agreed that the event was enjoyable (94% vs. 53%; p = 0.02), that their attention was high throughout the event (88% vs. 41%; p = 0.012), and that they would register for a similar event in the future (82% vs. 41%; p = .034).

Discussion

Summary of main results

We have identified only two studies of educational games for health professionals. The first game, used as a reinforcement technique, was based on the television game show "Family Feud" and focused on infection control. The game, as a reinforcement strategy, improved knowledge following a video tape intervention but not following a self-learning module intervention. The reason for this differential effect is not clear. Also, the statistically significant benefit (less than one point out of a maximum of 20 points) is of unclear educational significance.

The second game compared the use of a board-based game to case based learning. There was no difference between the 2 groups on the knowledge test, done immediately and 3-months after the intervention. Neither study assessed any patient or process of care outcome.

Overall completeness and applicability of evidence

Educational games have many potential advantages. Their innate competitive nature tends to motivate participants (Blenner 1991). They have the potential to promote learning in the cognitive, affective, and psychomotor domain (Kolb 1984; Lewis 1989). Another major advantage is the positive learners' perception of these games (Byrum 1996; Carroll 1991; Speers 1993; Waddell 1994). Educational games that involve teams can enhance communication and social interaction among members (Schmitz 1991). The participants have the opportunity to develop alliances and mutual respect, which promotes team work and collaboration and may simulate real work problems (Walljasper 1982; Sisson 1988). This could be particularly useful in enhancing the performance of health care professionals.

Educational games have a number of potential disadvantages. They might be time consuming in terms of game creation, set-up, explaining the rules, playing the game, and debriefing after the game (Walljasper 1982). They also require small group sizes, a flexible set-up, and may not allow for all learners to participate (Fitzgerald 1997). They may require special equipment (Haak 1990; McDougal 1992) and can be costly to purchase or create (Hayes 2000). On the other hand, the use of educational games may create stress or embarrassment to individuals who perform poorly (Lewis 1989). In some instances, learners may find it difficult to extract the information presented (Walljasper 1982). The evaluation of learning can be difficult if several players are involved (Rowles 1998). Also, it may be difficult to decide on a particular evaluation outcome (Berdemeier 1982) and to find a validated tool to assess that outcome (Sisson 1988).

Quality of the evidence

The quality of evidence for the secondary outcomes was low due to unclear risk of bias, and imprecision related to small sample sizes. Furthermore these outcomes are surrogate outcomes (implying indirectness) for the primary outcomes of interest (patient and process of care outcomes).

Potential biases in the review process

This systematic review has several strengths including the rigorous search strategy, and duplicate study selection to minimize the likelihood of missing relevant studies. We also evaluated methodological quality and abstracted data in duplicate to minimize random and systematic error. We used no language restrictions. Our definition of game required a competitiveness element; we thus excluded game-like interventions such as role playing.

Agreements and disagreements with other studies or reviews

We identified one Cochrane systematic review that assessed educational games for mental health professionals (Bhoopathi 2006). The review identified only one trial in mental health nursing students conducted in Northern Ireland. The game, called 'Trivia Psychotica', was designed based on the popular board game "Trivial Pursuit®" and covered psychiatric topics. Students allocated to the educational game scored six more points than the control students on a test of questions relevant to psychosis (WMD 6 CI 2.63 to 9.37)..

We also are aware of another published systematic review on the effects of educational games on medical students' learning outcomes (Akl 2010a). In that review we identified five trials and concluded that the available evidence to date neither confirms nor refutes the utility of educational games as an effective teaching strategy for medical students.

Also, there are a number of trials of educational games in nursing students (Cessario 1987; Cowen 2002; French 1980; Ingram 1998; Montpas 2004; Regan 2000; Sprengel 1992). Most of these trials reported positive effects on learning outcomes. One study showed that an educational game decreased anxiety scores for nursing students who participated in a community-health game prior to their actual clinical experience in the community setting (Hays 1989).

Authors' conclusions

Implications for practice

The findings of this systematic review do not confirm nor refute the utility of games as a teaching strategy for health professionals. More and better evidence are needed to make practice recommendations. However those designing and implementing educational games should carefully consider their advantages and disadvantages.

Implications for research

There is a need for more research to explore the role of games in the education of health professionals. Such research should be of high methodological quality ideally using a randomized design. The reporting of the research should also be of high quality by fully describing the game (objectives, type, rules, material needed to implement it, content, (subject, source of information, quality of information), context and location, duration, intensity, costs, challenges to implementation), the control, the evaluation instruments, the statistical methods, and the results. Researchers should also consider conducting process evaluations to explore the delivery of the game and the mechanisms underlying its effects. Finally, future research should assess outcomes related to performance and process of care and, ideally, patient outcomes.

Acknowledgements

We would like to thank Ms. Ann Grifasi for her administrative assistance. We would like to acknowledge Paranthaman Seth Bhoopathi for his contribution to the previous version of this systematic review. We would like to acknowledge the support and assistance provided by Jeremy Grimshaw, Alain Mayhew, Doug Salzwedel and Jennifer Gratton of the Cochrane Effective Practice and Organisation of Care Group. We would also like to thank Sasha Shepperd, Merrick Zwarenstein, Scott Reeves, Luke Vale, Craig Ramsay, Carl Heneghan and Tanya Horsley for their helpful peer review comments.

Data and analyses

Download statistical data

This review has no analyses.

Appendices

Appendix 1. Revised search strategies

MEDLINE (OVID)

Search dates: July 29, 2011 and January 3, 2012

MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) <1948 to Present>
--------------------------------------------------------------------------------
1-9 [Deleted lines; not referenced in subsequent lines]

10 education, dental, continuing/ or education, medical, continuing/ or education, nursing, continuing/ or education, pharmacy, continuing/ or education, professional, retraining/ (42352)
11 education, dental, graduate/ or education, medical, graduate/ or education, nursing, graduate/ or education, pharmacy, graduate/ (26788)
12 "internship and residency"/ or teaching rounds/ (29971)
13 (((continuing adj2 education) or (professional adj2 development) or inservice) adj3 (physician? or nurse or nurses or health professional? or practitioner? or doctor? or resident? or intern$)).ti,ab. (1706)
14 (continuing adj (medical? or nursing or health$) adj2 education).ti,ab. (3833)
15 ((intern$ or resident? or residency) adj2 (education$ or learning or training)).ti,ab. (8360)
16 ((postgraduat$ or post-graduat$) adj2 (education$ or training or learning) adj3 (physician? or nurse or nurses or health professional? or practitioner? or doctor? or resident? or intern? or internship?)).ti,ab. (522)
17 ((recertification or recertify or upgrad$ or upskill$) adj3 (nurse or nurses or physician? or doctor? or practitioner? or therapist? or allied health$)).ti,ab. (84)
18 education, medical, undergraduate/ or Education, Nursing, Associate/ or Education, Nursing, Baccalaureate/ or Education, Nursing, Diploma Programs/ or Education, Dental/ (43567)
19 ((undergrad$ or under-grad$ or student? or universit$ or college?) adj2 (education$ or training or learning) adj3 (physician? or nurse or nurses or nursing or surgery or surgical or surgeon or physiotherap$ or therap$ or pharmac$ or health$ or practitioner? or doctor?)).ti,ab. (1624)
20 or/10-19 [MEDICAL EDUCATION] (135751)

21 exp health personnel/ or exp allied health personnel/ or exp medical staff/ or exp nurses/ or exp nursing staff/ or pharmacists/ or exp physicians/ (325667)
22 exp Health Occupations/ (1173212)
23 (allied health or doctor? or nurse or nurses or physician? or nursing staff or nursing personnel or therapist? or physiotherapist? or intern or internship or interns or medical resident? or medical residen$ or provider? or practitioner? or gp? or ((health$ or medical) adj (staff or worker? or professional? or personnel))).ti,ab. [terms added from Orig] (655792)
24 exp students, health occupations/ (38638)
25 ((health$ or medicine? or medical or nurse or nurses or nursing or surgery or surgical or surgeon or physiotherap$ or therap$ or pharmac$ or doctor? or physician?) adj2 (student? or undergrad$ or under-grad$)).ti,ab. (38645)
26 or/21-25 [HEALTH PROFESSIONALS & STUDENTS -- PEOPLE] (1828716)

27 education, continuing/ or education, professional, retraining/ or exp education, professional/ (213420)
28 inservice training/ or staff development/ (20995)
29 education/ or learning/ or teaching/ or problem-based learning/ (91344)
30 ((postgraduat$ or post-graduat$) adj2 (education$ or training or learning)).ti,ab. (4979)
31 (training or learning or educat$ or instruct$).ti. (217115)
32 ((continuing adj2 education) or (professional adj2 development) or inservice).ti,ab. (17992)
33 (("on the job" or "at work") adj3 (train$ or learn$ or teaching or teach or skill? or upskill$ or upgrad$ or recertif$ or certific$ or certify)).ti,ab. (576)
34 (behavio?r$ adj2 intervention?).ti,ab. [added from Orig] (5603)
35 or/27-34 [Continuing Education/Education --General] (416397)

36 (game or gamer? or games or gaming or gameshow? or game-like).ti,ab. (13266)
37 (jeopardy or trivial pursuit or "wheel of fortune" or (memory adj2 card?) or family feud or "price is right" or "name that tune" or bingo or casino or poker or "word search?" or crossword? or cross word? or puzzle or puzzles or "who wants to be a millionaire" or "weakest link" or survivor or "reality show?" or "reality television?" or "reality tv?" or "reality t.v.?").ti,ab. (11015)
38 (learning adj3 play).ti,ab. (186)
39 (playful$ or plaything?).ti,ab. (371)
40 "Play and playthings"/ (6020)
41 Games, experimental/ (971)
42 Video games/ (1223)
43 (video game? or computer game?).ti,ab. (1412)
44 ((learner? or student?) adj5 (active or fun)).ti,ab. [Removed truncation from active] (1134)
45 fun.ti,ab. (1458)
46 entertain$.ti,ab. (2685)
47 ((learning and play$).ti. or (learning adj3 play$).ab.) not (role-play$ or role play$).ti. (357)
48 ((teaching and play$).ti. or (teaching adj3 play$).ab.) not (role-play$ or role play$).ti. (113)
49 or/36-48 [GAMES] (35648)

50 (exp specialties, surgical/ or exp surgical procedures, operative/) and ((simulator? or simulation? or VIRTUAL REALITY).ti. or computer simulation/) (6888)
51 ((surgical or laparoscopic) adj2 skill?).ti,ab. (2119)
52 or/50-51 [CONCEPTS TO EXCLUDE] (8639)

53 (20 and 49) not 52 [MED ED & GAMES] (763)
54 (26 and 35 and 49) not (or/52-53) [CE & ED & HLTH PERSONS & GAMES] (763)
55 53 or 54 [SEARCH RESULTS] (1526)

RESULTS

56 limit 55 to yr="2007 -August 2011" (421) [Search Date Aug 3, 2011]

((55 and RCT Filter) OR (55 and EPOC Filter)) = 238 [Search date January 3, 2012] All years searched.

