Development and Evaluation of a Serious Game for Teaching ICD-10 Diagnosis Coding to Medical Students.

Objective: Assessment of the pedagogical effect and technological acceptance of the serious game, CODIFICO, which has been designed to train medical students in ICD-10 diagnosis coding. Materials and Methods: We designed the serious game, CODIFICO, as an alternative way to teach ICD-10 diagnosis coding to undergraduate medical students. To assess the pedagogical effect of the game, we used the quasiexperimental pretest-posttest design. The participants began by completing a knowledge pretest on Blackboard. After the pretest, the teacher presented the game to the students and invited them to play it for 1 week. Then, the students completed the posttest on Blackboard. We applied the Wilcoxon test to establish the difference between the pretest and posttest. We designed a questionnaire to evaluate the participants' technology acceptance toward the game. Results: Sixty-one undergraduate medical students from a large Colombian private university took part. There was no statistically significant difference between the pretest and the posttest. However, the game had some positive effects on knowledge. The game was well accepted among the participants. Conclusion: The game, CODIFICO, was useful to teach diagnosis determination, not diagnostic coding. Some of the reasons that caused this situation were insufficient attention to the pedagogical theory, excessive reliance on clinical aspects of the medical training, limited resources, and lack of experience at the medical school to design gamification strategies.

Revisión sistemática de juegos serios para la educación médica. Rol del diseño en la efectividad / A Systematic Review about Serious Games for Medical Education. The Role of Effective Design

Introducción: La literatura pedagógica propone los juegos serios (serious games) como herramientas efectivas para el aprendizaje; sin embargo, los estudia como si fueran productos homogéneos que se diferencian solo por la temática. Así, sus diseños no se discuten y se dejan a la discreción de cada profesor-creador. Objetivo: Establecer la relación entre la efectividad en los resultados de aprendizaje y los criterios de diseño de los juegos para la educación médica. Métodos: Revisión sistemática de la literatura de juegos médicos, publicados entre 2011 y 2015 en inglés, español y portugués, siguiendo pautas de la Colaboración Cochrane. Sobre la base de la literatura, se construyó un sistema con 15 criterios de diseños para evaluar los juegos y se estableció una comparación con la efectividad reportada. Resultados: En los 26 artículos finales revisados los resultados de aprendizaje fueron positivos, en general, y los criterios de diseño de los juegos sí afectaron la efectividad en los resultados de aprendizaje. El grado de estos efectos y el nivel de evidencia científica variaron según los criterios de diseño. Conclusiones: La relación encontrada entre el diseño del juego y la efectividad en el aprendizaje debe conducir a desarrollos de juegos serios que potencien las propuestas ludificadas con un uso consciente de los criterios técnicos(AU)

Introduction: The pedagogical literature proposes serious games as effective tools for learning; however, it studies them as if they were homogeneous products that differ only by theme. Thus, their designs are not discussed and are left to the consideration of each teacher-creator. Objective: To establish the relationship between effectiveness in learning outcomes and the criteria for the design of games for medical education. Methods: Systematic review of the literature about medical games and published between 2011 and 2015, in English, Spanish and Portuguese, following the Cochrane Collaboration guidelines. Based on the literature, a system was constructed with 15 design criteria for assessing the games, and a comparison was established with the reported effectiveness. Results: In the 26 final articles that were reviewed, the learning outcomes were generally positive, and the game design criteria did affect the effectiveness of the learning outcomes. The degree of these effects and the level of scientific evidence varied according to the design criteria. Conclusions: The relationship found between game design and learning effectiveness should lead to developments of serious game that enhance the proposals made with a conscious usage of technical criteria(AU)

A systematic review of serious games in medical education: quality of evidence and pedagogical strategy.

INTRODUCTION: The literature shows an optimistic landscape for the effectiveness of games in medical education. Nevertheless, games are not considered mainstream material in medical teaching. Two research questions that arise are the following: What pedagogical strategies do developers use when creating games for medical education? And what is the quality of the evidence on the effectiveness of games? METHODS: A systematic review was made by a multi-disciplinary team of researchers following the Cochrane Collaboration Guidelines. We included peer-reviewed journal articles which described or assessed the use of serious games or gamified apps in medical education. We used the Medical Education Research Study Quality Instrument (MERSQI) to assess the quality of evidence in the use of games. We also evaluated the pedagogical perspectives of such articles. RESULTS: Even though game developers claim that games are useful pedagogical tools, the evidence on their effectiveness is moderate, as assessed by the MERSQI score. Behaviourism and cognitivism continue to be the predominant pedagogical strategies, and games are complementary devices that do not replace traditional medical teaching tools. Medical educators prefer simulations and quizzes focused on knowledge retention and skill development through repetition and do not demand the use of sophisticated games in their classrooms. Moreover, public access to medical games is limited. DISCUSSION: Our aim was to put the pedagogical strategy into dialogue with the evidence on the effectiveness of the use of medical games. This makes sense since the practical use of games depends on the quality of the evidence about their effectiveness. Moreover, recognition of said pedagogical strategy would allow game developers to design more robust games which would greatly contribute to the learning process.

