Background
The use of games as an educational strategy has the potential to improve health professionals' performance (e.g. adherence to standards of care) through improving their knowledge, skills and attitudes.

Objectives
The objective was to assess the effect of educational games on health professionals' performance, knowledge, skills, attitude and satisfaction, and on patient outcomes.

Search methods
We searched the following databases in January 2012: MEDLINE, AMED, CINAHL, Cochrane Central Database of Controlled Trials, EMBASE, EPOC Register, ERIC, Proquest Dissertations & Theses Database, and PsycINFO. Related reviews were sought in DARE and the above named databases. Database searches identified 1546 citations. We also screened the reference lists of included studies in relevant reviews, contacted authors of relevant papers and reviews, and searched ISI Web of Science for papers citing studies included in the review. These search methods identified an additional 62 unique citations for a total of 1608 for this update.

Selection criteria
We included randomized controlled trials (RCT), controlled clinical trials (CCT), controlled before and after (CBA) and interrupted time-series analysis (ITS). Study participants were qualified health professionals or in postgraduate training. The intervention was an educational game with "a form of competitive activity or sport played according to rules".

Data collection and analysis
Using a standardized data form we extracted data on methodological quality, participants, interventions and outcomes of interest that included patient outcomes, professional behavior (process of care outcomes), and professional's knowledge, skills, attitude and satisfaction.

Main results
The search strategy identified a total of 2079 unique citations. Out of 84 potentially eligible citations, we included two RCTs. The game evaluated in the first study used as a reinforcement technique, was based on the television game show "Family Feud" and focused on infection control. The study did not assess any patient or process of care outcomes. The group that was randomized to the game had statistically higher scores on the knowledge test (P = 0.02). The second study compared game-based learning ("Snakes and Ladders" board game) with traditional case-based learning of stroke prevention and management. The effect on knowledge was not statistically different between the two groups immediately and 3 months after the intervention. The level of reported enjoyment was higher in the game-based group.

Authors' conclusions
The findings of this systematic review neither confirm nor refute the utility of games as a teaching strategy for health professionals. There is a need for additional high-quality research to explore the impact of educational games on patient and performance outcomes.

Educational Games for Health Professionals

https://www.omicsonline.org/2167-1168/2167-1168-S1.002-089.pdf

Active-learning strategies: The use of a game to reinforce learning in nursing education. A case study

Gaming is an innovative teaching strategy that research has shown to be effective for improving nursing student learning outcomes. Specifically, gaming enhances retention of knowledge, promotes problem-based learning, and motivates nursing students to become more engaged in their learning. The literature also indicates that the use of gaming during nursing education promotes active learning, encourages critical thinking, makes learning more exciting, and can replicate real-life scenarios. However, empirical support for these advantages is lacking. This manuscript discusses the literature related to gaming, describes its use as a teaching strategy, and addresses implications for nursing education.

How gaming is used as an innovative strategy for nursing education.

Serious games have "re-emerged" as innovative teaching-learning strategies that researchers have shown to be effective in improving student learning outcomes. "Serious games" refer to games that are driven by educational goals, not entertainment. The use of serious games as part of the teaching-learning experience in nursing education fits into the philosophy and strategies of active learning. The "digital" nursing student needs engagement, stimulation, realism, and entertainment not more readings and Powerpoint supplements in the classroom to support learning. Nursing faculty at a mid-Atlantic Historical Black College and University introduced "serious gaming" technology into a Community Health Nursing course by using two web-based gamed simulations, Outbreak at WatersEdge: A Public Health Discovery Game, and EnviroRisk. This innovation proved to be effective in reinforcing learning and improving student learning outcomes.

Gamification: An Innovative Teaching-Learning Strategy for the Digital Nursing Students in a Community Health Nursing Course

OBJECTIVE To evaluate family physicians’ enjoyment of and knowledge gained from game-based learning, compared with traditional case-based learning, in a continuing medical education (CME) event on stroke prevention and management. DESIGN An equivalence trial to determine if game-based learning was as effective as case-based learning in terms of attained knowledge levels. Game questions and small group cases were developed. Participants were randomized to either a game-based or a case-based group and took part in the event. SETTING Ontario provincial family medicine conference. PARTICIPANTS Thirty-two family physicians and 3 senior family medicine residents attending the conference. INTERVENTION Participation in either a game-based or a case-based CME learning group. MAIN OUTCOME MEASURES Scores on 40-item immediate and 3-month posttests of knowledge and a satisfaction survey. RESULTS Results from knowledge testing immediately after the event and 3 months later showed no significant difference in scoring between groups. Participants in the game-based group reported higher levels of satisfaction with the learning experience. CONCLUSION Games provide a novel way of organizing CME events. They might provide more group interaction and discussion, as well as improve recruitment to CME events. They might also provide a forum for interdisciplinary CME. Using games in future CME events appears to be a promising approach to facilitate participant learning.

https://www.cfp.ca/content/cfp/56/9/e345.full.pdf

Game-based versus traditional case-based learning: Comparing effectiveness in stroke continuing medical education

An educational game was developed to promote student problem solving in the context of small group, problem-based learning (PBL). This study evaluated the game's effects on hypothesis and issue generation in PBL. Students in the Year III PBL course of a BScN program (N = 131) were stratified by program status and then randomly assigned to groups of 9 to 11 people per group. Half of the groups were randomly assigned to use the game (G); the remaining groups used the conventional method (CM) of generating issues and hypotheses. The G and CM groups crossed over for Term II. A Term I posttest demonstrated G groups had a higher proportion of accurate responses (85%) than CM groups (74%). A Term II posttest demonstrated no important differences between G and CM groups, suggesting the educational impact of the game persisted after students stopped using it. Strengths and limitations of the game as a learning aid also are addressed.

David R Keane

Papers

Evaluation of an educational game for health sciences students.