A serious video game—EmergenCSim™—for novice anesthesia trainees to learn how to perform general anesthesia for emergency cesarean delivery: a randomized controlled trial

Abstract

Purpose We developed EmergenCSim™, a serious game (SG) with an embedded assessment, to teach and assess performing general anesthesia for cesarean delivery. We hypothesized that first-year anesthesiology trainees (CA-1) playing EmergenCSim™ would yield superior knowledge scores versus controls, and EmergenCSim™ and high-fidelity simulation (HFS) assessments would correlate. Methods This was a single-blinded, longitudinal randomized experiment. Following a lecture (week 3), trainees took a multiple-choice question (MCQ) test (week 4) and were randomized to play EmergenCSim™ (N = 26) or a non-content specific SG (N = 23). Participants repeated the MCQ test (week 8). Between month 3 and 12, all repeated the MCQ test, played EmergenCSim™ and participated in HFS of an identical scenario. HFS performance was rated using a behavior checklist. Results There was no significant change in mean MCQ scores over time between groups F (2, 94) = 0.870, p = 0.42, and no main effect on MCQ scores, F (1, 47) = 1.110, p = 0.20. There was significant three-way interaction between time, gender and group, F (2, 90) = 3.042, p = 0.053, and significant two-way interaction between gender and time on MCQ scores, F (2, 94) = 107.77, p = 0.036; outcomes improved over time among males. There was no group difference in HFS checklist and SG scores. Both instruments demonstrated good internal consistency reliability but non-significant score correlation. Conclusions Playing EmergenCSim™ once did not improve MCQ scores; nonetheless scores slightly improved among males over time, suggesting gender may impact learning outcomes with SGs.

Validating Parallel-Forms Tests for Assessing Anesthesia Resident Knowledge

“…A detailed description of the development of EmergenCSim TM , and the complete list of items in the electronic feedback checklist, including the weighted scoring for each item have been previously published. 6 Congruent with the knowledge test, the checklist of expected actions within the game and the weighted scoring system were based on the content-validated weighted behavior checklist developed for this scenario by Scavone et al 16 …”

“…A detailed description of the game design and development has been previously published with a report of a single-blinded longitudinal experiment where novice CA-1 residents were randomized to play EmergenCSim TM or a noncontent specific (sham) game that had no embedded electronic feedback. 6 There was no difference between experimental groups in test scores, but a post hoc exploratory analysis found a slight improvement in male residents’ scores over time, suggesting that gender may impact learning outcomes with serious games.…”

“…In 2016, our research group developed a novel 3-D serious video game, 5 EmergenCSim TM , designed to teach novice first-year anesthesia (CA-1) residents the knowledge and skills to perform GA for emergency CD. 6 Electronic feedback appears automatically at the end of gameplay explaining the expected actions and the underlying rationale for this clinical scenario. A detailed description of the game design and development has been previously published with a report of a single-blinded longitudinal experiment where novice CA-1 residents were randomized to play EmergenCSim TM or a noncontent specific (sham) game that had no embedded electronic feedback.…”

Envisioning gamification in anesthesia, pain management, and critical care: basic principles, integration of artificial intelligence, and simulation strategies

“…However, the study group's final test scores significantly surpassed those of the control group ( p < 0.001). More recently, Lee et al [ 45 ] developed and tested the EmergenCSim™. It is a serious game incorporating an embedded assessment and a debriefing tool, aimed at instructing and evaluating the execution of general anesthesia for cesarean delivery in anesthesia trainees.…”