A Virtual Infection Control Simulation – the development of a serious game in the health care sector

1. A Virtual Infection Control Simulation – the development of a serious game in the health care sector • Andy Pulman - School of Health and Social Care • Mark Shufflebottom - Bournemouth Media School

2. Overview • Number of death certificates mentioning Staphylococcus aureus (S. aureus) infection increased each year from 51 in 1993 to 1,629 in 2005 in England and Wales. • Importance of greater education concerning hand washing. • Using a simulation within the health education curriculum. • Reflecting on the creative process, production and pilot feedback.

3. Demo • Volunteer to try the simulation

4. Simulation Gaming • “In the last few years there has been an increasing but limited interest in the use of gaming as a learning method. In common with many new methods of learning, gaming tends to cause a polarization of attitudes amongst teachers who become aware of it.” • French, 1980, p.601

5. Preparing the Possible Scenarios • Three scenarios developed. • One taken to development due to time constraints. • Infection control chosen - lent itself to simulation and interactivity. • Also important from an NHS perspective. • Pratt et al (2005) noted that in the UK, the Department of Health (DH) had focused a number of initiatives on combating Health Care Associated Infection (HCAI).

6. Game Design • Simulations are useful for representing complex relations (Laurillard, 1993, p. 132). • "The design of the interface to the simulation will affect how the particular goal is communicated to the students" Laurillard, 1993, p.133. • Background information and definition of terms start the simulation.

7. Game Design • "Active engagement, imaginative inquiry and the finding of a suitable level are all much more likely to occur if teaching methods that necessitate student activity, student problem-solving and question-asking, and co-operative learning are employed."Ramsden, 1994, p. 177 • "We retain 10% of what we read, 20% of what we hear, 30% of what we see, 50% of what we hear and see, 70% of what we say, 90% of what we say and do." Smith, 1998, p.13

8. Game Design • By engaging students with the doing, the participant becomes actively engaged with the learning experience (Iverson, 2005). • Allowing students to return and test their knowledge many times, each time refining their actions - 'pervasive' or 'ubiquitous' learning (Thomas, 2006). • A useful pedagogic tool for generating discussion in the classroom. The lecturer can incorporate this as a blended learning tool to enrich seminar discussions (Heinze, A. and C. Procter, 2004).

9. Game Design • Game built in Flash technology to work with a wide variety of platforms and devices. • Currently researching Flash on mobile technology • Designed to have game data stored extraneously to the game itself. This was achieved using XML (Extensible Meta Language). • Conversations can be completely altered by the clinical practice lecturers without requiring any recoding within the game. • Keyboard used as it avoided the user randomly clicking on objects

10. Design Problems • A learning process for the project team. • None of the academics involved had written scenarios for this type of learning environment. • “I was initially approached to write an infection control scenario, but in order to meet with the communication it now has two focuses. My concern is that this may confuse the learner as to the aim of the simulation. I also asked if dialogue could be audio as against written as there is quite a lot of dialogue in my scripts (which should not be problem). However, I was wondering whether there was too much looking and listening for the learner in my scripts and not enough interaction. I am mindful of the fact that the viewer is not watching a film but should be engaging in a learning package; otherwise we could just shoot a DVD in the labs!”

11. Design Problems • Project management process would have benefited from using a project management technique like Scrum. • Lack of interactivity in the early script iterations was resolved as the academic became more aware of writing style required for an effective educational simulation. • Limitations of using a full economic costing (FEC) model. • Problem with ensuring that academic members of the team complied with good project management practice.

12. Feedback From Pilot • Piloted with three 3rd year nursing groups during April/May 2008. Of the 24 respondents: • 83% enjoyed using the package. • 91% felt that using it was an interesting way of teaching infection control: • “It was interesting to find out how much you know.” • “It was easy to use and explained well.” • “Helps to highlight what is needed for looking after an MRSA patient.” • “Made us think about what we would do on the ward.”

13. Feedback From Pilot • 87% felt that the package helped them to understand how theory concerning infection control applied to their practice BUT thought it would be more beneficial for 1st years. • Thought it should sit alongside rather than replace face-to-face sessions: • “Should still be taught with lecturers in clinical skills.” • “I think it will be useful alongside teaching as an assessment tool.” • 67% would be happy to use a package like this in a home environment. • Consideration for students not used to/who don’t enjoy game-based learning: • “Not interested in computer games – more frustrating getting it to work.”

14. Feedback From Pilot • A range of areas for improvement (interactivity, navigation, error reporting): • “Different trusts have different infection control policies, with reference to the gown colours also things such as talk, I believe are banned in some trusts but not in others, maybe have different programmes for each trust to avoid confusion.” • Encouraged debate about procedures and interaction with objects (Sandbox): • “We queried whether gloves should be used for giving medication, if in contact with patient’s saliva?” • “I would have liked to of been able to wash my hands when I wanted to not when the computer allowed me to.”

15. Contacts • Andy Pulmanapulman@bournemouth.ac.uk01202 964729 • Mark Shufflebottommshuffle@bournemouth.ac.uk01202 965947