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Educational games for health professionals

  1. Elie A Akl1,*,
  2. Victor F Kairouz2,
  3. Kay M Sackett3,
  4. William S Erdley4,
  5. Reem A Mustafa5,6,
  6. Michelle Fiander7,
  7. Carolynne Gabriel8,
  8. Holger Schünemann9

Editorial Group: Cochrane Effective Practice and Organisation of Care Group

Published Online: 28 MAR 2013

Assessed as up-to-date: 13 NOV 2007

DOI: 10.1002/14651858.CD006411.pub4


How to Cite

Akl EA, Kairouz VF, Sackett KM, Erdley WS, Mustafa RA, Fiander M, Gabriel C, Schünemann H. Educational games for health professionals. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD006411. DOI: 10.1002/14651858.CD006411.pub4.

Author Information

  1. 1

    American University of Beirut, Department of Internal Medicine, Beirut, Lebanon

  2. 2

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

  3. 3

    Capstone College of Nursing, University of Alabama, Tuscaloosa, Alabama, USA

  4. 4

    State University of New York at Buffalo, Behling Simulation Center, Buffalo, New York, USA

  5. 5

    McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada

  6. 6

    University of Missouri-Kansas City, Division of General Internal Medicine and Nephrology, Kansas City, Missouri, USA

  7. 7

    Centre for Practice Changing Research, Ottawa Hospital Research Institute (OHRI), Effective Practice & Organisation of Care (EPOC) Group, Ottawa, Ontario, Canada

  8. 8

    Middlesex-London Health Unit, London, ON, Canada

  9. 9

    McMaster University, Departments of Clinical Epidemiology and Biostatistics and of Medicine, Hamilton, Ontario, Canada

*Elie A Akl, Department of Internal Medicine, American University of Beirut, Riad El Solh St, Beirut, Lebanon. ea32@aub.edu.lb.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 28 MAR 2013

SEARCH

 
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


InterventionsAll 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


OutcomesKnowledge 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

 
Summary of findings for the main comparison.

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-

KnowledgeOne 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.

 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.
 
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