The influence of a serious game's narrative on students' attitudes and learning experiences regarding delirium: an interview study.

BACKGROUND: Delirium is a neuropsychiatric syndrome that affects patients' attention and awareness as a result of a physical condition. In recent years, persistent gaps in delirium education have led to suboptimal delirium care. Still, little is known about what are the most important aspects of effective delirium education. Serious games are both entertainment and an interactive, safe learning environment where players can experiment and create new knowledge. They have the potential to contribute to improved delirium education. We used a video-based serious games' narrative to explore aspects essential to enhance students' attitudes and learning experiences regarding delirium. METHODS: We created a semi-structured interview guide and interviewed seven nursing and nine medical students about their attitudes and learning experiences, after they had played the game. A qualitative descriptive design and inductive content analysis with constant comparison were used. RESULTS: The patient's and nurse's perspective, interactivity to experiment, realistic views on care options, and feedback on care actions were important for enhancing students' attitudes and learning experiences regarding delirium. Students felt these aspects encouraged them to get actively involved in and experiment with the study material, which in turn led to enhanced reflection on delirium care and education. Our findings highlight the importance of a more patient-oriented focus to delirium education to drive attitudinal change. Students' learning experiences were further enhanced through their affective responses provoked by the perspectives, interactivity, realism, and feedback. CONCLUSIONS: Students considered the characters' perspectives, interactivity, realism, and feedback important aspects of the game to enhance their attitudes towards delirious patients and enrich their learning experiences. A patient-oriented narrative provides a clinically relevant experience in which reflection plays an important role. The serious game also serves as medium to actively experiment with care solutions to create better understanding of how healthcare professionals can influence a delirious patient's experience.

Dark Play of Serious Games: Effectiveness and Features (G4HE2018).

Objective: Choosing inappropriate or unethical actions in games is referred to as dark play. For a serious game on delirium for medical students, we aimed to investigate the potential differences between dark play and normal play on game effectiveness regarding abilities in advising care, learning motivation and engagement, and attitude toward delirious patients. Furthermore, we aimed to explore the use of different game features between the two types of play on empathy, self-efficacy, and consequences of care. Methods: We performed a two-arm randomized controlled trial including an exploratory qualitative approach with 157 medical students, who played the serious game "The Delirium Experience." Participants were randomly allocated to either the dark play or normal play group. Participants had to give three recommendations for taking care of delirious patients, and complete both the Delirium Attitude Scale, and Learning Motivation and Engagement Questionnaire to study game effectiveness. To explore game features, open questions were asked. Results: We did not find difference between the two types of play in game effectiveness. "Patient's and nurse's perspective" seem to be an important game feature for being able to empathize with a patient in both groups. To support self-efficacy, "practice how to care" and "feedback in the game" were important in both study groups. "Being able to see the importance of good interaction with the patient" was reported important for self-efficacy in the dark play group, whereas this was "seeing the consequences of care" in the normal play group. Conclusions: There seems to be no change to game effectiveness when providing players the opportunity to use dark play in a serious game. A realistic view of another person's perspective could be an important game feature to increase empathy.

Longitudinal training and assessing consultation competence, a role for self reflection on performance.

Medical consultation (patient-doctor encounter), consisting of history taking, physical examination and treatment, is the starting point of any contact between doctor and patient. Learning to conduct a consultation is a complex skill. Both communicative and medical contents need to be applied and integrated. Conducting an adequate consultation is a skill which is gradually learned and perfected during training and career. This article discusses the background and implementation of a longitudinal integrated consultation training programme in clerkships. In the programme, the student's reflection on the consultation plays an important role in education and assessment.

[The elderly patient]. / De oude patiënt.

Many elderly have mild physical disorders. It is difficult to differentiate between the physiological symptoms of ageing and disorders in the elderly patient. Many disorders present as non-specific signs or symptoms in the elderly. The relevance of an abnormality can be judged by comparing the patient's current state with his or her prior level of functioning: what aspect of his or her condition has changed? Attributing an abnormality to a disease instead of aging only makes sense if it has therapeutic consequences for the patient; in this respect, the patient's level of functioning is an important frame of reference.