Title: Virtual Simulation and Serious Games for Medical Education
Description: Background: Novel training modalities are needed for medical education, specifically to teach difficult and globally applicable skills such as peritoneal dialysis (PD). E-learning strategies, including serious games, have demonstrated effectiveness in teaching, including within nephrology. Here, we summarize the literature describing serious gaming in medical education and describe the development and release of a virtual PD simulator.

Methods: The simulator was developed in an iterative process that included formative evaluation. Thirteen subjects underwent Think Aloud Protocol testing and Likert scale system usability scale (SUS) surveys in four cycles. The simulator was released on OPENPediatrics (www.openpediatrics.org), a free medical education website, on January 28, 2016, with usage tracked through March 2016.

Results: A PD simulator incorporating best practices in game development and adult learning theory was developed. Feedback indicated high usability, utility, interest in future use, and enjoyment. Since its release, 223 users from 51 countries accessed the simulator. Users spent an average of 60 minutes on each of three sections. Completion rates for each section range from 41% to 61%. 47%-69% of users scrolled through the text, indicating engagement. For a small number of users (n=14), comparing pre- versus post- case-based multiple choice test scores showed an increase of 20 points on post-test scores (p=0.0015).

Conclusions: Through an iterative process and structured formative evaluation, we developed the virtual PD simulator. The process may be generalizable to future serious gaming development in the medical field. In testing, feedback was positive, indicating high utility and interest in use. Since its release, the simulator shows high time-on-task, engagement, and completion rates, as well as potential knowledge gains. The simulator has the potential to teach PD in an engaging, relevant and efficient manner worldwide. Future studies will assess its impact on knowledge gains and influence on practice.