AMED (OVID)

Search dates: August 3, 2011; January 3, 2012

AMED (Allied and Complementary Medicine) <1985 to August 2011>

1 education medical/ or education medical graduate/ or education nursing/ (4626)
2 (((continuing adj2 education) or (professional adj2 development) or inservice) adj3 (physician? or nurse or nurses or health professional? or practitioner? or doctor? or resident? or intern$)).ti,ab. (62)
3 (continuing adj (medical? or nursing or health$) adj2 education).ti,ab. (49)
4 ((intern? or internship? or resident? or residency) adj2 (education$ or learning or training)).ti,ab. (155)
5 ((postgraduat$ or post-graduat$) adj2 (education$ or training or learning) adj3 (physician? or nurse or nurses or health professional? or practitioner? or doctor? or resident? or intern? or internship?)).ti,ab. (9)
6 ((recertification or recertify or upgrad$ or upskill$) adj3 (nurse or nurses or physician? or doctor? or practitioner? or therapist? or allied health$)).ti,ab. (5)
7 ((undergrad$ or under-grad$ or student? or universit$ or college?) adj2 (education$ or training or learning) adj3 (physician? or nurse or nurses or nursing or surgery or surgical or surgeon or physiotherap$ or therap$ or pharmac$ or health$ or practitioner? or doctor?)).ti,ab. (264)
8 or/1-7 [MEDICAL EDUCATION] (4902)

9 exp health personnel/ (3707)
10 (allied health or doctor? or nurse or nurses or physician? or nursing staff or nursing personnel or therapist? or physiotherapist? or intern or internship or interns or medical resident? or medical residen$ or provider? or practitioner? or gp? or ((health$ or medical) adj (staff or worker? or professional? or personnel))).ti,ab. (25269)
11 ((health$ or medicine? or medical or nurse or nurses or nursing or surgery or surgical or surgeon or physiotherap$ or therap$ or pharmac$ or doctor? or physician?) adj2 (student? or undergrad$ or under-grad$ or graduate? or post-graduate? or postgraduate? or postdoc$ or post-doc$)).ti,ab. (2166)
12 or/9-11 [HEALTH PROFESSIONALS & STUDENTS--PEOPLE] (27732)

13 education continuing/ (365)
14 education professional/ (825)
15 staff development/ (188)
16 education/ or teaching/ (4096)
17 learning/ (1119)
18 (training or learning or educat$ or instruct$).ti. (11488)
19 ((continuing adj2 education) or (professional adj2 development) or inservice).ti,ab. (734)
20 (("on the job" or "at work") adj3 (train$ or learn$ or teaching or teach or skill? or upskill$ or upgrad$ or recertif$ or certific$ or certify)).ti,ab. (621)
21 (behavio?r$ adj2 intervention?).ti,ab. (409)
22 ((postgraduat$ or post-graduat$ or graduat$ or undergraduat$ or under-graduat$) adj2 (education$ or training or learning)).ti,ab. (440)
23 or/13-22 [CE & ED GENERAL] (16039)

24 "play and playthings"/ (216)
25 (game or gamer? or games or gaming or gameshow? or game-like).ti,ab. (480)
26 ((jeopardy adj2 (game? or show?)) or trivial pursuit or "wheel of fortune" or (memory adj2 card?) or family feud or "price is right" or "name that tune" or bingo or casino or poker or "word search?" or crossword? or cross word? or puzzle or puzzles or "who wants to be a millionaire" or "weakest link" or (survivor adj2 (game? or show?)) or "reality show?" or "reality television?" or "reality tv?" or "reality t.v.?").ti,ab. (75)
27 (learning adj3 play).ti,ab. (15)
28 (playful$ or plaything?).ti,ab. (58)
29 (video game? or computer game?).ti,ab. (61)
30 ((learner? or student?) adj5 (active or fun)).ti,ab. (76)
31 fun.ti,ab. (62)
32 entertain$.ti,ab. (44)
33 ((learning and play$).ti. or (learning adj3 play$).ab.) not (role-play$ or role play$).ti. (27)
34 ((teaching and play$).ti. or (teaching adj3 play$).ab.) not (role-play$ or role play$).ti. (13)
35 or/24-34 [GAMES] (966)

36 8 and 35 [MED ED & GAMES] (26)
37 (12 and 23 and 35) not 36 [CE & ED & HLTH PROS & GAMES] (13)

RESULTS
38 36 or 37 (12) [August 3, 2011] Limited by publication year 2007 to August 3, 2011

39 36 or 37 (27) [January 3, 2012] All years searched.

CINAHL (Ebsco)

Search Dates: August 2, 2011 & January 3, 2012

The search strategy showing results per line was not saved at the time this strategy was run. However, our records show that we exported two sets of results from this search: 240 citations to journals, books, book chapters; and 14 citations to theses/dissertations.

