Serious Games: Keys to Success

Know your target audience. If some learners might benefit more from alternatives, provide them. Different learners will like different types of games, so you may need to provide more than one game, targeted to different audiences.

Choose a game that supports the learning objectives and content, but balance this with the requirements of game play. Focus in on specific objectives and outcomes as much as possible.

Failure is not a bad thing. Don't make the game too easy. Easy learning games do not produce good learning outcomes. Leaners are more likely to remember when things go wrong

Use competition and/or collaboration. Competition motivates learners. Collaboration is even better: it allows social learning that is effective in motivating behavioral change.

Test, test, test! Even simple edutainment games can have unexpected glitches. For example, a monopoly game that was targeted at teaching visiting nurses specific infection control techniques turned out to requuire knowledge the nurses did not have before starting the game. This was solved by holding a short briefing before starting the game, but pre-testing might uncover this type of issue.

Consider having learners create their own games. In several reports, this was mentioned as one of the most useful exercises involving games, probably because it requires the student to think through the subject thoroughly.

Serious Games: Potential problems with using serious games

"Although games can be effective learning environments, not all games are effective, nor are all games educational. Similarly, not all games are good for all learners or for all learning outcomes."

- Diana Oblinger, 2006

When deciding to use a game for training, it's important to clearly state your learning objectives and to determine exactly what advantages the game will provide. If the game is too easy or too hard, or does not focus on the objectives, it may simply waste the learners' time. Depending on the type of game you intend to use, you may need to go through a substantial testing phase to ensure success.

Some of the possible issues to watch out for:

• Playing the game becomes more important than the learning
• Cost of producing a game exceeds learning return on investment
• Game takes a long time to produce and is ineffective at training
• Game too easy or too hard
• Learning curve to start playing game is too high for the target audience
• Learner remembers game but not content
• Other learning tools may be more effective
• Information incomplete or inaccurate in the game
• The game is too difficult to maintain or keep up to date

Despite the claims that can be made regarding the educational potential of OLEs, it is becoming apparent that some students, often including those who value what the learning environment has to offer, do not interact with them in a manner conducive to fully experiencing the benefits.

Many students have a tendency to procrastinate rather than exploiting the opportunity for self-paced learning that exists online, which typically leads to them 'falling behind' (Hiltz 1997). It is also common to find that much studying actually occurs offline, and is largely based around working with printed copies of material (Crook 1997; Ward & Newlands 1998). Furthermore, research into the influence of learner differences in online contexts tends to indicate that only a minority of more focused or active students will fully utilise the materials and tools at their disposal, while the majority limit themselves to working with core materials and only satisfy the basic
requirements for interacting with other features of their environments (Light et. al. 1997; Gibbs 1999; Karuppan 2001). Finally, in relation to online communication, it is widely accepted that students will rarely participate in
asynchronous discussion or collaboration simply because a facility for this has been provided (Tolmie & Boyle 2000; Salmon 2002).

http://www.ejel.org

Serious Games: Why use games for training?

Why use games for training?

Serious Games: discussion of the Virtual Knee Surgery game

Virtual Knee Surgery is designed to teach high school students some of the
concepts and steps in a knee replacement procedure. It is fairly simplistic but demonstrates some typical game structures and objectives well. You can try the real Virtual Knee Surgery game here, or just follow along with some of the screenshots below.

Your first task is to check the patient's vital signs, comparing them to healthy ranges:

After viewing X-rays, you are asked to mark the correct knee. I
found I actually had to stop and think for a moment, a great
demonstration of how easy it could be to get the site wrong. The tool
interface is a nice solution to the problem of simulating skills
online. This game does just enough to get the point across.

You click the right tool...

Then draw your initials on the knee.

After the patient is draped, and the incision is marked, you make the incision by dragging a scalpel down the marked incision line. The scalpel moves as if it is on rails, which eliminates the need for manual dexterity with the mouse.

On the interactivity spectrum, the virtual knee surgery falls nearer to the low end of the scale, similar to a story or movie. From one try to the next there is very little change in the way the game plays out.

This is an example of a "Progression" game. You are presented with a series of challenges, where all the options and solutions have been pre-designed by the games developers. You can't do anything they did not explicitly create.