Cultura innovadora y grupos relacionados de diagnóstico en un hospital de alta complejidad, Colombia / Innovative culture and diagnosis related groups in a high complexity hospital, Colombia

Objetivos Caracterizar la percepción sobre los Grupos Relacionados de Diagnóstico GRD como una innovación entre el personal médico, de enfermería y de soporte administrativo, en un Hospital en Colombia. Métodos Estudio de caso de la cultura innovadora en un hospital. Se realizaron encuestas y grupos focales con el personal médico, de enfermería y de soporte administrativo. Se calcularon estadísticos descriptivos para las percepciones de la cultura innovadora y análisis comparativos entre los grupos profesionales en mención. Los grupos focales fueron trascritos y analizados para profundizar en los hallazgos de las encuestas. Resultados Se encontraron diferencias significativas en las percepciones de la cultura innovadora. El personal de enfermería fue más entusiasta que los médicos al evaluar la cultura innovadora y el liderazgo de las directivas del Hospital. Los médicos se sintieron más autónomos para discutir asuntos profesionales. Los administrativos, por su parte, evaluaron la voluntad del Hospital para adquirir nuevas tecnologías más alto que los médicos. Los tres grupos conocen poco sobre los GRD. Conclusiones Al implementar una innovación en salud es recomendable analizar su efecto sobre los profesionales que participarán en su implementación. El personal médico percibe los GRD como una amenaza a su autonomía profesional; en tanto el personal de enfermería aparece como una fuerza pro-innovación, por lo cual a la gerencia le conviene involucrarlo en el proceso de implementación de los GRD junto al personal administrativo.(AU)

Objectives To characterize the perception of Diagnosis-Related Groups (DRGs) as an innovation among physicians, nurses and administrative staff in a hospital in Colombia. Methods A case study of innovative culture in a hospital. Surveys and focus groups were carried out with the medical, nursing and administrative staff. Descriptive statistics were calculated for the perceptions of innovative culture. Comparative analysis was done between professional groups. The results of the focus groups were transcribed and analyzed to deepen the findings of the surveys. Results Significant differences were found in perceptions of the innovative culture. The nursing staff were more enthusiastic than doctors when evaluating the innovative culture and leadership. Physicians felt more autonomy when discussing professional issues. Administrative staff assessed the Hospital's disposition to acquire new medical technologies as higher than that of physicians. The three groups know little about DRG's. Conclusions When implementing a health innovation it is advisable to analyze its effect on the professionals who participate in the implementation. Physicians perceive DRGs as a threat to their professional autonomy, while nurses see it as a pro-innovation force. It is important to involve nursing and administrative staff when implementing this kind of innovation.(AU)

[Innovative culture and diagnosis related groups in a high complexity hospital, Colombia]. / Cultura innovadora y grupos relacionados de diagnóstico en un hospital de alta complejidad, Colombia.

Objectives To characterize the perception of Diagnosis-Related Groups (DRGs) as an innovation among physicians, nurses and administrative staff in a hospital in Colombia. Methods A case study of innovative culture in a hospital. Surveys and focus groups were carried out with the medical, nursing and administrative staff. Descriptive statistics were calculated for the perceptions of innovative culture. Comparative analysis was done between professional groups. The results of the focus groups were transcribed and analyzed to deepen the findings of the surveys. Results Significant differences were found in perceptions of the innovative culture. The nursing staff were more enthusiastic than doctors when evaluating the innovative culture and leadership. Physicians felt more autonomy when discussing professional issues. Administrative staff assessed the Hospital's disposition to acquire new medical technologies as higher than that of physicians. The three groups know little about DRG's. Conclusions When implementing a health innovation it is advisable to analyze its effect on the professionals who participate in the implementation. Physicians perceive DRGs as a threat to their professional autonomy, while nurses see it as a pro-innovation force. It is important to involve nursing and administrative staff when implementing this kind of innovation.