 (S67 AND RCT FILTER) OR (S67 AND EPOC FILTER) = 134 [all years searched; search date Jan 3, 2012]
S68S66 or S67 = 254 [August 2, 2011] Limited by publication year from 2007 to August 2011
S67S42 and S53 and S65
S66S36 and S65
S65S54 or S55 or S56 or S57 or S58 or S59 or S60 or S61 or S62 or S63 or S64
S64TI ( (teaching and play*) ) OR AB (teaching N3 play*) NOT TI ( role-play* or role play* )
S63TI ( (learning and play*) ) OR AB (learning N3 play*) NOT TI ( role-play* or role play* )
S62TI entertain* OR AB entertain*
S61TI fun OR AB fun
S60TI ( (learner N5 active) or (learner N5 fun) or (student N5 active) or (student N5 fun) ) OR AB ( (learner N5 active) or (learner N5 fun) or (student N5 active) or (student N5 fun) )
S59TI ( (video game or computer game) ) OR AB ( (video game or computer game) )
S58(MH "Games") OR (MH "Video Games")
S57TI ( (playful* or plaything) ) OR AB ( (playful* or plaything) )
S56TI (learning N3 play) OR AB (learning N3 play)
S55TI ( jeopardy or trivial pursuit or "wheel of fortune" or (memory N2 card) or family feud or "price is right" or "name that tune" or bingo or casino or poker or "word search" or crossword or cross word or puzzle or puzzles or "who wants to be a millionaire" or "weakest link" or (survivor N2 show) or (survivor N2 game) or (survivor N3 television) or (survivor N3 t.v) or "reality show" or "reality television" or "reality tv" or "reality t.v." ) OR AB ( jeopardy or trivial pursuit or "wheel of fortune" or (memory N2 card) or family feud or "price is right" or "name that tune" or bingo or casino or poker or "word search" or crossword or cross word or puzzle or puzzles or "who wants to be a millionaire" or "weakest link" or (survivor N2 show) or (survivor N2 game) or (survivor N3 television) or (survivor N3 t.v) or "reality show" or "reality television" or "reality tv" or "reality t.v." )
S54TI ( (game or gamer or games or gaming or gameshow or game-like) ) OR AB ( (game or gamer or games or gaming or gameshow or game-like) )
S53S43 or S44 or S45 or S46 or S47 or S48 or S49 or S50 or S51 or S52
S52TI (behavio#r* N2 intervention) OR AB (behavio#r* N2 intervention)
S51TI ( ("on the job" N3 train*) or (“on the job” N3 learn*) or (“on the job” N3 teaching) or (“on the job” N3 teach) or (“on the job” N3 skill) or (“on the job” N3 upskill*) or (“on the job” N3 upgrad*) or (“on the job” N3 recertif*) or (“on the job” N3 certific*) or (“on the job” N3 certify) or (“at work” N3 train*) or (“at work” N3 learn*) or (“at work” N3 teaching) or (“at work” N3 teach) or (“at work” N3 skill) or (“at work” N3 upskill*) or (“at work” N3 upgrad*) or (“at work” N3 recertif*) or (“at work” N3 certific*) or (“at work” N3 certify) ) OR AB ( ("on the job" N3 train*) or (“on the job” N3 learn*) or (“on the job” N3 teaching) or (“on the job” N3 teach) or (“on the job” N3 skill) or (“on the job” N3 upskill*) or (“on the job” N3 upgrad*) or (“on the job” N3 recertif*) or (“on the job” N3 certific*) or (“on the job” N3 certify) or (“at work” N3 train*) or (“at work” N3 learn*) or (“at work” N3 teaching) or (“at work” N3 teach) or (“at work” N3 skill) or (“at work” N3 upskill*) or (“at work” N3 upgrad*) or (“at work” N3 recertif*) or (“at work” N3 certific*) or (“at work” N3 certify) )
S50TI ( (continuing N2 education) or (professional N2 development) or inservice ) OR AB ( (continuing N2 education) or (professional N2 development) or inservice )
S49TI training or learning or educat* or instruct*
S48TI ( (postgraduat* N2 education*) or (postgraduat* N2 training) or (postgraduat* N2 learning) or (post-graduat N2 education*) or (post-graduat* N2 training) or (post-graduat* N2 learning) ) OR AB ( (postgraduat* N2 education*) or (postgraduat* N2 training) or (postgraduat* N2 learning) or (post-graduat N2 education*) or (post-graduat* N2 training) or (post-graduat* N2 learning) )
S47(MH "Education") OR (MH "Learning Methods") OR (MH "Problem-Based Learning") OR (MH "Teaching") OR (MH "Teaching Methods")
S46(MH "Staff Development+")
S45(MH "Refresher Courses")
S44(MH "Professional Development")
S43(MH "Education, Continuing")
S42S37 or S38 or S39 or S40 or S41
S41TI ( allied health or doctor or nurse or nurses or physician or nursing staff or nursing personnel or therapist or physiotherapist or intern or internship or interns or (medical N1 resident) or (medical N1 residen*) or provider or practitioner or gp or (health* N1 staff) or (health* N1 worker) or (health* N1 professional) or (health* N1 personnel) or (medical N1 staff) or (medical N1 worker) or (medical N1 professional) or (medical N1 personnel) ) OR AB ( allied health or doctor or nurse or nurses or physician or nursing staff or nursing personnel or therapist or physiotherapist or intern or internship or interns or (medical N1 resident) or (medical N1 residen*) or provider or practitioner or gp or (health* N1 staff) or (health* N1 worker) or (health* N1 professional) or (health* N1 personnel) or (medical N1 staff) or (medical N1 worker) or (medical N1 professional) or (medical N1 personnel) )
S40TI ( (health* N2 student) or (health* N2 undergrad*) or (health* N2 under-grad*) or (health* N2 graduat*) or (health* N2 postgraduat*) or (health* N2 post-graduat*) or(medicine N2 student) or (medicine N2 undergrad*) or (medicine N2 under-grad*) or (medicine N2 graduat*) or (medicine N2 postgraduat*) or (medicine N2 post-graduat*) or(medical N2 student) or (medical N2 undergrad*) or (medical N2 under-grad*) or (medical N2 graduat*) or (medical N2 postgraduat*) or (medical N2 post-graduat*) or(nurse N2 student) or (nurse N2 undergrad*) or (nurse N2 under-grad*) or (nurse N2 graduat*) or (nurse N2 postgraduat*) or (nurse N2 post-graduat*) or(nurses N2 student) or (nurses N2 undergrad*) or (nurses N2 under-grad*) or (nurses N2 graduat*) or (nurses N2 postgraduat*) or (nurses N2 post-graduat*) or (nursing N2 student) or (nursing N2 undergrad*) or (nursing N2 under-grad*) or (nursing N2 graduat*) or (nursing N2 postgraduat*) or (nursing N2 post-graduat*) or (surgery N2 student) or (surgery N2 undergrad*) or (surgery N2 under-grad*) or (surgery N2 graduat*) or (surgery N2 postgraduat*) or (surgery N2 post-graduat*) or (surgical N2 student) or (surgical N2 undergrad*) or (surgical N2 under-grad*) or (surgical N2 graduat*) or (surgical N2 postgraduat*) or (surgical N2 post-graduat*) or (surgeon N2 student) or (surgeon N2 undergrad*) or (surgeon N2 under-grad*) or (surgeon N2 graduat*) or (surgeon N2 postgraduat*) or (surgeon N2 post-graduat*) or(physiotherap* N2 student) or (physiotherap* N2 undergrad*) or (physiotherap* N2 under-grad*) or (physiotherap* N2 graduat*) or (physiotherapy* N2 postgraduat*) or (physiotherapy* N2 post-graduat*) or (therap* N2 student) or (therap* N2 undergrad*) or (therap* N2 under-grad*) or (therap* N2 graduat*) or (therap* N2 postgraduat*) or (therap* N2 post-graduat*) or (pharmac* N2 student) or (pharmac* N2 undergrad*) or (pharmac* N2 under-grad*) or (pharmac* N2 graduat*) or (pharmac* N2 postgraduat*) or (pharmac* N2 post-graduat*) or(doctor N2 student) or (doctor N2 undergrad*) or (doctor N2 under-grad*) or (doctor N2 graduat*) or (doctor N2 postgraduat*) or (doctor N2 post-graduat*) or (physician N2 student) or (physician N2 undergrad*) or (physician N2 under-grad*) or (physician N2 graduat*) or (physician N2 postgraduat*) or (physician N2 post-graduat*) ) OR AB ( (health* N2 student) or (health* N2 undergrad*) or (health* N2 under-grad*) or (health* N2 graduat*) or (health* N2 postgraduat*) or (health* N2 post-graduat*) or(medicine N2 student) or (medicine N2 undergrad*) or (medicine N2 under-grad*) or (medicine N2 graduat*) or (medicine N2 postgraduat*) or (medicine N2 post-graduat*) or(medical N2 student) or (medical N2 undergrad*) or (medical N2 under-grad*) or (medical N2 graduat*) or (medical N2 postgraduat*) or (medical N2 post-graduat*) or(nurse N2 student) or (nurse N2 undergrad*) or (nurse N2 under-grad*) or (nurse N2 graduat*) or (nurse N2 postgraduat*) or (nurse N2 post-graduat*) or(nurses N2 student) or (nurses N2 undergrad*) or (nurses N2 under-grad*) or (nurses N2 graduat*) or (nurses N2 postgraduat*) or (nurses N2 post-graduat*) or (nursing N2 student) or (nursing N2 undergrad*) or (nursing N2 under-grad*) or (nursing N2 graduat*) or (nursing N2 postgraduat*) or (nursing N2 post-graduat*) or (surgery N2 student) or (surgery N2 undergrad*) or (surgery N2 under-grad*) or (surgery N2 graduat*) or (surgery N2 postgraduat*) or (surgery N2 post-graduat*) or (surgical N2 student) or (surgical N2 undergrad*) or (surgical N2 under-grad*) or (surgical N2 graduat*) or (surgical N2 postgraduat*) or (surgical N2 post-graduat*) or (surgeon N2 student) or (surgeon N2 undergrad*) or (surgeon N2 under-grad*) or (surgeon N2 graduat*) or (surgeon N2 postgraduat*) or (surgeon N2 post-graduat*) or(physiotherap* N2 student) or (physiotherap* N2 undergrad*) or (physiotherap* N2 under-grad*) or (physiotherap* N2 graduat*) or (physiotherapy* N2 postgraduat*) or (physiotherapy* N2 post-graduat*) or (therap* N2 student) or (therap* N2 undergrad*) or (therap* N2 under-grad*) or (therap* N2 graduat*) or (therap* N2 postgraduat*) or (therap* N2 post-graduat*) or (pharmac* N2 student) or (pharmac* N2 undergrad*) or (pharmac* N2 under-grad*) or (pharmac* N2 graduat*) or (pharmac* N2 postgraduat*) or (pharmac* N2 post-graduat*) or(doctor N2 student) or (doctor N2 undergrad*) or (doctor N2 under-grad*) or (doctor N2 graduat*) or (doctor N2 postgraduat*) or (doctor N2 post-graduat*) or (physician N2 student) or (physician N2 undergrad*) or (physician N2 under-grad*) or (physician N2 graduat*) or (physician N2 postgraduat*) or (physician N2 post-graduat*) )
S39(MH "Students, Health Occupations")
S38(MH "Health Occupations+")
S37(MH "Health Personnel+")
S36S19 or S20 or S21 or S22 or S23 or S24 or S25 or S26 or S27 or S28 or S29 or S30 or S31 or S32 or S33 or S34 or S35
S35TI ( (college* N2 education* N3 physician) or (college* N2 education* N3 nurse) or (college* N2 education* N3 nurses) or (college* N2 education* N3 health professional) or (college* N2 education* N3 practitioner) or (college* N2 education* N3 doctor) or (college* N2 education* N3 resident) or (college* N2 education* N3 intern) or (college* N2 education* N3 internship) or (college* N2 education* N3 residenc*) or (college* N2 learning N3 physician) or (college* N2 learning N3 nurse) or (college* N2 learning N3 nurses) or (college* N2 learning N3 health professional) or (college* N2 learning N3 practitioner) or (college* N2 learning N3 doctor) or (college* N2 learning N3 resident) or (college* N2 learning N3 intern) or (college* N2 learning N3 internship) or (college* N2 learning N3 residenc*) or(college* N2 training N3 physician) or (college* N2 training N3 nurse) or (college* N2 training N3 nurses) or (college* N2 training N3 health professional) or (college* N2 training N3 practitioner) or (college* N2 training N3 doctor) or (college* N2 training N3 resident) or (college* N2 training N3 intern) or (college* N2 training N3 internship) or (college* N2 training N3 residenc*) ) OR AB ( (college* N2 education* N3 physician) or (college* N2 education* N3 nurse) or (college* N2 education* N3 nurses) or (college* N2 education* N3 health professional) or (college* N2 education* N3 practitioner) or (college* N2 education* N3 doctor) or (college* N2 education* N3 resident) or (college* N2 education* N3 intern) or (college* N2 education* N3 internship) or (college* N2 education* N3 residenc*) or (college* N2 learning N3 physician) or (college* N2 learning N3 nurse) or (college* N2 learning N3 nurses) or (college* N2 learning N3 health professional) or (college* N2 learning N3 practitioner) or (college* N2 learning N3 doctor) or (college* N2 learning N3 resident) or (college* N2 learning N3 intern) or (college* N2 learning N3 internship) or (college* N2 learning N3 residenc*) or(college* N2 training N3 physician) or (college* N2 training N3 nurse) or (college* N2 training N3 nurses) or (college* N2 training N3 health professional) or (college* N2 training N3 practitioner) or (college* N2 training N3 doctor) or (college* N2 training N3 resident) or (college* N2 training N3 intern) or (college* N2 training N3 internship) or (college* N2 training N3 residenc*) )
S34TI ( (universit* N2 education* N3 physician) or (universit* N2 education* N3 nurse) or (universit* N2 education* N3 nurses) or (universit* N2 education* N3 health professional) or (universit* N2 education* N3 practitioner) or (universit* N2 education* N3 doctor) or (universit* N2 education* N3 resident) or (universit* N2 education* N3 intern) or (universit* N2 education* N3 internship) or (universit* N2 education* N3 residenc*) or (universit* N2 learning N3 physician) or (universit* N2 learning N3 nurse) or (universit* N2 learning N3 nurses) or (universit* N2 learning N3 health professional) or (universit* N2 learning N3 practitioner) or (universit* N2 learning N3 doctor) or (universit* N2 learning N3 resident) or (universit* N2 learning N3 intern) or (universit* N2 learning N3 internship) or (universit* N2 learning N3 residenc*) or(universit* N2 training N3 physician) or (universit* N2 training N3 nurse) or (universit* N2 training N3 nurses) or (universit* N2 training N3 health professional) or (universit* N2 training N3 practitioner) or (universit* N2 training N3 doctor) or (universit* N2 training N3 resident) or (universit* N2 training N3 intern) or (universit* N2 training N3 internship) or (universit* N2 training N3 residenc*) ) OR AB ( (universit* N2 education* N3 physician) or (universit* N2 education* N3 nurse) or (universit* N2 education* N3 nurses) or (universit* N2 education* N3 health professional) or (universit* N2 education* N3 practitioner) or (universit* N2 education* N3 doctor) or (universit* N2 education* N3 resident) or (universit* N2 education* N3 intern) or (universit* N2 education* N3 internship) or (universit* N2 education* N3 residenc*) or (universit* N2 learning N3 physician) or (universit* N2 learning N3 nurse) or (universit* N2 learning N3 nurses) or (universit* N2 learning N3 health professional) or (universit* N2 learning N3 practitioner) or (universit* N2 learning N3 doctor) or (universit* N2 learning N3 resident) or (universit* N2 learning N3 intern) or (universit* N2 learning N3 internship) or (universit* N2 learning N3 residenc*) or(universit* N2 training N3 physician) or (universit* N2 training N3 nurse) or (universit* N2 training N3 nurses) or (universit* N2 training N3 health professional) or (universit* N2 training N3 practitioner) or (universit* N2 training N3 doctor) or (universit* N2 training N3 resident) or (universit* N2 training N3 intern) or (universit* N2 training N3 internship) or (universit* N2 training N3 residenc*) )
S33TI ( (student N2 education* N3 physician) or (student N2 education* N3 nurse) or (student N2 education* N3 nurses) or (student N2 education* N3 health professional) or (student N2 education* N3 practitioner) or (student N2 education* N3 doctor) or (student N2 education* N3 resident) or (student N2 education* N3 intern) or (student N2 education* N3 internship) or (student N2 education* N3 residenc*) or (student N2 learning N3 physician) or (student N2 learning N3 nurse) or (student N2 learning N3 nurses) or (student N2 learning N3 health professional) or (student N2 learning N3 practitioner) or (student N2 learning N3 doctor) or (student N2 learning N3 resident) or (student N2 learning N3 intern) or (student N2 learning N3 internship) or (student N2 learning N3 residenc*) or(student N2 training N3 physician) or (student N2 training N3 nurse) or (student N2 training N3 nurses) or (student N2 training N3 health professional) or (student N2 training N3 practitioner) or (student N2 training N3 doctor) or (student N2 training N3 resident) or (student N2 training N3 intern) or (student N2 training N3 internship) or (student N2 training N3 residenc*) ) OR AB ( (student N2 education* N3 physician) or (student N2 education* N3 nurse) or (student N2 education* N3 nurses) or (student N2 education* N3 health professional) or (student N2 education* N3 practitioner) or (student N2 education* N3 doctor) or (student N2 education* N3 resident) or (student N2 education* N3 intern) or (student N2 education* N3 internship) or (student N2 education* N3 residenc*) or (student N2 learning N3 physician) or (student N2 learning N3 nurse) or (student N2 learning N3 nurses) or (student N2 learning N3 health professional) or (student N2 learning N3 practitioner) or (student N2 learning N3 doctor) or (student N2 learning N3 resident) or (student N2 learning N3 intern) or (student N2 learning N3 internship) or (student N2 learning N3 residenc*) or(student N2 training N3 physician) or (student N2 training N3 nurse) or (student N2 training N3 nurses) or (student N2 training N3 health professional) or (student N2 training N3 practitioner) or (student N2 training N3 doctor) or (student N2 training N3 resident) or (student N2 training N3 intern) or (student N2 training N3 internship) or (student N2 training N3 residenc*) )