Despite its apparent simplicity, this game keeps the player's interest and teaches some of the steps and associated concepts (like sterility, how the prostheses are fitted, vital sign ranges, etc.) of surgery and knee surgery in particular.

The Virtual Knee Surgery game demonstrates some contextual learning. The player is given a little scrap of new knowledge, which can be used immediately, then another for the next step. You have very limited options in how to use the new ideas, so you may not understand or retain as much as if you could try things out and fail some of the time.

In general, adult Learners tend to prefer more control over the speed and direction of the learning process, so that is something to keep in mind for designing learning games.

You will probably notice that there is really only one path through this game. If you make the wrong choice, you are soon steered back to the correct path again, with corrective feedback as shown in the diagram below:

You might recognize the similarity between this simple branching and the decision trees healthcare workers often use to describe their thinking processes and procedures.
For example, this was a decision tree used a few years ago for managing cases that might call for restraint.  Game developers working to create scenario based games, have found that medical educators  are very well equipped to work on these types of games - it's a good fit. 

Medical educators are used to presenting cases as complex, branching narratives and they often invite interaction requiring critical thinking and understanding from learners.

Serious Games: Online game terminology

• An Open World game is one where players can freely roam a virtual world. Usually the
  term is used to describe a game that has objectives and a storyline, but is sometimes used to describe completely open-ended virtual worlds like Second Life.


• Non-Linear gameplay: Players are presented with challenges that can be completed in more than one order. Nonlinear sequencing may consist of multiple entire plot sequences to complete the game, subplots or small branches off the main plot. 


• Sandbox games have no predefined story. An example of this might be the Sims, where the player controls the storyline.


• Persistent worlds are game-worlds that continue to develop and evolve even when the player is signed off.


• Pervasive games are games that overlay or are tightly interwoven with the everyday life of the player, often using mobile devices or other technology to provide the link between the player and the game world. Some of the types of pervasive games include: treasure hunts, alternate reality games, pervasive live action role-playing games, urban adventure games, smart street sports, and massively multiplayer mobile games.
  

Serious Games: The Virtual Patient specification

The Virtual Patient - a common standard for medical simulations

The Virtual Patient specification was developed to take advantage of the natural affinity for the branching narrative style of much of medical education. The Virtual Patient is a common standard by which patient cases can be structured in a manner that can be read by many game and simulation systems.

A virtual patient represents whichever characteristics of the patient are relevant to the current educational context.

The VP format contains these segments:

• Patient History
• Investigations
• Differential Diagnosis
• Final Diagnosis

This is specified using a standardized document structure for the description of the patient called CaseML .

What software can utilize Virtual Patients? 

The Labyrinth system, developed at University of Edinburgh is one example of an elegant use of the standard without attempting high fidelity realism.

The Labyrinth system uses mostly text-based interaction, along with beeper windows, test results and various other messages and alerts that pop up to provide a realistic experience (See below).

Moving up the realism scale a little, is this first phase of a project from the Imperial College of Medicine.

Serious Games: Attributes of games

Attributes of games

 Games of emergence vs. games of progression

Jesper Juul notes that games, in particular computer games, present challenge to the player in one of two ways: "Emergence" (simple rules combining into interesting variation, and "Progression" (serially introduced challenges). 

• Emergence: a number of simple rules combining to form interesting variation


• Progression: separate challenges presented serially

Chess, board games, card games and strategy games are good examples of the emergence type of game. A small number of rules combine to create enormous variation. These games tend to be played over and over, with infinite strategies. 

Progression games present a fixed sequence of events, with each challenge requiring a predefined set of actions to complete it. The old game Myst was a good example of this type, as are many adventure games.  




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Interactivity

Interactions by the player(s) which change the course of the activity distinguish games from passive activities like reading stories and watching movies. In the case of toys and virtual worlds, the rules/storyline becomes so flexible that there is no one game: the activity is shaped by the whim of the player.

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Representation

According to Chris Crawford, a noted game designer and game researcher, games subjectively represent some piece of reality. Games don't physically recreate the situations they represent, but they become subjectively real to the player through fantasy. A game creates a fantasy representation, not a scientific model.

