Development and Evaluation of a New Serious Game for Continuing Medical Education of General Practitioners (Hygie): Double-Blinded Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND Continuing medical education is important but time-consuming for general practitioners (GPs). Current learning approaches are limited and lack the ability to engage some practitioners. Serious games are new learning approaches that use video games as engaging teaching material. They have significant advantages in terms of efficiency and dissemination. OBJECTIVE The aim of this study was to create a serious game and to evaluate it in terms of effectiveness and satisfaction, comparing it with a traditional method of continuing education—article reading. METHODS We produced a prototype video game called <italic>Hygie</italic> on the 5 most common reasons of consultation in general practice using 9 articles from independent evidence-based medicine journals (reviews from <italic>Prescrire</italic> and <italic>Minerva</italic>). We created 51 clinical cases. We then conducted a double-blinded randomized trial comparing the learning provided by a week of access to the game versus source articles. Participants were GPs involved as resident supervisors in 14 French university departments of family practice, recruited by email. Primary outcomes were (1) mean final knowledge score completed 3 to 5 weeks after the end of the intervention and (2) mean difference between knowledge pretest (before intervention) and posttest (3 to 5 weeks after intervention) scores, both scaled on 10 points. Secondary outcomes were transfer of knowledge learned to practice, satisfaction, and time spent playing. RESULTS A total of 269 GPs agreed to participate in the study. Characteristics of participants were similar between learning groups. There was no difference between groups on the mean score of the final knowledge test, with scores of 4.9 (95% CI 4.6-5.2) in the <italic>Hygie</italic> group and 4.6 (95% CI 4.2-4.9) in the reading group (<italic>P</italic>=.21). There was a mean difference score between knowledge pre- and posttests, with significantly superior performance for <italic>Hygie</italic> (mean gain of 1.6 in the <italic>Hygie</italic> group and 0.9 in the reading group; <italic>P</italic>=.02), demonstrating a more efficient and persistent learning with Hygie. The rate of participants that reported to have used the knowledge they learned through the teaching material was significantly superior in the <italic>Hygie</italic> group: 77% (47/61) in the <italic>Hygie</italic> group and 53% (25/47) in the reading group; odds ratio 2.9, 95% CI 1.2-7.4. Moreover, 87% of the opinions were favorable, indicating that <italic>Hygie</italic> is of interest for updating medical knowledge. Qualitative data showed that learners enjoyed <italic>Hygie</italic> especially for its playful, interactive, and stimulating aspects. CONCLUSIONS We conclude that <italic>Hygie</italic> can diversify the offering for continuing education for GPs in an effective, pleasant, and evidence-based way. CLINICALTRIAL ClinicalTrials.gov NCT03486275; https://clinicaltrials.gov/ct2/show/NCT03486275