S32TI ( (recertification N3 nurse) or (recertification N3 nurses) or (recertification N3 physician) or (recertification N3 doctor) or (recertification N3 practitioner) or (recertification N3 therapist) or (recertification N3 allied health*) or (recertify N3 nurse) or (recertify N3 nurses) or (recertify N3 physician) or (recertify N3 doctor) or (recertify N3 practitioner) or (recertify N3 therapist) or (recertify N3 allied health*) or (upgrad* N3 nurse) or (upgrad* N3 nurses) or (upgrad* N3 physician) or (upgrad* N3 doctor) or (upgrad* N3 practitioner) or (upgrad* N3 therapist) or (upgrad* N3 allied health*) or (upskill* N3 nurse) or (upskill* N3 nurses) or (upskill* N3 physician) or (upskill* N3 doctor) or (upskill* N3 practitioner) or (upskill* N3 therapist) or (upskill* N3 allied health*) ) OR AB ( (recertification N3 nurse) or (recertification N3 nurses) or (recertification N3 physician) or (recertification N3 doctor) or (recertification N3 practitioner) or (recertification N3 therapist) or (recertification N3 allied health*) or (recertify N3 nurse) or (recertify N3 nurses) or (recertify N3 physician) or (recertify N3 doctor) or (recertify N3 practitioner) or (recertify N3 therapist) or (recertify N3 allied health*) or (upgrad* N3 nurse) or (upgrad* N3 nurses) or (upgrad* N3 physician) or (upgrad* N3 doctor) or (upgrad* N3 practitioner) or (upgrad* N3 therapist) or (upgrad* N3 allied health*) or (upskill* N3 nurse) or (upskill* N3 nurses) or (upskill* N3 physician) or (upskill* N3 doctor) or (upskill* N3 practitioner) or (upskill* N3 therapist) or (upskill* N3 allied health*) )
S31TI ( (graduat* N2 education* N3 physician) or (graduat* N2 education* N3 nurse) or (graduat* N2 education* N3 nurses) or (graduat* N2 education* N3 health professional) or (graduat* N2 education* N3 practitioner) or (graduat* N2 education* N3 doctor) or (graduat* N2 education* N3 resident) or (graduat* N2 education* N3 intern) or (graduat* N2 education* N3 internship) or (graduat* N2 education* N3 residenc*) or (graduat* N2 learning N3 physician) or (graduat* N2 learning N3 nurse) or (graduat* N2 learning N3 nurses) or (graduat* N2 learning N3 health professional) or (graduat* N2 learning N3 practitioner) or (graduat* N2 learning N3 doctor) or (graduat* N2 learning N3 resident) or (graduat* N2 learning N3 intern) or (graduat* N2 learning N3 internship) or (graduat* N2 learning N3 residenc*) or(graduat* N2 training N3 physician) or (graduat* N2 training N3 nurse) or (graduat* N2 training N3 nurses) or (graduat* N2 training N3 health professional) or (graduat* N2 training N3 practitioner) or (graduat* N2 training N3 doctor) or (graduat* N2 training N3 resident) or (graduat* N2 training N3 intern) or (graduat* N2 training N3 internship) or (graduat* N2 training N3 residenc*) ) OR AB ( (graduat* N2 education* N3 physician) or (graduat* N2 education* N3 nurse) or (graduat* N2 education* N3 nurses) or (graduat* N2 education* N3 health professional) or (graduat* N2 education* N3 practitioner) or (graduat* N2 education* N3 doctor) or (graduat* N2 education* N3 resident) or (graduat* N2 education* N3 intern) or (graduat* N2 education* N3 internship) or (graduat* N2 education* N3 residenc*) or (graduat* N2 learning N3 physician) or (graduat* N2 learning N3 nurse) or (graduat* N2 learning N3 nurses) or (graduat* N2 learning N3 health professional) or (graduat* N2 learning N3 practitioner) or (graduat* N2 learning N3 doctor) or (graduat* N2 learning N3 resident) or (graduat* N2 learning N3 intern) or (graduat* N2 learning N3 internship) or (graduat* N2 learning N3 residenc*) or(graduat* N2 training N3 physician) or (graduat* N2 training N3 nurse) or (graduat* N2 training N3 nurses) or (graduat* N2 training N3 health professional) or (graduat* N2 training N3 practitioner) or (graduat* N2 training N3 doctor) or (graduat* N2 training N3 resident) or (graduat* N2 training N3 intern) or (graduat* N2 training N3 internship) or (graduat* N2 training N3 residenc*) )
S30TI ( (undergrad* N2 education* N3 physician) or (undergrad* N2 education* N3 nurse) or (undergrad* N2 education* N3 nurses) or (undergrad* N2 education* N3 health professional) or (undergrad* N2 education* N3 practitioner) or (undergrad* N2 education* N3 doctor) or (undergrad* N2 education* N3 resident) or (undergrad* N2 education* N3 intern) or (undergrad* N2 education* N3 internship) or (undergrad* N2 education* N3 residenc*) or (undergrad* N2 learning N3 physician) or (undergrad* N2 learning N3 nurse) or (undergrad* N2 learning N3 nurses) or (undergrad* N2 learning N3 health professional) or (undergrad* N2 learning N3 practitioner) or (undergrad* N2 learning N3 doctor) or (undergrad* N2 learning N3 resident) or (undergrad* N2 learning N3 intern) or (undergrad* N2 learning N3 internship) or (undergrad* N2 learning N3 residenc*) or (undergrad* N2 training N3 physician) or (undergrad* N2 training N3 nurse) or (undergrad* N2 training N3 nurses) or (undergrad* N2 training N3 health professional) or (undergrad* N2 training N3 practitioner) or (undergrad* N2 training N3 doctor) or (undergrad* N2 training N3 resident) or (undergrad* N2 training N3 intern) or (undergrad* N2 training N3 internship) or (undergrad* N2 training N3 residenc*) ) OR AB ( (undergrad* N2 education* N3 physician) or (undergrad* N2 education* N3 nurse) or (undergrad* N2 education* N3 nurses) or (undergrad* N2 education* N3 health professional) or (undergrad* N2 education* N3 practitioner) or (undergrad* N2 education* N3 doctor) or (undergrad* N2 education* N3 resident) or (undergrad* N2 education* N3 intern) or (undergrad* N2 education* N3 internship) or (undergrad* N2 education* N3 residenc*) or (undergrad* N2 learning N3 physician) or (undergrad* N2 learning N3 nurse) or (undergrad* N2 learning N3 nurses) or (undergrad* N2 learning N3 health professional) or (undergrad* N2 learning N3 practitioner) or (undergrad* N2 learning N3 doctor) or (undergrad* N2 learning N3 resident) or (undergrad* N2 learning N3 intern) or (undergrad* N2 learning N3 internship) or (undergrad* N2 learning N3 residenc*) or (undergrad* N2 training N3 physician) or (undergrad* N2 training N3 nurse) or (undergrad* N2 training N3 nurses) or (undergrad* N2 training N3 health professional) or (undergrad* N2 training N3 practitioner) or (undergrad* N2 training N3 doctor) or (undergrad* N2 training N3 resident) or (undergrad* N2 training N3 intern) or (undergrad* N2 training N3 internship) or (undergrad* N2 training N3 residenc*) )
S29TI ( (post-graduat* N2 education* N3 physician) or (post-graduat* N2 education* N3 nurse) or (post-graduat* N2 education* N3 nurses) or (post-graduat* N2 education* N3 health professional) or (post-graduat* N2 education* N3 practitioner) or (post-graduat* N2 education* N3 doctor) or (post-graduat* N2 education* N3 resident) or (post-graduat* N2 education* N3 intern) or (post-graduat* N2 education* N3 internship) or (post-graduat* N2 education* N3 residenc*) or (post-graduat* N2 learning N3 physician) or (post-graduat* N2 learning N3 nurse) or (post-graduat* N2 learning N3 nurses) or (post-graduat* N2 learning N3 health professional) or (post-graduat* N2 learning N3 practitioner) or (post-graduat* N2 learning N3 doctor) or (post-graduat* N2 learning N3 resident) or (post-graduat* N2 learning N3 intern) or (post-graduat* N2 learning N3 internship) or (post-graduat* N2 learning N3 residenc*) or (post-graduat* N2 training N3 physician) or (post-graduat* N2 training N3 nurse) or (post-graduat* N2 training N3 nurses) or (post-graduat* N2 training N3 health professional) or (post-graduat* N2 training N3 practitioner) or (post-graduat* N2 training N3 doctor) or (post-graduat* N2 training N3 resident) or (post-graduat* N2 training N3 intern) or (post-graduat* N2 training N3 internship) or (post-graduat* N2 training N3 residenc*) ) OR AB ( (post-graduat* N2 education* N3 physician) or (post-graduat* N2 education* N3 nurse) or (post-graduat* N2 education* N3 nurses) or (post-graduat* N2 education* N3 health professional) or (post-graduat* N2 education* N3 practitioner) or (post-graduat* N2 education* N3 doctor) or (post-graduat* N2 education* N3 resident) or (post-graduat* N2 education* N3 intern) or (post-graduat* N2 education* N3 internship) or (post-graduat* N2 education* N3 residenc*) or (post-graduat* N2 learning N3 physician) or (post-graduat* N2 learning N3 nurse) or (post-graduat* N2 learning N3 nurses) or (post-graduat* N2 learning N3 health professional) or (post-graduat* N2 learning N3 practitioner) or (post-graduat* N2 learning N3 doctor) or (post-graduat* N2 learning N3 resident) or (post-graduat* N2 learning N3 intern) or (post-graduat* N2 learning N3 internship) or (post-graduat* N2 learning N3 residenc*) or (post-graduat* N2 training N3 physician) or (post-graduat* N2 training N3 nurse) or (post-graduat* N2 training N3 nurses) or (post-graduat* N2 training N3 health professional) or (post-graduat* N2 training N3 practitioner) or (post-graduat* N2 training N3 doctor) or (post-graduat* N2 training N3 resident) or (post-graduat* N2 training N3 intern) or (post-graduat* N2 training N3 internship) or (post-graduat* N2 training N3 residenc*) )
S28TI ( (postgraduat* N2 education* N3 physician) or (postgraduat* N2 education* N3 nurse) or (postgraduat* N2 education* N3 nurses) or (postgraduat* N2 education* N3 health professional) or (postgraduat* N2 education* N3 practitioner) or (postgraduat* N2 education* N3 doctor) or (postgraduat* N2 education* N3 resident) or (postgraduat* N2 education* N3 intern) or (postgraduat* N2 education* N3 internship) or (postgraduat* N2 education* N3 residenc*) or (postgraduat* N2 learning N3 physician) or (postgraduat* N2 learning N3 nurse) or (postgraduat* N2 learning N3 nurses) or (postgraduat* N2 learning N3 health professional) or (postgraduat* N2 learning N3 practitioner) or (postgraduat* N2 learning N3 doctor) or (postgraduat* N2 learning N3 resident) or (postgraduat* N2 learning N3 intern) or (postgraduat* N2 learning N3 internship) or (postgraduat* N2 learning N3 residenc*) or (postgraduat* N2 training N3 physician) or (postgraduat* N2 training N3 nurse) or (postgraduat* N2 training N3 nurses) or (postgraduat* N2 training N3 health professional) or (postgraduat* N2 training N3 practitioner) or (postgraduat* N2 training N3 doctor) or (postgraduat* N2 training N3 resident) or (postgraduat* N2 training N3 intern) or (postgraduat* N2 training N3 internship) or (postgraduat* N2 training N3 residenc*) ) OR AB ( (postgraduat* N2 education* N3 physician) or (postgraduat* N2 education* N3 nurse) or (postgraduat* N2 education* N3 nurses) or (postgraduat* N2 education* N3 health professional) or (postgraduat* N2 education* N3 practitioner) or (postgraduat* N2 education* N3 doctor) or (postgraduat* N2 education* N3 resident) or (postgraduat* N2 education* N3 intern) or (postgraduat* N2 education* N3 internship) or (postgraduat* N2 education* N3 residenc*) or (postgraduat* N2 learning N3 physician) or (postgraduat* N2 learning N3 nurse) or (postgraduat* N2 learning N3 nurses) or (postgraduat* N2 learning N3 health professional) or (postgraduat* N2 learning N3 practitioner) or (postgraduat* N2 learning N3 doctor) or (postgraduat* N2 learning N3 resident) or (postgraduat* N2 learning N3 intern) or (postgraduat* N2 learning N3 internship) or (postgraduat* N2 learning N3 residenc*) or (postgraduat* N2 training N3 physician) or (postgraduat* N2 training N3 nurse) or (postgraduat* N2 training N3 nurses) or (postgraduat* N2 training N3 health professional) or (postgraduat* N2 training N3 practitioner) or (postgraduat* N2 training N3 doctor) or (postgraduat* N2 training N3 resident) or (postgraduat* N2 training N3 intern) or (postgraduat* N2 training N3 internship) or (postgraduat* N2 training N3 residenc*) )
S27TI ( (intern N2 education*) or (intern N2 learning) or (intern N2 training) or (internship N2 education*) or (internship N2 learning) or (internship N2 training) or (resident N2 education*) or (resident N2 learning) or (resident N2 training) or (residency N2 education*) or (residency N2 learning) or (residency N2 training) ) OR AB ( (intern N2 education*) or (intern N2 learning) or (intern N2 training) or (internship N2 education*) or (internship N2 learning) or (internship N2 training) or (resident N2 education*) or (resident N2 learning) or (resident N2 training) or (residency N2 education*) or (residency N2 learning) or (residency N2 training) )
S26TI ( (continuing N1 medical N2 education) or (continuing N1 nursing N2 education) or (continuing N1 health* N2 education) ) OR AB ( (continuing N1 medical N2 education) or (continuing N1 nursing N2 education) or (continuing N1 health* N2 education) )
S25TI ( (inservice N3 physician) or (inservice N3 nurse) or (inservice N3 nurses) or (inservice N3 health professional) or (inservice N3 practitioner) or (inservice N3 doctor) or (inservice N3 resident) or (inservice N3 intern) or (inservice N3 internship) ) OR AB ( (inservice N3 physician) or (inservice N3 nurse) or (inservice N3 nurses) or (inservice N3 health professional) or (inservice N3 practitioner) or (inservice N3 doctor) or (inservice N3 resident) or (inservice N3 intern) or (inservice N3 internship) )
S24TI ( (professional N2 development N3 physician) or (professional N2 development N3 nurse) or (professional N2 development N3 nurses) or (professional N2 development N3 health professional) or (professional N2 development N3 practitioner) or (professional N2 development N3 doctor) or (professional N2 development N3 resident) or (professional N2 development N3 intern) or (professional N2 development N3 internship) ) OR AB ( (professional N2 development N3 physician) or (professional N2 development N3 nurse) or (professional N2 development N3 nurses) or (professional N2 development N3 health professional) or (professional N2 development N3 practitioner) or (professional N2 development N3 doctor) or (professional N2 development N3 resident) or (professional N2 development N3 intern) or (professional N2 development N3 internship) )
S23TI ( (continuing N2 education N3 physician) OR (continuing N2 education N3 nurse) or (continuing N2 education N3 nurses) or (continuing N2 education N3 health professional) or (continuing N2 education N3 practitioner) or (continuing N2 education N3 doctor) or (continuing N2 education N3 resident) or (continuing N2 education N3 intern) or (continuing N2 education N3 internship) ) OR AB ( (continuing N2 education N3 physician) OR (continuing N2 education N3 nurse) or (continuing N2 education N3 nurses) or (continuing N2 education N3 health professional) or (continuing N2 education N3 practitioner) or (continuing N2 education N3 doctor) or (continuing N2 education N3 resident) or (continuing N2 education N3 intern) or (continuing N2 education N3 internship) )
S22(MH "Internship and Residency")
S21(MH "Education, Health Sciences") OR (MH "Education, Allied Health") OR (MH "Education, Dental") OR (MH "Education, Medical") OR (MH "Education, Midwifery") OR (MH "Education, Nursing") OR (MH "Education, Pharmacy") OR (MH "Education, Podiatry")
S20(MH "Education, Nursing, Graduate")
S19(MH "Education, Medical, Continuing") OR (MH "Education, Nursing, Continuing")
 Lines 1-18 are not referenced subsequently and so have been deleted.

