Gamification involves the integration of game elements such as a scoreboard, timer, points, locks, and keys into educational activities to increase engagement among the learners. When applied thoughtfully, gamification can enhance intrinsic motivation and encourage undergraduate learners to engage with the educational content meaningfully. A combination of gamification principles with healthcare simulation can create innovative, experiential learning experiences. These activities can promote deeper understanding, enhanced knowledge retention, and improved learning outcomes. This HealthySimulation.com article by Dr. Ayesha Ahmed will explore the purposeful design of gamified clinical simulation for undergraduate students. After this article, be sure to check out the Serious Play Conference for more great ideas!
Steps to Design a Gamified Clinical Simulation for Undergraduate Students
For early-stage learners like undergraduate students, gamified clinical simulations help maintain attention, minimize distractions, spark curiosity, and cultivate a sense of achievement while learning. These experiences can help students track their progress and remain actively engaged in the learning task. Gamifications can help to reduce anxiety and apprehension when implemented in a psychologically safe environment, where learners can make mistakes and reflect without fear of judgment or repercussions. Carefully planned clinical simulated games can be an effective tool to boost self-efficacy and build confidence in the learner.
Several deliberate steps are required to design gamified simulations for undergraduate healthcare students that blend educational principles and innovative thinking. This can be a challenge for new educators or simulationists. But gamified healthcare simulations are rarely developed in one iteration. They almost always require reviews and revisions before the final version emerges. The steps below reflect practical lessons drawn from personal experiences in simulation-based game development and review of relevant literature.
Identify content that suits gamification: The first and most important step is to identify an appropriate content area within the curriculum where game-based simulation can strengthen learning. This step requires the collaboration between the subject experts (e.g., faculty) and healthcare simulationists to ensure relevance and feasibility. Gamification is best suited for topics that require teamwork, interdisciplinary integration, problem-solving, critical thinking, and decision-making. These areas naturally align well with elements of competition, collaboration, challenges, and achievements, which enhance learner motivation and engagement. In contrast, topics involving sensitive, emotional, psychological, or ethical issues, such as patient death, psychiatric issues, and ethical dilemmas, may not fit a game format. Selection of the right content is therefore essential. A set of relevant learning objectives (LOs) should be used as the foundation of the game. These objectives will shape the game and ensure that every component adds value to the student’s progress. LOs will also set the difficulty level and number of learners in each game.
View the HealthySimulation.com Webinar The Impact of Serious Games and Gamification in Healthcare and Clinical Education to learn more!
Select the Game Elements: Once the content and learning objectives are decided, the next step is to select which game elements to include. Educators may choose from buzzers, locks, scoreboards, puzzles, equations, points, timers, awards, rules, hidden objects, role play, and progressive achievements. These elements may exist in both physical and digital spaces and depend on available resources and infrastructure. Each element should support the learning objectives directly or indirectly. For example, a timer can be included for time-sensitive tasks, puzzles can be used to improve problem-solving, rules can impose restrictions that foster critical thinking, and roles like captain can be used to create a sense of teamwork. After the selection of a feasible set of game elements, educators may add a narrative or storyline to make connections between elements of the game. The narrative can follow a clinical case study or a fictional / sci-fi scenario. This can deepen immersion for young learners, although not essential for successful gameplay.
Choose the Game Format: The next task is to select an appropriate game format. Common formats reported in the literature include escape rooms, tournaments, races, puzzles, scavenger hunts, obstacle courses, board games, missions, and riddles. Educators may also design entirely new games to better fit the learning goals. Undergraduate learners often respond well to energetic and innovative formats with collaborative activities. Regardless of the chosen format, the activity must lie within the learnerโs Zone of Proximal Development. The challenge level must match the learnerโs current stage of development and should not be too easy or complex. An optimal difficulty level will prevent cognitive overload and ensure the game provides a meaningful learning experience without discouraging students. An example of a game format is written below for inspiration:
Examples: PPE Match, two teams of the infectious disease department compete with each other to correctly select personal protective equipment (PPE) needed for a tuberculosis case. A table will display various PPE items, and each team has 60 seconds to collect relevant equipment. The winner will be selected based on the least time used for the most accurate PPE selection. โPPE Champโ badges can be given as rewards to the winners.