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Challenge



"Challenge" can mean very different things depending on the game. It can be the mystery to be unraveled, a problem to be solved, or it can involve more perceived conflict and risk to the player: beating the clock, defeating opponents, or keeping your own character alive in the face of multiple threats. It is possible to have a very challenging game with little perceived in-game risk, but usually conflict and competition come into play.
Some players simply prefer less risk overall: they want to explore and experiment without the external pressure of competition. Game researchers distinguish between intrinsically motivated players (those who prefer exploration) and extrinsically motivated players, who prefer competition and risk. Players who are intrinsically motivated will want time to look around practice and not be hurried through the game in pursuit of points or to beat the clock.


However, studies indicate that up to a point more challenge and more conflict improve retention and cognitive learning. Beyond that point, if a game is too hard, players will feel like they are going to fail and lose motivation.

Serious Games: What is a game?

What is a game?

Note: This series of posts is from the handout for a talk on serious games, given at UMHS on May 12.

We all have an idea of what a game is, but it is not so easy to define precisely  what makes games different from other activities. No definition of games is entirely complete, but we can approach an understanding by considering games in relation to similar activities, such as reading stories, watching movies, playing with toys, solving puzzles, and so on, and try to see where the significant differences lie.

Stories, games, toys, puzzles, races, etc. all have some attributes in common, but the proportions of those attributes make some activities more gamelike. Thinking about the role of attributes such as interactivity, representation, challenge, and risk can help us understand the nature of a particular learning game, what types of learning objectives it might be most effectively used for, and what kind of learner might benefit from it.

With these limits in mind, one good place to start is Debra Lieberman's definition: "A rule-based activity involving challenge to reach a goal. Rules, Challenge and Goal are themselves very flexible terms, but they do set up a structure we can work within. We'll be discussing these and other attributes, as well as which attributes seem to most affect learning.

Some game researchers consider the game's rules as the key difference between a game and other forms of narrative, but I think, particularly in health care, the narrative has a privileged role.

Debra Lieberman has served on the advisory board for Games for Health for the past two years. Her extensive expertise in this area has been invaluable in shaping this emerging field. Debra Lieberman is a lecturer in the Department of Communication and a researcher in the Institute for Social, Behavioral, and Economic Research (ISBER) at the University of California, Santa Barbara.

Set duration in Windows Media

A quick way to create shorter clips out of longer ones without video editing: set the Starttime and Duration parameters in the ASX file.

Example ASX file:

<ASX version = "3.0">

  <Title>the title of the video/s</Title>

  <Entry>

  <StartTime Value="00:09:36.00" />

  <Ref href = "mms://myvideoserver.com/myvideo.wmv" />

  <DURATION value="00:00:05.00"/>

  </Entry>

  </ASX>

Serious Games presentation

These slides are from an inservice I gave the other day on the attributes and effectiveness of Serious Games. Thesea are mostly pictures so you will probably get more from viewing the narrated, captioned version of the presentation HERE

Music: why not a finger-sensing keyboard?

Electronic keyboards like the Yamaha Motif or Korg M50 often have a "Split" feature, allowing different patches to be assigned to different sections. For example, the bottom 18 or 20 keys can be assigned to a bass patch, leaving the rest of the keys assigned to an electric piano sound. These splits allow not just the patch to change, but the pitches as well. For example the bottom keys can sound an octave lower than they ordinarily would.

Small keyboards often have buttons that shift the octave to the left or right on the fly, effectively increasing the number of keys without the weight.

There is another split type that is possible nowadays but apparently no manufacturer has done it yet. What if the patch or pitch range were assigned to each key in real time by which finger or which hand touched the key?

This would require some type of signalling device on finger or hand that would be instantly recognized by the keyboard. Of course the device would need to be very small and non-interfering with the sense of touch or movements of the fingers. The speed of the sensors involved would have to be quite rapid as well.

What could you do with this? Well, if you are a good pianist, you could play contrapuntal melodies, with each voice in a different instrument.

Or, if you set the keyboard to recognize the left hand as the bass, any key touched by the left hand could sound an octave lower than when touched by the right. Even when the hands crossed, the voices would maintain their separation.

This would make it possible to use much smaller, lighter keyboards to get the full range of notes, or multitimbral setups that ordinarily take multiple manuals could be done with one.