Cochrane Central Register of Controlled Trials (Wiley)

Search Date: August 3, 2011 and January 3, 2012

#1MeSH descriptor Play and Playthings, this term only
#2MeSH descriptor Games, Experimental, this term only
#3(game or gaming or "structured experience" or "structured experiences"):ti,kw,ab
#4(#1 OR #2 OR #3)
#5MeSH descriptor Education, Continuing explode all trees
#6MeSH descriptor Education, Professional explode all trees
#7professional development:ti,kw,ab
#8MeSH descriptor Learning explode tree 1
#9((medical or clinical or professional or clinician) NEXT (train* or learn*)):ti,ab,kw
#10((behaviour* or behavior*) NEAR/2 (intervention or interventions)):ti,ab,kw
#11(#5 OR #6 OR #7 OR #8 OR #9 OR #10)
#12MeSH descriptor Students, Health Occupations explode all trees
#13MeSH descriptor Health Personnel explode all trees
#14(provider or practitioner or doctor or gp or physician or nurs*):ti,ab,kw
#15((health or healthcare or "health care" or medical) NEXT (student or staff or worker or professional or personnel)):ti,ab,kw
#16(#12 OR #13 OR #14 OR #15)
#17(#4 AND #11 AND #16) [ORIG STRAT]
#18MeSH descriptor Education, Dental, Graduate, this term only
#19MeSH descriptor Education, Medical, Graduate, this term only
#20MeSH descriptor Education, Nursing, Graduate, this term only
#21MeSH descriptor Education, Pharmacy, Graduate, this term only
#22MeSH descriptor Internship and Residency, this term only
#23MeSH descriptor Teaching Rounds, this term only
#24(((continuing NEAR/2 education) or (professional NEAR/2 development) or inservice) NEAR/3 (physician or nurse or nurses or "health professional" or "health professionals" or practitioner or doctor or resident or intern or internship)):ti,ab
#25(continuing NEXT (medical or nursing or health*) NEAR/2 education):ti,ab
#26((intern or internship or resident or residency) NEAR/2 (education* or learning or training)):ti,ab
#27((postgraduat* or post-graduat*) NEAR/2 (education* or training or learning) NEAR/3 (physician or nurse or nurses or "health professional" or "health professionals" or practitioner or doctor of resident or intern or internship)):ti,ab
#28((recertification OR recertify OR upgrad* OR upskill*) NEAR/3 (nurse or doctor or physician or practitioner or therapist or health*)):ti,ab
#29MeSH descriptor Education, Medical, Undergraduate, this term only
#30MeSH descriptor Education, Nursing, Associate, this term only
#31MeSH descriptor Education, Nursing, Baccalaureate, this term only
#32MeSH descriptor Education, Nursing, Diploma Programs, this term only
#33MeSH descriptor Education, Dental, this term only
#34((undergrad* or under-grad* or student or universit* or college) NEAR/2 (education* or learning or training) NEAR/3 (physician or nurse or surgery or surgical or surgeon or physiotherap* or therap* or pharmac* or health* or practitioner or doctor)):ti,ab
#35(#18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34)
#36MeSH descriptor Health Personnel explode all trees
#37MeSH descriptor Allied Health Personnel explode all trees
#38MeSH descriptor Medical Staff explode all trees
#39MeSH descriptor Nurses explode all trees
#40MeSH descriptor Nursing Staff explode all trees
#41MeSH descriptor Pharmacists explode all trees
#42MeSH descriptor Physicians explode all trees
#43MeSH descriptor Health Occupations explode all trees
#44((allied NEXT health*) or doctor or nurse or physician or "nursing staff" or "nursing personnel" or therapist or physiotherapist or intern or internship or "medical resident" or "medical residents" or "medical residency" or "medical residencies" or provider or practitioner or gp or ((health* or medical) NEXT (staff or worker or professional or personnel))):ti,ab
#45MeSH descriptor Students, Health Occupations explode all trees
#46((health* or medicine or medical or nurse or nursing or surgery or surgical of surgeion or physiotherap* or therap* or pharmac* or doctor or physician) NEAR/2 (student or undergrad* or under-grad*)):ti,ab
#47(#36 OR #37 OR #38 OR #39 OR #40 OR #41 OR #42 OR #43 OR #44 OR #45 OR #46)
#48MeSH descriptor Education, Continuing, this term only
#49MeSH descriptor Education, Professional, Retraining, this term only
#50MeSH descriptor Education, Professional explode all trees
#51MeSH descriptor Inservice Training explode all trees
#52MeSH descriptor Education, this term only
#53MeSH descriptor Learning, this term only
#54MeSH descriptor Teaching, this term only
#55MeSH descriptor Problem-Based Learning, this term only
#56((postgraduat* or post-graduat*) NEAR/2 (education* or training or learning)):ti,ab
#57(training of learning or educat* or instruct*):ti
#58((continuing NEAR/2 education) or (professional NEAR/2 development) or inservice):ti,ab
#59(("on the job" or "at work") NEAR/3 (train* or learn* or teaching or teach or skill or upskill* or upgrad* or recertif* or certific* or certify)):ti,ab
#60((behaviour or behavior) NEAR/2 intervention):ti,ab
#61(#48 OR #49 OR #50 OR #51 OR #52 OR #53 OR #54 OR #55 OR #56 OR #57 OR #58 OR #59 OR #60)
#62(game or gamer or games or gaming or gameshow or game-like):ti,ab
#63((jeopardy NEAR/2 (game or show)) or "trivial pursuit" or "wheel of fortune" or (memory NEAR/2 card) or "family feud" or "price is right" or "name that tune" or bingo or casino or poker or "word search" or crossword or "cross word" or "cross words" or puzzle or "who wants to be a millionaire" or "weakest link" or (survivor NEAR/2 (show or game or television)) or "reality show" or "reality shows" or "reality television" or "reality tv" or "reality t.v."):ti,ab
#64(learning NEAR/3 play):ti,ab
#65(playful* or plaything):ti,ab
#66MeSH descriptor Play and Playthings, this term only
#67MeSH descriptor Games, Experimental explode all trees
#68MeSH descriptor Video Games, this term only
#69("video game" or "video games" or "computer game" or "computer games"):ti,ab
#70((learner or student) NEAR/5 (active or fun)):ti,ab
#71fun:ti,ab
#72entertain*:ti,ab
#73((learning and play*):ti or (learning NEAR/3 play*):ab) not (role-play* or "role play" or "role playing" or "role plays" or "role played"):ti
#74((teaching and play*):ti or (teaching NEAR/3 play*):ab) not (role-play* or "role play" or "role playing" or "role plays" or "role played"):ti
#75(#62 OR #63 OR #64 OR #65 OR #66 OR #67 OR #68 OR #69 OR #70 OR #71 OR #72 OR #73 OR #74)
#76(#35 AND #75)
#77(#47 AND #61 AND #75)

RESULTS
#78(#77 OR #76) = 10 Limited to 2007 to August 3, 2011

(#77 or #76) = 14 All years searched; search date January 3, 2012

Dissertations & Theses Database (ProQuest)

Search Date: August 5, 2011 and January 3, 2012

IF(Games OR Games and learning OR Games for learning OR Games for Understanding OR Games teaching OR Video games OR Video gaming OR Board games) OR ((game or games or gaming or gamer or gamers or gameshow or gameshows)) AND TITLE((doctor* or physician* or nurse or nurses or nursing or allied health* or therapist or physiotherapist or medical or ((health* or medical) W/1 (staff or worker or professional* or personnel))) OR IF(Health personnel OR Health occupations OR Health occupations students)) AND (educat* or learn* or instruct* or train* or teach*)

RESULTS

August 3, 2011 = 12; 2007 to Aug 3, 2011 searched

January 3, 2012 = 27; all years searched

EMBASE (OVID)

