JMIR Publications

ABSTRACT

Background:

In healthcare, teamwork skills are critical for patient safety and, therefore, there is great emphasis on training these skills. Given that training is increasingly designed in a blended way, serious games may offer an efficient form of preparing face-to-face simulation training of these procedural skills.

Objective:

The objective of our study was to investigate which teamwork principles were used during gameplay by medi-cal students and teamwork experts. Findings can improve our understanding of the potential of serious games for training these complex skills.

Methods:

We investigated an online multiplayer game designed for training students’ interprofessional teamwork skills. During gameplay, four players in different roles (physician, nurse, medical student, student nurse) have to share information, prioritize tasks, and decide on next steps to take in virtual patient scenarios, using one-to-one and team chats. We first performed a qualitative study with 144 5th year medical students, playing the game in 36 groups. Secondly, we set up a replication study among 24 healthcare teamwork experts to increase the robustness of our findings and ecological validity. Game chat-data from two scenarios was analyzed. For the analysis, a deductive approach was used, starting with a conceptual framework based on Crew Resource Management (CRM) principles, including: Shared situational awareness, Decision making, Communication, Team management and Debriefing.

Results:

Results showed that most teamwork principles: shared situational awareness, decision making (e.g. re-evaluation), communication (e.g. closed loop), team management (e.g. distributing workload) were used during gameplay. Among students, these principles were often used on a more basic level. Some specific CRM principles were less observed, e.g. appointing a leader and prevention of fixation errors. Among experts, teamwork principles were used on a higher level (e.g. more frequently appointing a leader, more open forms of speak-up or more justification of decisions), reflecting their level of experi-ence. Similar to the student groups, some principles were hardly observed among experts, such as the use of cognitive aids. Both groups showed relatively superficial debriefing reflections.

Conclusions:

Playing a multiplayer game for interprofessional teamwork seems to facilitate exercising teamwork skills by students in all important CRM domains, on a basic level. Expert players applied teamwork skills on a higher complexity level during gameplay. Some teamwork principles were less observed among both students and expert groups, probably caused by the characteristics of the scenarios or the artefacts of the game environment (e.g. chatting instead of talking). A multiplayer game, aimed at training teamwork skills, seems to be able to facilitate the use of main teamwork principles, providing students a flexible, accessible, and engaging way of exercising these skills on a basic level. This creates more time in the face-to-face simulation training for skills on a more complex level.