Progress in the fight against Hospital Acquired Infections

The problem:

Over the last few years, public attention has been focused increasingly on the problem of nosocomial or hospital acquired infections (HAI's). Why is there so much concern? A study by the CDC published in the March/April 2007 issue of the journal Public Health Reports, estimated that 1.7 million hospital patients per year ― 4.5 of every 100 admissions ― become infected, causing or contributing to the deaths of nearly 100,000 people per year. (IHI.org) 100,000 people per year is about 1/5 of the total deaths from cancer per year in the US, or about the same as the total stroke or accidental deaths. Or, another way to understand the size of this number, picture the population of South Bend Indiana, dying every year of mostly preventable causes. This is an epidemic.

Hospital acquired infections may be the sixth leading cause of death, but many people do survive, only to experience long, difficult recoveries, sometimes with devastating surgeries, or permanent disability. Each time a patient becomes infected it adds an average of $30,000.00 to the charges for their hospital stay, money that is no longer reimbursed by Medicare. So it is not surprising that there are many initiatives seeking to reduce the incidence of these infections.

Burn patients, patients who are on ventilators, certain types of surgery patient particularly those with diabetes, and patients with a central line inserted are most likely to get these types of infections, but they are an increasing problem for all sorts of patients. In 2008, the US Government Accounting Office issued several reports calling for a greater role for the Department of Health and Human Services to obtain reliable data on HAI's from inpatient settings and outpatient procedures and to prioritize prevention practices. Link and Link

What works to prevent these infections?

Researchers are working to find effective means of reducing the incidence of nosocomial infections. Some of the best practices coming out of recent studies include

• Following the infection control policies already in place, like washing hands, improper sterilization of equipment, etc.
• The incidence of ventilator associated pneumonia (VAP) can be reduced by 50% if patients' teeth are brushed 3 times a day, even if they are unconscious. Link
• Bathing intensive care patients daily with antibacterial (chlorhexidine) reduces catheter-associated bloodstream infections. Link
• Performing laparoscopic surgery instead of open incision procedures Link
• All the little places we touch without thinking: pens, paper, wristwatches, doctor's white coats, sink taps, bed rails, etc. have to be looked at as sources of cross-contamination.

But some of the changes that would help the most are very difficult to accomplish. These involve changing the physical configuration of hospitals and health care settings. Research suggests that single-patient rooms can reduce infection rates up to 45%. This can require new building or expensive remodelling. Or, simply halving the bed space in a given unit. I've seen this done in some facilities, where they appear to have decided after the fact and given each patient a really big room. In some older hospitals, handwashing sinks are located far from the patients, so staff either wash less than they should or use the patient bathroom, a source of contamination. Clean wheelchairs, walkers and canes must be stored apart from used supplies - this requires more space. Link

The American Institute of Architects' 2006 Guidelines for Design and Construction of Health Care Facilities lists Single-bed rooms as the minimum standard for typical nursing units in general hospitals, based on US federal guidelines. Link

Initiatives currently underway

• The IHI has targeted some types of infections for zeroing out. They are focusing on infections that can be reduced by following evidence-based procedures or by simply not violating the policies that are already in place. IHI.org
• The Department of Health and Human Services has made it a national priority to increase transparency of healthcare so consumers can make informed decisions. This means better reporting about quality of care. Link
• A conference on Healthcare Transparency and Patient Advocacy will be held in Lexington, Kentucky on November 20, 2009. According to this article, a key goal of the conference is to make information on hospital-acquired infections more widely available to the public.
• At least 22 states have enacted laws requiring public disclosure of hospital acquired infections. A good summary of the current laws is available on AboutHealthTransparency.org. Link
• A few of the new hospital buildings being built with all or mostly private rooms:
  • St. Mary Medical Center in Long Beach, CA Link
  • Rockingham Memorial Hospital Link
  • Medicare Hospital-Acquired Conditions Initiative Link
  • Dublin Methodist Hospital, near Columbus, Ohio Link
  • Simi Valley Hospital, Simi Valley, CA Link
  • Children's Hospital, Pittsburgh, PA Link
  • Kaiser Permanente's new Santa Clara hospital Link
  • Mayo Eugenio Litta Children's Hospital in Scottsdale, Arizona Link
  • Henry Ford West Bloomfield Hospital in Michigan Link

The public transparency initiatives will probably do the most to accelerate progress, along with hospital's new understanding of the savings possible when infections are reduced.