Search Dates, August 3, 2011 and January 3, 2012

Embase Classic+Embase <1947 to 2011 August 01>
--------------------------------------------------------------------------------
1 medical education/ or clinical education/ or dental education/ or physician assistant education/ or residency education/ or surgical training/ or teaching round/ (196299)
2 exp paramedical education/ (73211)
3 (((continuing adj2 education) or (professional adj2 development) or inservice) adj3 (physician? or nurse or nurses or health professional? or practitioner? or doctor? or resident? or intern$)).ti,ab. (1952)
4 (continuing adj (medical? or nursing or health$) adj2 education).ti,ab. (4879)
5 ((intern$ or resident? or residency) adj2 (education$ or learning or training)).ti,ab. (9540)
6 ((postgraduat$ or post-graduat$) adj2 (education$ or training or learning) adj3 (physician? or nurse or nurses or health professional? or practitioner? or doctor? or resident? or intern? or internship?)).ti,ab. (659)
7 ((recertification or recertify or upgrad$ or upskill$) adj3 (nurse or nurses or physician? or doctor? or practitioner? or therapist? or allied health$)).ti,ab. (101)
8 ((undergrad$ or under-grad$ or student? or universit$ or college?) adj2 (education$ or training or learning) adj3 (physician? or nurse or nurses or nursing or surgery or surgical or surgeon or physiotherap$ or therap$ or pharmac$ or health$ or practitioner? or doctor?)).ti,ab. (1837)
9 or/1-8 [MEDICAL ED] (272738)
10 exp health care personnel/ (715581)
11 medical profession/ (23782)
12 nursing as a profession/ (33)
13 (allied health or doctor? or nurse or nurses or physician? or nursing staff or nursing personnel or therapist? or physiotherapist? or intern or internship or interns or medical resident? or medical residen$ or provider? or practitioner? or gp? or ((health$ or medical) adj (staff or worker? or professional? or personnel))).ti,ab. (801451)
14 exp medical student/ (32971)
15 exp nursing student/ (14544)
16 exp paramedical student/ (5989)
17 ((health$ or medicine? or medical or nurse or nurses or nursing or surgery or surgical or surgeon or physiotherap$ or therap$ or pharmac$ or doctor? or physician?) adj2 (student? or undergrad$ or under-grad$)).ti,ab. (45371)
18 or/10-17 [HEALTH PROFESSIONALS & STUDENTS -- PEOPLE] (1258860)
19 professional development/ (2977)
20 education/ or continuing education/ or curriculum/ or doctoral education/ or in service training/ or masters education/ or postdoctoral education/ or postgraduate education/ or vocational education/ (326356)
21 learning/ or problem based learning/ (104615)
22 teaching/ (56996)
23 ((postgraduat$ or post-graduat$) adj2 (education$ or training or learning)).ti,ab. (6515)
24 (training or learning or educat$ or instruct$).ti. (254411)
25 ((continuing adj2 education) or (professional adj2 development) or inservice).ti,ab. (22086)
26 (("on the job" or "at work") adj3 (train$ or learn$ or teaching or teach or skill? or upskill$ or upgrad$ or recertif$ or certific$ or certify)).ti,ab. (735)
27 (behavio?r$ adj2 intervention?).ti,ab. (6658)
28 or/19-27 [CE & Ed GENERAL] (588503)
29 game/ (2976)
30 play/ (2724)
31 (game or gamer? or games or gaming or gameshow? or game-like).ti,ab. (15937)
32 (jeopardy or trivial pursuit or "wheel of fortune" or (memory adj2 card?) or family feud or "price is right" or "name that tune" or bingo or casino or poker or "word search?" or crossword? or cross word? or puzzle or puzzles or "who wants to be a millionaire" or "weakest link" or "reality show?" or "reality television?" or "reality tv?" or "reality t.v.?").ti,ab. (7260)
33 (learning adj3 play).ti,ab. (209)
34 (playful$ or plaything?).ti,ab. (542)
35 (video game? or computer game?).ti,ab. (1629)
36 ((learner? or student?) adj5 (active or fun)).ti,ab. (1259)
37 fun.ti,ab. (1891)
38 entertain$.ti,ab. (3643)
39 ((learning and play$).ti. or (learning adj3 play$).ab.) not (role-play$ or role play$).ti. (418)
40 ((teaching and play$).ti. or (teaching adj3 play$).ab.) not (role-play$ or role play$).ti. (142)
41 or/29-40 [GAMES] (33484)
42 exp *surgery/ or surgical training/ (1604608)
43 computer simulation/ (61752)
44 (simulator? or simulation? or VIRTUAL REALITY).ti. (33853)
45 42 and (43 or 44) [CONCEPTS TO EXCLUDE] (3944)
46 (9 and 41) not 45 [MED ED & GAMES] (1299)
47 (18 and 28 and 41) not (or/45-46) [EDU & HLTH PEOPLE & GAMES] (621)
48 exp Recreation/ (33466)
49 Play/ (2724)
50 Game/ (2976)
51 (game? or gaming).tw. (15991)
52 structured experience?.tw. (22)
53 or/48-52 [ORIG--GAMES] (50922)
54 exp Medical Education/ (215064)
55 exp Paramedical Education/ (73211)
56 continuing education/ (24505)
57 professional development.tw. (4278)
58 exp Learning/ (253383)
59 ((medical or clinical or professional or clinician) adj (train$ or learn$)).tw. (8941)
60 (behavio?r$ adj2 intervention?).tw. (6658)
61 or/54-60 [ORIG--EDUCATION] (546706)
62 exp Health Personnel/ (715581)
63 (provider?or practitioner?or doctor? or gp? or physician?or nurs$).tw. (70251)
64 ((health or healthcare or health care or medical) adj (student? or staff or worker? or professional? or personnel)).tw. (91980)
65 or/62-64 [ORIG--HLTH PEOPLE] (815895)
66 53 and 61 and 65 [ORIG RESULTS] (830)
67 (46 or 47) not 66 [UNIQUE NEW STRAT] (1607)
68 limit 67 to yr="1900 - 2006" (1136)
69 46 or 47 (1920)

RESULTS
70 limit 69 to yr="2007 - 2011" (586) August 3, 2011

(69 and RCT Filter) OR (69 AND EPOC Filter) No date limit. Search date January 3, 2012

EPOC Register (Reference Manager)

January 3, 2012

All non-indexed fields: game OR gaming OR games OR gamer OR gameshow OR boardgame OR game-like

 OR

All indexed fields: game* OR gaming OR gameshow* OR boardgame*

Results = 14

Note: the following terms were searched by yielded no relevant results All non-indexed fields: Sport, recreation, interactive multimedia, structured activit*, (learn AND play), (teach AND play), fun

Fun was NOT’ed against “function” and “fund” as these made up the majority that were retrieved.

ERIC (ProQuest)

RESULTS

27 citations; 2007-August 3, 2011

225 citations; no limits; search date January 3, 2012

Search Query #32 (((DE=("medical students" or "premedical students" or "allied health occupations" or "allied health personnel" or "health occupations" or "health personnel" or "mental health workers" or "nurses" or "physicians" or "psychologists")) or(TI=(allied health* or doctor or doctors or nurse or nurses or physician or physicians or "nursing staff" or "nursing personnel" or physiotherapist or physiotherapists or intern or interns orinternship or internships or "medical resident" or "medical residents" or "medical residence" or "medical residencies" or gp or ((health* or medical) WITHIN 1 (staff or worker or workers or professional or professionals or personnel))) or AB=(allied health* or doctor or doctors or nurse or nurses or physician or physicians or "nursing staff" or "nursing personnel" or physiotherapist or physiotherapists or intern or interns orinternship or internships or "medical resident" or "medical residents" or "medical residence" or "medical residencies" or gp or ((health* or medical) WITHIN 1 (staff or worker or workers or professional or professionals or personnel)))) or(TI=((health* or medicine or medical or nurse or nurses or nursing or surgery or surgical or surgeon or physiotherap* or pharmac* or doctor or doctors or physician or physicians) WITHIN 2 (student or students or undergrad* or under-grad)))) and((DE=("on the job training" or "staff development" or "adult education" or "continuing education" or "professional continuing education" or "professional development" or "professional education")) or(DE=("learning" or "problem based learning" or "instruction" or "teaching methods")) or(TI=((postgraduat* or post-graduat* or student or students or graduat* or undergraduat*) WITHIN 2 (education* or training or learning)) or AB=((postgraduat* or post-graduat* or student or students or graduat* or undergraduat*) WITHIN 2 (education* or training or learning))) or(TI=(training or learning or educat* or instruct*)) or(TI=((continuing WITHIN 2 education) or (professional WITHIN 2 development) or inservice) or AB=((continuing WITHIN 2 education) or (professional WITHIN 2 development) or inservice)) or(TI=(("on the job" or "at work") WITHIN 3 (train* or learn* or teaching or teach or skill or skills or upskill* or upgrad* or recertif* or certific* or certify)) or AB=(("on the job" or "at work") WITHIN 3 (train* or learn* or teaching or teach or skill or skills or upskill* or upgrad* or recertif* or certific* or certify))) or(TI=((behavior* or behaviour*) WITHIN 2 (intervention or interventions)) or AB=((behavior* or behaviour*) WITHIN 2 (intervention or interventions)))) and((DE=("games" or "educational games" or "puzzles" or "video games" or "play")) or(TI=(game or gamer or gamers or games or gaming or gameshow or gameshows or game-like) or AB=(game or gamer or gamers or games or gaming or gameshow or gameshows or game-like)) or(TI=((jeopardy WITHIN 2 show) or "trivial pursuit" or "wheel of fortune" or (memory WITHIN 2 cards) or "family feud" or "price is right" or "name that tune" or bingo or casino or poker or "word search" or "word searches" or crossword or crosswords or "cross word" or "cross words" or puzzle or puzzles or "who wants to be a millionaire" or "weakest link" or (survivor WITHIN 2 (show or television)) or "reality show" or "reality shows" or "reality television" or "reality tv" or "reality t.v.") or AB=((jeopardy WITHIN 2 show) or "trivial pursuit" or "wheel of fortune" or (memory WITHIN 2 cards) or "family feud" or "price is right" or "name that tune" or bingo or casino or poker or "word search" or "word searches" or crossword or crosswords or "cross word" or "cross words" or puzzle or puzzles or "who wants to be a millionaire" or "weakest link" or (survivor WITHIN 2 (show or television)) or "reality show" or "reality shows" or "reality television" or "reality tv" or "reality t.v.")) or(TI=(learning AND play) or AB=(learning WITHIN 3 play)))) or(((DE="medical education") or(DE=("graduate medical education" or "nursing education" or "pharmaceutical education" or "allied health occupations education")) or(DE="internship programs") or(TI=(((continuing WITHIN 2 education) or (professional WITHIN 2 development) or inservice) WITHIN 3 (physician or physicians or nurse or nurses or "health professional" or "health professionals" or doctor or doctors or resident or residents or intern or interns or internship or internships)) or AB=(((continuing WITHIN 2 education) or (professional WITHIN 2 development) or inservice) WITHIN 3 (physician or physicians or nurse or nurses or "health professional" or "health professionals" or doctor or doctors or resident or residents or intern or interns or internship or internships))) or(TI=(continuing WITHIN 1(medical or nursing or health*) WITHIN 2 education) or AB=(continuing WITHIN 1(medical or nursing or health*) WITHIN 2 education)) or(TI=((intern or interns or internship or internships or resident or residents or residency or residencies) WITHIN 2 (education* or learning or training)) or AB=((intern or interns or internship or internships or resident or residents or residency or residencies) WITHIN 2 (education* or learning or training))) or(TI=((postgraduat* or post-graduat* or graduat* or undergraduat* or under-graduat* or student or students or universit* or college or colleges) WITHIN 2 (education* or training or learning) WITHIN 3 (physician or physicians or nurse or nurses or "health professional" or "health professionals" or doctor or doctors or resident or residents or intern or interns or internship or internships or surgeon or surgery or surgical or physiotherap* or pharmac* or nursing)) or AB=((postgraduat* or post-graduat* or graduat* or undergraduat* or under-graduat* or student or students or universit* or college or colleges) WITHIN 2 (education* or training or learning) WITHIN 3 (physician or physicians or nurse or nurses or "health professional" or "health professionals" or doctor or doctors or resident or residents or intern or interns or internship or internships or surgeon or surgery or surgical or physiotherap* or pharmac* or nursing))) or(TI=((recertification or recertify or upgrad* or upskill*) WITHIN 3 (nurse or nurses or physician or physicians or doctor or doctors or physiotherap* or health*)) or AB=((recertification or recertify or upgrad* or upskill*) WITHIN 3 (nurse or nurses or physician or physicians or doctor or doctors or physiotherap* or health*)))) and((DE=("games" or "educational games" or "puzzles" or "video games" or "play")) or(TI=(game or gamer or gamers or games or gaming or gameshow or gameshows or game-like) or AB=(game or gamer or gamers or games or gaming or gameshow or gameshows or game-like)) or(TI=((jeopardy WITHIN 2 show) or "trivial pursuit" or "wheel of fortune" or (memory WITHIN 2 cards) or "family feud" or "price is right" or "name that tune" or bingo or casino or poker or "word search" or "word searches" or crossword or crosswords or "cross word" or "cross words" or puzzle or puzzles or "who wants to be a millionaire" or "weakest link" or (survivor WITHIN 2 (show or television)) or "reality show" or "reality shows" or "reality television" or "reality tv" or "reality t.v.") or AB=((jeopardy WITHIN 2 show) or "trivial pursuit" or "wheel of fortune" or (memory WITHIN 2 cards) or "family feud" or "price is right" or "name that tune" or bingo or casino or poker or "word search" or "word searches" or crossword or crosswords or "cross word" or "cross words" or puzzle or puzzles or "who wants to be a millionaire" or "weakest link" or (survivor WITHIN 2 (show or television)) or "reality show" or "reality shows" or "reality television" or "reality tv" or "reality t.v.")) or(TI=(learning AND play) or AB=(learning WITHIN 3 play)))

