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. 2019 Sep 26;7(3):e13748.
doi: 10.2196/13748.

Impact of Using a 3D Visual Metaphor Serious Game to Teach History-Taking Content to Medical Students: Longitudinal Mixed Methods Pilot Study

Hussain Alyami  1   2 , Mohammed Alawami  3 , Mataroria Lyndon  1 , Mohsen Alyami  1 , Christin Coomarasamy  4 , Marcus Henning  1 , Andrew Hill  1 , Frederick Sundram  1
Affiliations

Impact of Using a 3D Visual Metaphor Serious Game to Teach History-Taking Content to Medical Students: Longitudinal Mixed Methods Pilot Study

Hussain Alyami et al. JMIR Serious Games. .

Abstract

Background: History taking is a key component of clinical practice; however, this skill is often poorly performed by students and doctors.

Objective: The study aimed to determine whether Metaphoria, a 3D serious game (SG), is superior to another electronic medium (PDF text file) in learning the history-taking content of a single organ system (cardiac).

Methods: In 2015, a longitudinal mixed methods (quantitative and qualitative) pilot study was conducted over multiple sampling time points (10 weeks) on a group of undergraduate medical students at The University of Auckland Medical School, New Zealand. Assessors involved in the study were blinded to group allocation. From an initial sample of 83, a total of 46 medical students were recruited. Participants were assigned to either a PDF group (n=19) or a game group (n=27). In total, 1 participant left the PDF group after allocation was revealed and was excluded. A total of 24 students in the game group and 14 students in the PDF group completed follow-up 7 weeks later. Using an iterative design process for over a year, with input from a variety of clinical disciplines, a cardiac history-taking game and PDF file were designed and informed by Cognitive Load Theory. Each group completed its intervention in 40 min. A total of 3 levels of Kirkpatrick training evaluation model were examined using validated questionnaires: affective (perception and satisfaction), cognitive (knowledge gains and cognitive load), and behavioral attitudes (Objective Structured Clinical Exam) as well as qualitative assessment. A priori hypotheses were formulated before data collection.

Results: Compared with baseline, both groups showed significant improvement in knowledge and self-efficacy longitudinally (P<.001). Apart from the game group having a statistically significant difference in terms of satisfaction (P<.001), there were no significant differences between groups in knowledge gain, self-efficacy, cognitive load, ease of use, acceptability, or objective structured clinical examination scores. However, qualitative findings indicated that the game was more engaging and enjoyable, and it served as a visual aid compared with the PDF file.

Conclusions: Students favored learning through utilization of an SG with regard to cardiac history taking. This may be relevant to other areas of medicine, and this highlights the importance of innovative methods of teaching the next generation of medical students.

Keywords: clinical competence; instructional technology; learning; memory; metaphor; retention; video games.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

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In-game snapshot showing the symptoms and signs relevant to the cardiovascular system.
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Visual metaphor and game design process in each game version.
Figure 3
Figure 3
Iterative visual metaphor design.
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In-game snapshot showing the visual metaphor in the background, question and multiple choice options. The number of points (29) represents that it took the player in the beginner level one second to decipher the visual metaphor and answer the question correctly (out of the 30 seconds allocated per question).
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Study design and sampling time points.
Figure 6
Figure 6
Knowledge across baseline, postintervention and follow up time points (no statistically significant differences).
Figure 7
Figure 7
History-taking self-efficacy across baseline, postintervention and follow up time points (no statistically significant differences).
See this image and copyright information in PMC

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