Activity
Five
Student Driven Exploration of Anesthetic Monitoring Using Gamification
By Denise Forbes
Background:
A significant number of students in the course, 5158
Anesthesia and Analgesia, have difficulty interpreting the factual information
taught during this course, which limits their ability to evaluate the actual
condition and well-being of their anaesthetized patient when performing their
assessment of anesthetic monitoring, the culmination of their coursework at the
end of the year. This is demonstrated by
students submitting anesthetic records and videos in which they failed to
identify or explain patient abnormalities, or did not modify their anesthetic
protocol in response to anesthetic complications. As this is a key component of performing well
as a qualified veterinary nurse anesthetist, failing to develop this ability to
think critically and analyze the patient’s situation indicates that a core portion
of the learning outcome desired of this course is being missed.
To facilitate a greater degree of student critical
thought and better practical application of the principles of anesthesia, which
in turn would reduce patient risk and improve the probability for favorable
outcomes with anesthesia, the desirable goal would be to get the students
thinking at a much earlier date about the meaning and interpretation of
anesthetic monitoring information. This may be accomplished by introducing case
studies, based off of real life anesthesia cases, for the students to work
through in the classroom over a period of time.
Incorporation of these case studies into a game format online, or
gamification of this learning process would improve student engagement and use
of these case studies. The need to interpret data within the game to achieve
high scores or win, would in turn improve the interpretive anesthesia
monitoring skills of the student.
The Horizon Report (2013) identifies games and
gamification as a mid-term horizon, with an expected increasing use within the
next 2-3 years. Games may be full
immersion in nature where the student creates an avatar to represent them in a
fully developed virtual environment.
Gamification is defined as using or adding game-like components to a
learning experience or educational delivery format. Both ideas have the potential to increase
student engagement with the course material and participation in the learning
process, provided that they are well designed.
Poorly designed games would also have the risk of alienating students
and discouraging further participation.
It would therefore be critically important to devise well thought out
and developed games before initiating them.
Gamification, however, could be instituted in an incremental fashion by
first introducing elements of a game in the classroom, even before transferring
it to a computer or internet platform.
In fact, implementing portions of the game in the classroom might serve
to weed out poorly designed ideas, or those which were ineffective in
stimulating the students’ interest. Effective game ideas could then be expanded
upon or digitally enhanced and pieced together to develop an in depth and
extensive learning game.
Format:
A small group of students could be given an online
access to a set of anesthesia record documents from a real case seen in
practice and the objective would be to be able to fully interpret every detail
of this record by the end of the working time frame. Smaller groups would be best, in fact it
might be ideal to involve only 2 students per case study so that both students
would feel some responsibility to contribute to the work, and students would be
less likely to opt out of participation as they might if they were part of a
larger group.
Various copies of anesthetic records of a real patients
could be modified to look like a kind of treasure map. .At first glance, the document would seem to
contain a lot of foreign looking material because students are not familiar
with most of the terminology or abbreviations used in anesthesia, or with how
the graphs work. Students would have to
decipher (interpret) different portions of this record during their progress in
the course. Teams could be awarded a gold
doubloon for each item that they correctly deciphered (interpreted), with a scoreboard
for all of the participating teams being posted in the online classroom. Each
time a team completes a task of analyzing a graph or chart of monitoring
information, they will receive a gold doubloon and move forward on the results
tally. When all graphs or charts are
correctly interpreted, the first team to complete the task could be given a
special award of winning the treasure chest.
During their participation in the game, students would have to source
information to correctly analyze the data. For example, one area on the document would
delineate a graph of SpO2 recordings during the anesthetic period. Students would have to research, what is
SpO2, what is considered a normal SpO2 during anesthesia, and what does it mean
if SpO2 becomes abnormal as well as what should be done about an abnormal
SpO2. Picture representations of
associated items, such as a pulse-ox monitor which measures SpO2 could be
located nearby for the students to click on, and access information about this
machine, what it records and why. Links to additional sources of information
about related topics would also be located nearby each chart or graph. The treasure map design would encourage
students to progress along a “path” of learning encountering each of the
important topics of monitoring along the way.