PsycINFO (OVID)

Search dates: August 2, 2011, January 3, 2011, 2012

PsycINFO <1806- >
--------------------------------------------------------------------------------
1 exp medical education/ (13254)
2 nursing education/ (2985)
3 dental education/ (126)
4 exp psychology education/ (12191)
5 paraprofessional education/ (621)
6 exp internship programs/ (1300)
7 (((continuing adj2 education) or (professional adj2 development) or inservice) adj3 (physician? or nurse or nurses or health professional? or practitioner? or doctor? or resident? or intern$)).ti,ab. (373)
8 (continuing adj (medical? or nursing or health$) adj2 education).ti,ab. (456)
9 ((intern? or internship? or resident? or residency) adj2 (education$ or learning or training)).ti,ab. (2048)
10 ((postgraduat$ or post-graduat$) adj2 (education$ or training or learning) adj3 (physician? or nurse or nurses or health professional? or practitioner? or doctor? or resident? or intern? or internship?)).ti,ab. (60)
11 ((recertification or recertify or upgrad$ or upskill$) adj3 (nurse or nurses or physician? or doctor? or practitioner? or therapist? or allied health$)).ti,ab. (10)
12 ((undergrad$ or under-grad$ or student? or universit$ or college?) adj2 (education$ or training or learning) adj3 (physician? or nurse or nurses or nursing or surgery or surgical or surgeon or physiotherap$ or therap$ or pharmac$ or health$ or doctor?)).ti,ab. (494)
13 or/1-12 [MEDICAL ED] (30406)

14 exp health personnel/ (84686)
15 exp physicians/ (27950)
16 exp nurses/ (17587)
17 pharmacists/ (593)
18 Dentists/ (323)
19 medical students/ (7468)
20 dental students/ (182)
21 (allied health or doctor? or nurse or nurses or physician? or nursing staff or nursing personnel or therapist? or physiotherapist? or intern or internship or interns or medical resident? or medical residen$ or medical provider? or health$ provider? or practitioner? or medical practitioner? or gp? or ((health$ or medical) adj (staff or worker? or professional? or personnel))).ti,ab. (202320)
22 ((health$ or medicine? or medical or nurse or nurses or nursing or surgery or surgical or surgeon or physiotherap$ or therap$ or pharmac$ or doctor? or physician?) adj2 (student? or undergrad$ or under-grad$)).ti,ab. (16069)
23 or/14-22 [HEALTH PROFESSIONALS & STUDENTS -- PEOPLE] (246661)

24 exp continuing education/ (3788)
25 professional development/ or career development/ or inservice training/ (15124)
26 exp higher education/ (30056)
27 vocational education/ (2086)
28 Teaching Methods/ (29677)
29 Teaching/ (20744)
30 Problem Based Learning/ or Learning/ (37741)
31 exp personnel training/ (12356)
32 ((postgraduat$ or post-graduat$) adj2 (education$ or training or learning)).ti,ab. (921)
33 (training or learning or educat$ or instruct$).ti. (205440)
34 ((continuing adj2 education) or (professional adj2 development) or inservice).ti,ab. (11602)
35 (("on the job" or "at work") adj3 (train$ or learn$ or teaching or teach or skill? or upskill$ or upgrad$ or recertif$ or certific$ or certify)).ti,ab. (929)
36 (behavio?r$ adj2 intervention?).ti,ab. (7596)
37 or/24-36 [CE & ED GENERAL] (289296)

38 games/ or chess/ or childrens recreational games/ or computer games/ or entrapment games/ or non zero sum games/ (7044)
39 educational toys/ (50)
40 (game or gamer? or games or gaming or gameshow? or game-like).ti,ab. (20957)
41 ((jeopardy adj2 (game? or show?)) or trivial pursuit or "wheel of fortune" or (memory adj2 card?) or family feud or "price is right" or "name that tune" or bingo or (casino adj2 game?) or poker or "word search?" or crossword? or cross word? or puzzles or "who wants to be a millionaire" or "weakest link" or (survivor adj2 (game? or show?)) or "reality show?" or "reality television?" or "reality tv?" or "reality t.v.?").ti,ab. (1776)
42 (learning adj3 play).ti,ab. (641)
43 (playful$ or plaything?).ti,ab. (1738)
44 (video game? or computer game?).ti,ab. (2417)
45 ((learner? or student?) adj5 (active or fun)).ti,ab. (1610)
46 fun.ti,ab. (2264)
47 entertain$.ti,ab. (4485)
48 ((learning and play$).ti. or (learning adj3 play$).ab.) not (role-play$ or role play$).ti. (1177)
49 ((teaching and play$).ti. or (teaching adj3 play$).ab.) not (role-play$ or role play$).ti. (331)
50 or/38-49 [GAMES] (33533)

51 13 and 50 (342)
52 (23 and 37 and 50) not 51 [EDU & HLTH PRO & GAMES] (265)
53 51 or 52 [ RESULTS] (607)

RESULTS

limit 53 to yr="2007 - 2011" (240) Search date: August 2, 2011

(53 and RCT Filter) OR (53 and EPOC Filter) = 75; no date limits applied; search date January 3, 2012

Appendix 2. Original search strategies (2008)

DatabaseSearch Strategy
MEDLINE1. Video Games/
2. "Play and Playthings"/
3. Games, Experimental/
4. (game? or gaming).tw.
5. structured experience?.tw.
6. or/1-5
7. exp *education,continuing/
8. exp Education, Professional/
9. professional development.tw.
10. exp Learning/
11. ((medical or clinical or professional or clinician) adj (train$ or learn$)).tw.
12. (behavio?r$ adj2 intervention?).tw.
13. or/7-12
14. exp Students, Health Occupations/
15. exp Health Personnel/
16. (provider? or practitioner? or doctor? or gp? or physician? or nurs$).tw.
17. ((health or healthcare or health care or medical) adj (student? or staff or worker? or professional? or personnel)).tw.
18. or/14-17
19. 6 and 13 and 18
EMBASE1. exp Recreation/
2. Play/
3. Game/
4. (game? or gaming).tw.
5. structured experience?.tw.
6. or/1-5
7. exp Medical Education/
8. exp Paramedical Education/
9. Continuing Education
10. professional development.tw.
11. exp Learning/
12. ((medical or clinical or professional or clinician) adj (train$ or learn$)).tw.
13. (behavio?r$ adj2 intervention?).tw.
14. or/7-13
15. exp Health Personnel/
16. (provider? or practitioner? or doctor? or gp? or physician? or nurs$).tw.
17. ((health or healthcare or health care or medical) adj (student? or staff or worker? or professional? or personnel)).tw.
18. or/15-17
19. 6 and 14 and 18
CINAHL1. Video Games/
2. "Play and Playthings"/
3. Games/
4. (game? or gaming).tw.
5. structured experience?.tw.
6. or/1-5
7. exp Education, Health Sciences/
8. professional development.tw.
9. exp Learning/
10. exp Teaching Methods/
11. ((medical or clinical or professional or clinician or practitioner or nurs$) adj (train$ or learn$)).tw.
12. (behavio?r$ adj2 intervention?).tw.
13. or/7-12
14. exp Health Personnel/
15. (provider? or practitioner? or doctor? or gp? or physician? or nurs$).tw.
16. ((health or healthcare or health care or medical) adj (student? or staff or worker? or professional? or personnel)).tw.
17. or/14-16
18. 6 and 13 and 17
PsycINFO1. exp Games/
2. Game Theory/
3. (game? or gaming).tw.
4. structured experience?.tw.
5. or/1-4
6. exp Medical Education/
7. exp Continuing Education/
8. Professional Development/
9. exp Learning/
10. ((medical or clinical or professional or clinician) adj (train$ or learn$)).tw.
11. (behavio?r$ adj2 intervention?).tw.
12. or/6-11
13. exp Health Personnel/
14. (provider? or practitioner? or doctor? or gp? or physician? or nurs$).tw.
15. ((health or healthcare or health care or medical) adj (student? or staff or worker? or professional? or personnel)).tw.
16. or/13-15
17. 5 and 12 and 16
AMED1. "Play and playthings"/
2. video game?.tw.
3. (game? or gaming).tw.
4. structured experience?.tw.
5. or/1-4
6. exp Education Professional/
7. professional development.tw.
8. exp Learning/
9. ((medical or clinical or professional or clinician) adj (train$ or learn$)).tw.
10. (behavio?r$ adj2 intervention?).tw.
11. or/6-10
12. exp Health Personnel/
13. (provider? or practitioner? or doctor? or gp? or physician? or nurs$).tw.
14. ((health or healthcare or health care or medical) adj (student? or staff or worker? or professional? or personnel)).tw.
15. or/12-14
16. 5 and 11 and 15
ERIC (EBSCOhost)S1. SU play
S2. SU video games
S3. SU games
S4. TI (game* or gaming)
S5. TI (structured experience*)
S6. S1 or S2 or S3 or S4 or S5
S7. SU medical education
S8. SU continuing education
S9. SU professional development
S10. SU learning
S11. SU medical schools
S12. TI (medical N1 train* or medical N1 learn* or clinical N1 train* or clinical N1 learn* or professional N1 train* or professional N1 learn* or clinician N1 train* or clinician N1 learn*)
S13. TI (behaviour* N2 intervention or behavior* N2 intervention)
S14. S7 or S8 or S9 or S10 or S11 or S12 or S13
S15. SU health personnel
S16. SU nurses
S17. SU physicians
S18. SU medical students
S19. TI (provider* or practitioner* or doctor or doctors or gp* or physician* or nurse* )
S20. TI (health N1 student or health N1 staff or health N1 worker* or health N1 professional* or health N1 personnel or healthcare N1 student or healthcare N1 staff or healthcare N1 worker* or healthcare N1 professional* or healthcare N1 personnel or health care N1 student or health care N1 staff or health care N1 worker* or health care N1 professional* or health care N1 personnel or medical N1 student or medical N1 staff or medical N1 worker* or medical N1 professional* or medical N1 personnel)
S21. S15 or S16 or S17 or S18 or S19 or S20
S22. S6 and S14 and S21
Dissertations abstracts online(game* or gaming or video game*) OR IF(play*) OR TITLE(structured experience*) AND (medical educat* or medical school*) OR (continuing education) OR (professional development) OR IF (learn*) OR IF (teaching) OR TITLE((medical or clinical or professional or clinician) w/1 (train* or learn*)) OR TITLE((behavior* or behaviour*) w/2 intervention*) AND (provider* or practitioner* or doctor* or gp* or physician* or nurs*) OR IF (health personnel) OR IF(medical student*) OR TITLE((health or healthcare or health care or medical) w/1 (student* or staff worker* or professional* or personnel))

Appendix 3. Search filters

Below are filters used in searches of OVID Medline and EMBASE. Translations of the filters for other databases are available on request.

RCT Filter--MEDLINE

Note: the filter below is an adaptation of a Cochrane RCT filter. Subsequent updates will use a validated RCT filter from the Cochrane Handbook.