Prepare and Pilot Test: A gamified healthcare simulation requires thorough preparation to ensure a smooth learning experience. This includes review of the game elements, rules, physical or digital materials, and tests of supplies (timer, locks, scoreboards), and alignment with the learning objectives. For puzzles or riddles, the educator may prepare hints or cues that can be given without offsetting the challenge. Clear instructions must be prepared in advance for both students and facilitators. For undergraduate learners, guidance should be simple and accurate to maximize benefit from the activity. A preparatory checklist can support this stage by outlining the setup requirements and materials. Depending on the activity, educators may also create a scoring sheet or a rubric to measure learner performance, which can later be used for feedback.
After preparation, a comprehensive pilot test is necessary. Educators may pilot test the activity with a small group of students, teaching assistants, or junior faculty members. A pilot test helps identify gaps, inaccuracies, or inconsistencies in the game and reveals tasks that may not match the difficulty level of the undergraduate learners. Subject matter experts may also provide valuable input in this stage. Feedback and observation from the pilot test can be used to refine the activity to ensure optimal alignment with the learning objectives.
Implement and Facilitate: After the careful planning and testing are completed, the time has arrived to put the gamified healthcare simulation in action. Educators should use a checklist to set up the space for the game, arrange materials, and position the game elements to ensure completeness. A structured and supportive environment can help students remain focused on the learning objectives and gain maximum benefit from the gamified experience. To achieve this, a pre-game briefing should be given to students that outlines the game structure, environment, expectations, learning objectives, rules, and establishes psychological safety. During the activity, the facilitator should closely observe the performance with minimal interruptions and allow students to progress through the game independently. This approach boosts the studentsโ sense of competence and autonomy. The facilitator also upholds the rules, maintains safety, and provides essential guidance through cues. Key observations may be recorded on a scoring sheet for later use in debriefing. After the game, students should be debriefed to help them reflect on performance, consolidate learning, and improve in the future.
Evaluate: Evaluation determines whether the gamified healthcare simulation provided an adequate opportunity for the learners to meet the learning objectives. This stage includes a review of learner and facilitator performance, as well as stakeholder feedback. The scoring sheet or rubric offers a less biased measure of performance, while feedback from students, faculty, facilitators, or educators can reveal the challenges and strengths of the activity. This step should also include self-reflection by the game designer. Reflection on the development process, ease or difficulty of execution, helps identify what went well and what needs improvement. These reflections and feedback allow the educator to grow as the โGame Masterโ and support the creation of more refined, engaging, and effective games in the future.
View the new HealthySimulation.com Community Scenario Design Group to discuss this topic with your Global Healthcare Simulation peers!
Pro Tips for Bringing in Serious Games to Healthcare Simulation
- Start small! Begin with simple games, and progress to more complex ones.
- Allow enough time for planning and pilot testing. The process may take a few months of iterative work before the game is ready for implementation.
- Select the number of learners according to the game. A group of 4 to 7 works well, but the ideal number depends on the game.
- Allow the learner to voluntarily participate in the gamified healthcare simulation. This respect for autonomy boosts intrinsic motivation to learn.
- Do not sweat the small stuff. Every game has room for improvement.
- Keep extras! Prepare extra locks, buzzers, and other components to minimize interruption and technical failures.
- Follow the INASCL Healthcare Simulation Standards of Best Practice, as applicable, to design and deliver an effective simulation.
- Enjoy the game! A positive attitude from the educator sets the tone for the game and encourages enthusiasm.
Gamified clinical simulations offer undergraduate learners a dynamic and engaging way to interact with the educational content and build essential skills such as problem-solving, critical thinking, and teamwork. Careful content selection, purposeful design, thorough preparation, and facilitation lead to an effective game-based simulation. The addition of simulation components like structured briefing and debriefing is necessary to support meaningful learning. With a strong commitment to continuous improvement, each gamified healthcare simulation offers learners the opportunity to improve and educators the chance to refine their craft.
Learn More About How to Enhance Healthcare Simulation Through Gamification!
