Evaluation of a 3D serious game for advanced life support retraining
Introduction
Resuscitation Councils endorse advanced life support (ALS) training courses in which ALS instructors (i.e., doctors and registered nurses who show distinguished ALS knowledge and skills, followed courses for instructors, and are regularly involved in ALS courses) train ALS providers (i.e., doctors and registered nurses who can be required to frequently or occasionally provide ALS to patients). More precisely, ALS instructors teach knowledge, decision-making and practical skills to new ALS providers or update already trained providers about new ALS guidelines, which are released every five years.
ALS training courses usually last a few days and effectively improve resuscitation competence [1], [2], [3], yet there is invariably a significant decrease over time of the knowledge and skills acquired [3], [4], [5], [6], [7], [8]. To ensure that ALS providers maintain their competence, ALS retraining courses (i.e., one-day courses in which ALS providers can refresh their knowledge and skills about ALS guidelines they are already trained on) are recommended [9].
Unfortunately, although ALS providers are generally aware of their need for retraining, only a few actually attend ALS retraining courses [10], [11]. Motivational and financial issues, along with time constraints imposed by work shifts, make it difficult to devote a full day to retraining. Moreover, even with sufficient resources, many centers plan retraining events once every two years, while several studies suggest that ALS knowledge and skills decrease in as little as 3 months [8], [12], [13], [14]. Therefore, new approaches to facilitate compliance with the suggested retraining schedules and prevent knowledge and skills decrease are needed.
Computer-based training systems could offer a solution to these issues, since they allow trainees to follow different lessons individually and over time without the financial overhead and logistic issues involved in organizing a training course [15], [16], [17], [18], [19], [20], [21]. In addition, computer-based training systems can employ virtual reality (VR) techniques to create 3D virtual environments that are believable reproductions of the real world. In these environments, trainees can learn by directly interacting with virtual characters and objects as recommended by constructivist theories [22], [23]. Moreover, they can take advantage of: (i) realistic 3D graphics and sound that create an immersive experience which could be difficult and expensive to simulate in traditional training courses, (ii) different camera viewpoints and multimedia resources that illustrate important aspects of simulated patients, (iii) changes in virtual patients that give real-time feedback about trainees’ actions, and (iv) animations that help in understanding complex situations and cause–effect relationships [23].
VR systems for medical training have traditionally concentrated on the fidelity of the patient or organ simulation and of the actions that can be performed on them [24], [25], [26]. However, this may not be sufficient to motivate or engage learners [27]. Moreover, medical VR systems often require expensive special hardware and software [24], [25]. To overcome such limitations, there is a growing interest on building training systems, called serious games [28], that employ video game techniques to better engage trainees and to be used on low-cost PCs [29].
To build a serious game, an immersive and engaging story that embeds instruction is fundamental [28]. Moreover, serious games can exploit the familiarity of people with the interaction styles of entertainment video games to make the training system easier to use and more attractive. While playing, trainees may improve their skills with repeated attempts at completing game levels, failing and succeeding, understanding which strategies are successful [27].
The aim of our study was to assess the effectiveness of a 3D serious game as a novel tool for frequent ALS retraining. In particular, the objective of the study was to assess the possible gain in ALS knowledge and decision-making skills after a retraining session with the serious game as well as retention three months later. In addition, we investigated the perceived effectiveness of the serious game and ALS providers’ willingness to keep retraining with it.
Section snippets
Serious game
The study used EMSAVE, a single-player serious game we designed to refresh trainees’ ALS knowledge and decision-making skills by means of 3D scenario-based simulation.
This section summarizes the main features of EMSAVE, which are also illustrated by a video in the supplementary material.
Participants
Forty ALS providers enrolled in the study, 25 (62.5%) female and 15 (37.5%) male. Age ranged from 24 to 49 years, the median was 36, and the mean was 35.5 (SD = 6.4).
As shown in Table 1, all participants used computers. In particular, 86% of participants used them for more than 5 years. About one third of participants used computers a few times a week and about two thirds every day.
Most participants regularly used applications for office, Internet, and e-mail as well as applications related to
Need for retraining
As previously reported, several ALS providers in the considered sample had never received ALS retraining despite their perceived need to frequently attend retraining sessions. Such need is further motivated by the results of the pre-test which revealed lack in ALS knowledge and skills (about a third of questions were correctly answered by less than half of participants). In addition, decrease in knowledge and skills in 3 months affected about 60% of questions, highlighting the importance of
Authors’ contributions
EC and LC conceived and obtained funding for the research project that includes the described study. FB, LC and ACV designed the 3D serious game used in the study, and FB and ACV developed it. All authors contributed to the design and the organization of the study. DP and TP handled recruitment of participants. FB, ACV, DP and TP supervised the conduct of the study and data collection. FB and LC analyzed the data. FB, LC, TP, and ACV drafted the manuscript, and all authors contributed to its
Conflict of interest statement
No author has conflicts of interest.
Acknowledgments
The research project was co-financed by the Friuli Venezia Giulia region. The co-financing institution had no role in the design and conduct of the study, collection, management, analysis, and interpretation of data or the preparation, review, or approval of the paper.
References (36)
Developing leaders for advanced life support: evaluation of a training programme
Resuscitation
(2001)- et al.
Quality of CPR during advanced resuscitation training
Resuscitation
(2008) - et al.
The significance of clinical experience on learning outcome from resuscitation training-a randomised controlled study
Resuscitation
(2009) - et al.
Immediate life support (ILS) training Impact in a primary care setting?
Resuscitation
(2007) - et al.
European Resuscitation Council Guidelines for Resuscitation 2010 Section 9. Principles of education in resuscitation
Resuscitation
(2010) Advanced life support training
Resuscitation
(2001)- et al.
Randomised controlled trials of staged teaching for basic life support
Resuscitation
(2001) - et al.
Evaluation of staff's retention of ACLS and BLS skills
Resuscitation
(2008) Retention of advanced cardiopulmonary resuscitation knowledge by intensive care trained nurses
Intens. Crit Care Nurs.
(1992)- et al.
Collaborative environment for clinical reasoning and distance learning sessions
Int. J. Med. Inform.
(2003)
VISION2003: virtual learning units for medical training and education
Int. J. Med. Inform.
Virtual biomedical universities and e-learning
Int. J. Med. Inform.
Can design principles of traditional learning theories be fulfilled by computer-based training systems in medicine: the example of CAMPUS
Int. J. Med. Inform.
Training inter-physician communication using the Dynamic Patient Simulator®
Int. J. Med. Inform.
Using a web-based system for the continuous distance education in cytopathology
Int. J. Med. Inform.
Web3D technologies in learning, education and training: motivations, issues, opportunities
Comput. Educ.
Simulating tumour removal in neurosurgery
Int. J. Med. Inform.
Haptic reproduction and interactive visualization of a beating heart for cardiovascular surgery simulation
Int. J. Med. Inform.
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