(randomized controlled trial or controlled clinical trial).pt. or randomized.ab. or clinical trials as topic.sh. or randomly.ab. or trial.ti. (750001)
86 exp animals/ not humans.sh. (3723345)
87 (rat or rats or mice or mouse or horse or equine or cow or bovine or pig or porcin$).ti,hw.
88 "comment on".cm. or systematic review.ti. or literature review.ti. or editorial.pt. or meta-analysis.pt. or news.pt. or review.pt.

RCT Filter--EMBASE

71 controlled clinical trial/ or controlled study/ or randomized controlled trial/ [EM] (3721953)
72 (book or conference paper or editorial or letter or review).pt. not randomized controlled trial/ [Per BMJ Clinical Evidence filter] (3582596)
73 (random sampl$ or random digit$ or random effect$ or random survey or random regression).ti,ab. not randomized controlled trial/ [Per BMJ Clinical Evidence filter] (41082)
74 (animal$ not human$).sh,hw. (3613604)
75 71 not (or/72-74) [Trial filter per BMJ CLinical Evidence] (2424176)

EPOC Methodological Filter version 1.9-2.4 for MEDLINE & EMBASE

Note: Readers interested in using this filter should contact the EPOC TSC for the most recent version.

1 intervention?.ti. or (intervention? adj6 (clinician? or collaborat$ or community or complex or DESIGN$ or doctor? or educational or family doctor? or family physician? or family practitioner? or financial or GP or general practice? or hospital? or impact? or improv$ or individuali?e? or individuali?ing or interdisciplin$ or multicomponent or multi-component or multidisciplin$ or multi-disciplin$ or multifacet$ or multi-facet$ or multimodal$ or multi-modal$ or personali?e? or personali?ing or pharmacies or pharmacist? or pharmacy or physician? or practitioner? or prescrib$ or prescription? or primary care or professional$ or provider? or regulatory or regulatory or tailor$ or target$ or team$ or usual care)).ab. (125105)
2 (pre-intervention? or preintervention? or "pre intervention?" or post-intervention? or postintervention? or "post intervention?").ti,ab. [added 2.4] (7052)
3 (hospital$ or patient?).hw. and (study or studies or care or health$ or practitioner? or provider? or physician? or nurse? or nursing or doctor?).ti,hw. (637822)
4 demonstration project?.ti,ab. (1767)
5 (pre-post or "pre test$" or pretest$ or posttest$ or "post test$" or (pre adj5 post)).ti,ab. (51481)
6 (pre-workshop or post-workshop or (before adj3 workshop) or (after adj3 workshop)).ti,ab. (463)
7 trial.ti. or ((study adj3 aim?) or "our study").ab. (483413)
8 (before adj10 (after or during)).ti,ab. (313394)
9 ("quasi-experiment$" or quasiexperiment$ or "quasi random$" or quasirandom$ or "quasi control$" or quasicontrol$ or ((quasi$ or experimental) adj3 (method$ or study or trial or design$))).ti,ab,hw. [ML] (88700)
10 ("time series" adj2 interrupt$).ti,ab,hw. [ML] (689)
11 (time points adj3 (over or multiple or three or four or five or six or seven or eight or nine or ten or eleven or twelve or month$ or hour? or day? or "more than")).ab. (6802)
12 pilot.ti. (31380)
13 Pilot projects/ [ML] (69422)
14 (clinical trial or controlled clinical trial or multicenter study).pt. [ML] (576710)
15 (multicentre or multicenter or multi-centre or multi-center).ti. (23449)
16 random$.ti,ab. or controlled.ti. (626707)
17 (control adj3 (area or cohort? or compare? or condition or design or group? or intervention? or participant? or study)).ab. not (controlled clinical trial or randomized controlled trial).pt. [ML] (342171)
18 "comment on".cm. or review.ti,pt. or randomized controlled trial.pt. [ML] (2589948)
19 review.ti. [EM] (212932)
20 (rat or rats or cow or cows or chicken? or horse or horses or mice or mouse or bovine or animal?).ti. (1258960)
21 exp animals/ not humans.sh. [ML] (3723345)
22 (animal$ not human$).sh,hw. [EM] (3629399)
23 *experimental design/ or *pilot study/ or quasi experimental study/ [EM] (17613)
24 ("quasi-experiment$" or quasiexperiment$ or "quasi random$" or quasirandom$ or "quasi control$" or quasicontrol$ or ((quasi$ or experimental) adj3 (method$ or study or trial or design$))).ti,ab. [EM] (88700)
25 ("time series" adj2 interrupt$).ti,ab. [EM] (689)
26 (or/1-17) not (or/18,20-21) [EPOC Methods Filter ML 2.4] (1808746) USE THIS LINE IN MEDLINE
27 (or/1-8,11-12,15-16,23-25) not (or/19,22) [EPOC Methods Filter EM 1.9-2.4] (1825125) Use this line in EMBASE

What's new

DateEventDescription
22 February 2013New citation required but conclusions have not changedAuthor added

History

Protocol first published: Issue 1, 2007
Review first published: Issue 1, 2008

DateEventDescription
6 December 2012New citation required but conclusions have not changedUpdated search, 1 new study
3 January 2012New search has been performedSearch strategy revised; revised strategy run retrospectively.
24 June 2008AmendedConverted to new review format.
13 November 2007New citation required and conclusions have changedSubstantive amendment

Contributions of authors

EAA: protocol development, search for trials, screening, data extraction, data analysis, manuscript drafting

VFK: screening, data extraction
KS: screening, data extraction

SE: screening, data extraction

MF: search strategy development
HJS: protocol development, screening

Declarations of interest

Three of the authors were involved in developing games for medical education (EAA, HJS).

Sources of support

Internal sources

  • State University of New York at Buffalo, Department of Medicine, USA.

  • Italian National Cancer Institute Regina Elena, Rome, Italy.

External sources

  • Research for Health in Erie County, USA.

  • EU Marie Curie Reintegration Grant (IGR 42192) (for HS), Italy.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Burke 2001

MethodsFactorial design RCT. Initial training: self-learning module vs. video tape; reinforcement: gaming vs. no intervention
Participants273 healthcare workers (excluding office staff and administrators) in a small community acute care hospital in the US. Mean age 39.7 SD=10.99 and 82% were females.
No patients were involved in this study
InterventionsThe game was based on the TV show "Family Feud" and focused on infection control. Game rules were clearly described and the game had elements of fun and competition. The game was played once; the "winning team" received no monetary reward.
OutcomesRetention of knowledge (knowledge test with true-false and multiple choice questions)
NotesFunding source not reported
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskQuote: "The study subjects were randomly assigned via employee badge numbers"
Allocation concealment (selection bias)High riskQuote: "The study subjects were randomly assigned via employee badge numbers"
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNot reported
Incomplete outcome data (attrition bias)
All outcomes
Unclear riskNot reported
Selective reporting (reporting bias)Unclear riskNot reported
Other biasLow riskThe study appears to be fee of other bias

Telner 2010

MethodsEquivalent parallel design individually randomized RCT. Reinforcement: game-based learning vs. traditional case-based learning
ParticipantsThree senior family medicine residents and 32 family physicians participated in this study. There were 67% and 41% of males in the game-based and case-based groups respectively. No patients were involved in this study
Interventions

All participants received a videotaped lecture on stroke prevention and management to ensure similar baseline knowledge.

The intervention consisted of an one hour session during which a team of 6 physicians (total of 3 teams participated in the study) played a game based on the "Snakes and Ladders" board game. Each team read and discussed the 22 true-or-false and multiple-choice questions. A neurologist was available to answer questions and a trained moderator facilitated the game by keeping the time and answering to the game's questions.

The comparison group received one hour session during which a team of 5-6 physicians (total of 3 teams participated in the study) received conventional case-based learning. A neurologist was available to answer questions and a trained facilitator was involved. Both groups viewed a 30-minute videotaped lecture by a neurologist on stroke prevention and management before receiving the one hour session.

There were no monetary rewards

Outcomes

Knowledge retention: evaluated by an immediate and 3 months posttest.

Level of enjoyment: The subjective feedback of the participants showed significant higher in the game-based group.

Evaluation of the experience including: enjoyment of the event, subjective learning experiences, and willingness to attend future CME events using the same form

NotesFunding source not reported
Risk of bias
BiasAuthors' judgementSupport for judgement
Random sequence generation (selection bias)Unclear riskNot reported
Allocation concealment (selection bias)Unclear riskNot reported
Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNot reported
Incomplete outcome data (attrition bias)
All outcomes
Low riskThirty-one (89%) of the 35 participants completed the three-month posttest (15 in the game-based group and 16 in the case-based group)
Selective reporting (reporting bias)Unclear riskNot reported
Other biasLow riskThe study appears to be fee of other bias

Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion
Akl 2008aStudy design not appropriate
Akl 2010Review of gaming theory
Amos1994Study design not appropriate
Andrade 2008Study design not appropriate
Backstein 2010Study design not appropriate
Barber-Madden1989Study design not appropriate
Bauman 2010Abstract
Begg 2008Review of gaming theory
Bergeron 2008Study design not appropriate
Bhoopathi 2006Study design not appropriate
Bhoopathi 2007Review of gaming theory
Boreham 1989Population composed of students and not professionals
Boulet 2007Study design not appropriate
Brinson 1988No description of the game
Burns 1984Study design not appropriate
Carlson 1992Study design not appropriate
Cessario 1987Population composed of students and not professionals
Christmas 2007Study design not appropriate
Cowen 2002Population composed of students and not professionals
D'Alessandro 2002Study design not appropriate
Dowd 2003Review of gaming theory
Dowd 2004Review of gaming theory
Durman 2002Study design not appropriate
Espinosa 2006Abstract
Feldman 1985Study design not appropriate
Finn 2011Abstract
Ford 1996Study design not appropriate
French 1980Population composed of students and not professionals
Gage 2011Study design not appropriate
Geyer1990Review of creative teaching strategies
Girardi 2006Population composed of students and not professionals
Gordon 1995Study design not appropriate
Gruending 1991Study design not appropriate
Guidry 2000Study design not appropriate
Hansen 2008Review of gaming theory
Harding 2001Population composed of students and not professionals
Hodges 2007Abstract
Ingram 1998Population composed of students and not professionals
Jirasevijinda 2010Study design not appropriate
Jones 2000Study design not appropriate
Kurenov 2009Study design not appropriate
LeCroy 2006Study design not appropriate
Leidy 1992Study design not appropriate
Leonard 2008Abstract
Lim 2008Abstract
Lopes 2003Study design not appropriate
Meidani 2006Abstract
Meterissian 2007Study design not appropriate
Montpas 2004Population composed of students and not professionals
Morton 2001Study design not appropriate
O'Kane 1988Not about a specific game
Ogershok 2004Study design not appropriate
Olbrich 1997Not about a specific game
Parker 2005Study design not appropriate
Pearce-Smith 2007Study design not appropriate
Petersen 2010Study design not appropriate
Pittiglio 2011Review of gaming theory
Pocock 1987Study design not appropriate
Reeve 2008Abstract
Regan 2000Population composed of students and not professionals
Reiner 2008Review of gaming theory
Roubidoux 2002Population composed of students and not professionals
Saethang 1998Study design not appropriate
Schmitz 1991Study design not appropriate
Silva 1989Study design not appropriate
Sisson 1988Review of games
Skinner 2000Study design not appropriate
Stefanelli 1992Study design not appropriate
Stephenson 1998Study design not appropriate
Stewart 2006Study design not appropriate
Sturgis 2006Abstract
Taekman 2010Study design not appropriate
Thornburg 1998Not about a specific game
Tumosa 2006Review
Turley 2007Study design not appropriate
Udin 1985Population composed of students and not professionals
Verdaasdonk 2009Study design not appropriate
Wargo 2000Study design not appropriate
Warihay 1986Study design not appropriate
White 1985Study design not appropriate
Wilson 1995Study design not appropriate

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