Percepción de Grupos Relacionados de Diagnóstico y cultura innovadora por profesionales de enfermería / Perception of diagnosis related groups and the innovative culture by nursing professionals

Los profesionales de enfermería desempeñan un importante rol en el Hospital a la hora de implementar innovaciones. Se desconoce su percepción frente a los Grupos Relacionados de Diagnóstico como una innovación. Objetivos: Caracterizar la percepción de los profesionales del departamento de enfermería sobre los Grupos Relacionados de Diagnóstico como una innovación, en un Hospital de alta complejidad en Colombia. Metodología: Estudio de caso. La información se obtuvo de encuesta y grupo focal. Se calcularon estadísticos descriptivos para las percepciones de la innovación; se transcribieron y analizaron los datos del grupo focal. Resultados: La percepción de la cultura innovadora fue positiva y se encontraron diferencias según educación, posición jerárquica y sexo; las demás variables no fueron significativas. Frente a los Grupos Relacionados de Diagnóstico como innovación sólo el 12,5 % de los participantes los conocían, predominando una actitud positiva. El atributo que generó menos entusiasmo y mayor dispersión, fue la complejidad de los GRD. No hubo diferencias en la percepción frente a los cinco atributos por ninguna variable demográfica. Conclusiones: La homogeneidad de la percepción sugiere un ambiente favorable para implementar los Grupos Relacionados de Diagnóstico.

Nursing professionals play an important role at Hospitals when innovation is to be implemented. However, their perception regarding diagnosis related groups as an innovation is unknown. Objective: to characterize how the professionals of a nursing department of a high complexity hospital in Colombia perceive the innovation of diagnosis related groups. Methodology: A case study. Data were collected from surveys and focus groups. Descriptive statistics were calculated for the perception of innovation, and the data from the focus groups were transcribed and analyzed. Results: The perception of the innovative culture was positive and there were differences according to education, hierarchical position and sex; the other variables were not significant. As for the diagnosis related groups as an innovation, only 12.5% of the participants were familiar with them, and their attitude was predominantly positive. The attribute that generated less enthusiasm and greater dispersion, was the complexity of said groups. No differences were observed in the perception of the five attributes for any demographic variable. Conclusions: The homogeneity of perception suggests a favorable environment for implementing the system of diagnosis related groups.

[Why are diagnosis-related groups unpopular in Colombia?]. / ¿Por qué los grupos relacionados de diagnóstico no se implementan en Colombia?

The aim of this study was to explore the determinants of non-implementation of diagnosis-related groups (DRGs) by hospitals in Colombia. A qualitative case was carried out to analyze the directors' perceptions in six hospitals with and without DRGs in Bogotá. The interviews are based on the Innovation Diffusion Theory. The directors had similar perceptions of the determinates. DRGs were seen as positive, but encountered organizational and institutional obstacles. Without a targeted public policy, the likelihood of implementing DRGs in Colombia is slight.

Sistema de salud en Colombia: una revisión sistemática de literatura / Health system in Colombia: a systematic review of literature / Sistema de saúde na Colômbia: revisão sistemática de literatura

Problema: el Sistema General de Seguridad Social en Salud de Colombia, es objeto de críticaspor diferentes medios de opinión debido a sus altos costos de transacción, baja competitividady eficiencia. Surge entonces el interrogante sobre la contribución que hace la Academia colombianaa la reflexión sobre el sistema de salud durante sus veinte años de existencia. El objetivodel estudio fue el de caracterizar la contribución de publicaciones académicas a la reflexiónsobre el sistema de salud colombiano durante estos veinte años. Método: revisión sistemáticade literatura en la base de datos de Scielo entre 1993 y 2012, utilizando criterios de inclusión yexclusión. Resultados: 102 publicaciones cumplieron con los criterios de inclusión y exclusión.De estas publicaciones, dieciséis evalúan el sistema de salud de manera positiva o negativa. Loscriterios de inclusión y exclusión están detallados en la sección del método. Conclusiones: laspublicaciones se limitan a caracterizar el sistema de salud sin formular sugerencias ni modelosalternativos. Los trabajos académicos aparecen como poco relevantes para el debate nacional...