Completion of each task would be required before the team is allowed to
progress to the next station so that the learning would progress in a logical
fashion to encourage a sequence of actions on the part of the learning to be
performed in real life when they are monitoring a live patient.
Gamification of analyzing the anesthetic record would
increase the participation of the students because of competition to complete
the tasks and a desire to win the game.
Students would need to interpret the information correctly to choose the
correct answer, or give the correct response as to what action should be taken.
The format of a competitive game, in which the students can proceed at their
own pace, but are encouraged to move forward by following the path by obtain
smaller rewards progressing towards a goal of treasure at the end would enhance
the student’s desire to participate, and to complete the program. Working in
groups of two would encourage collaborative learning and participation.
An second phase, or alternative game format might be a
more real life (SIM) game where students have to actually monitor a patient,
and react to programmed changes in the patient’s status, in order to keep them anesthetized
and alive through a surgical procedure, in the face of real time
difficulties. The reward for this game
might be a scoring of the students’ anesthetic death rates and a ranking based
on this figure.
Requirements:
Initially, if only the smaller portions of the game
were presented in the classroom, only a few props and some real anesthetic
patient records would be required.
The requirements for progressing to a computer game
technology would be that the students would need to have access to computers which
they could use in a shared participation fashion. This could be achieved by
allowing students to bring their own computers to class and by having WiFi internet
access for students in the classroom. As
a large percentage of our students already own laptop computers, it is
anticipated that over fifty percent of students would be able to bring a laptop
to class, so teams of two students sharing would be feasible. The other
requirement would be for development of an attractive game format that
functions well, which would require some technological expertise.
Advantages:
The use of games or gamification of course material
offers several advantages over the standard lecture format of delivery. One of the most significant advantages is
that there is a high potential for encouraging increased student participation
in the learning process at a much earlier time frame in the course. Games have demonstrated the ability to
increase participation by the use of rewards and recognition for achievement.
As discussed in the Horizon Report (2013), games and gamification changes the
chore of studying into the challenge of solving a problem. They encourage exploration
of the subject material to learn how to make something work, or solve the
puzzle. They encourage progression along
a learning pathway by awarding points or achievement levels, and by offering a
goal or prize to be won. The popularity and effectiveness of self-directed
study in an on-line learning environment is now being demonstrated by the use
of reward systems such as Mozilla’s Open Badge Project as discussed in Oblinger
(2012), which allows participants to collect badges for obtaining levels in any
registered organization’s game or incentive program. Participants can even
build a portfolio of their awards, which might be useful tool for an educational
program with many courses or topics of knowledge.
Gamification also encourages and rewards self-directed
study because the student is positively rewarded by choosing which direction to
progress, and by exploring down various pathways which lead to additional
challenges and the rewards of achieving success with each challenge. Students with difficulty in a subject have
the opportunity to continue exploring or attempting the challenge until success
is achieved. They are not penalized for unsuccessful
attempts, but redirected towards new paths of additional learning.
Disadvantages:
A poorly designed game could produce quick rejection
by today’s students, particularly those with experience in sophisticated,
elaborate virtual worlds such as those in high tech, well developed games that
are available today, such as World of Warcraft.
The initial cost of developing a game, especially a
well-designed, elaborate SIM environment could easily be prohibitively
expensive.
It might be difficult to be sure that all course
requirements are included and achieved unless the game was one facet of a
multidimensional learning approach.
References:
http://www.nmc.org/pdf/2013-horizon-report-HE.pdf
NMC Horizon Report 2013 Higher Education
Edition
Oblinger, D (2012). Game Changers:
Education and Information Technologies. USA: Educause. Retrieved from http://www.educause.edu/research-publications/books/game-changers-education-and-information-technologies