Problem: The Social Security System in Health of Colombia, is criticized by different mainstreammedia due to its high transaction costs, low competitiveness and efficiency. The question arisesabout the contribution made by the Colombian Academy on the reflection over the health systemduring its twenty years of existence. The aim of the study was to characterize the contributionof academic publications to the reflection on the Colombian health system over the last twentyyears. Method: systematic literature review in the SciELO database between 1993 and 2012,using inclusion and exclusion criteria. Results: 102 publications met the inclusion and exclusioncriteria. From these publications, sixteen evaluate the health system positively or negatively. Theinclusion and exclusion criteria are detailed in the method section. The Inclusion and exclusioncriteria are detailed in the method section. Conclusions: publications merely characterize thehealth system without making suggestions or alternative models. The academic papers are oflittle relevance to the national debate...

Problema: o Sistema Geral de Segurança Social em Saúde da Colômbia é objeto de críticaspor diferentes meios de opinião devido aos altos custos de transação, baixa competitividadee eficiência. Surge, então, a questão sobre a contribuição que a Academia colombiana faz àreflexão sobre o sistema de saúde durante seus vinte anos de existência. O objetivo do estudofoi o de caracterizar a contribuição de publicações acadêmicas à reflexão sobre o sistema desaúde colombiano durante estes vinte anos. Método: revisão sistemática de literatura na base dedados de Scielo entre 1993 e 2012, utilizando critérios de inclusão e exclusão. Resultados: 102publicações cumpriram com os critérios de inclusão e exclusão. Destas publicações, dezesseisavaliam o sistema de saúde de maneira positiva ou negativa. Os critérios de inclusão e exclusãoestão detalhados na seção do método. Conclusões: as publicações limitam-se a caracterizar osistema de saúde sem formular sugestões nem modelos alternativos. Os trabalhos acadêmicosaparecem como pouco relevantes para o debate nacional...

Percepciones del personal hospitalariosobre la preparación institucional para la implementación de innovaciones en el sector salud, específicamente grupos relacionados con el diagnóstico (GRD) / Hospital Staff Perceptions of Institutional Readiness for Implementation of Innovations in the Health Sector, Specifically Diagnostic Related Groups (DRG)

Objetivos: Caracterizar el estado de la cultura innovadora y la actitud del personalhospitalario frente a los grupos relacionados de diagnóstico (GRD) como innovaciónpara el sector de la salud en Colombia. Métodos: Estudio de caso mediante unamuestra por conveniencia realizada entre el personal clínico y administrativo dequienes depende el éxito del proyecto de los GRD. El análisis estadístico se realizapor medio de la estadística descriptiva, la regresión y el análisis de correspondencia.Resultados: El estado de la cultura innovadora en el hospital es favorable parala innovación. No se observan diferencias significativas entre las perspectivasa la innovación que tienen el personal clínico y el administrativo. El personaladministrativo y los médicos jóvenes desconocen los GRD. En cambio, los médicoscon experiencia y los que ocupan puestos de mando, conocen los GRD. Se encontróuna correlación significativa entre la cultura innovadora y la actitud frente a los GRD.Conclusiones: La homogeneidad de la cultura innovadora en el hospital augura unambiente favorable para implementar los GRD...

Objectives: To characterize the state of the innovativeculture and attitude of hospital staff towardsDiagnosis Related Groups (DRG) like an innovationfor the Colombian health care. Methods: Acase study through convenience sampling amongclinical and administrative staff who determinethe success of the DRG. Statistical analysis wasperformed using descriptive statistics, regressionand correspondence analysis. Results: The stateof innovative culture in the Hospital is favorablefor the innovation. There were no significant differencesbetween the views on the innovationof the clinical and administrative staff. The administrativestaff and junior doctors are unawareof the DRG. In contrast, experienced doctors andthose in management positions know DRG. Significantcorrelation was found between innovativeculture and attitude to the DRG. Conclusions:The homogeneity of the innovative culture in theHospital predicts a favorable climate for DRGimplementation...

[Pay for performance in Colombian healthcare]. / Pago por desempeño en el sistema colombiano de salud.

OBJECTIVE: Describing the extent and forms of use of pay for performance (P4P) in Colombian healthcare. METHODS: This was a descriptive study based on interviews and surveys of health insurance agency managers in Bogotá, Colombia. The authors relied on transaction cost theory to interpret the results. RESULTS: P4P was found to be used by contribution scheme insurers in an outpatient setting, basically in promotion and prevention; P4P is not being used in a hospital setting. Subsidized scheme insurers do not use P4P. Similarly, P4P is not being used in the case of so called associated users. CONCLUSIONS: P4P use in Colombia is limited. Colombian practice only partially validates the transaction costs theory approach to governance model attributes, one of which is incentive intensity.