title: InsuOnline, a Serious Game to Teach Insulin Therapy to Primary Care Physicians: Design of the Game and a Randomized Controlled Trial for Educational Validation.
abstract: BACKGROUND
  Physicians´ lack of knowledge contributes to underuse of insulin and poor glycemic control in adults with diabetes mellitus (DM). Traditional continuing medical education have limited efficacy, and new approaches are required.
  
  
  OBJECTIVE
  We report the design of a trial to assess the educational efficacy of InsuOnline, a game for education of primary care physicians (PCPs). The goal of InsuOnline was to improve appropriate initiation and adjustment of insulin for the treatment of DM. InsuOnline was designed to be educationally adequate, self-motivating, and attractive.
  
  
  METHODS
  A multidisciplinary team of endocrinologists, experts in medical education, and programmers, was assembled for the design and development of InsuOnline. Currently, we are conducting usability and playability tests, with PCPs and medical students playing the game on a desktop computer. Adjustments will be made based on these results. An unblinded randomized controlled trial with PCPs who work in the city of Londrina, Brazil, will be conducted to assess the educational validity of InsuOnline on the Web. In this trial, 64 PCPs will play InsuOnline, and 64 PCPs will undergo traditional instructional activities (lecture and group discussion). Knowledge on how to initiate and adjust insulin will be assessed by a Web-based multiple choice questionnaire, and attitudes regarding diabetes/insulin will be assessed by Diabetes Attitude Scale 3 at 3 time points-before, immediately after, and 6 months after the intervention. Subjects´ general impressions on the interventions will be assessed by a questionnaire. Software logs will be reviewed.
  
  
  RESULTS
  To our knowledge, this is the first research with the aim of assessing the educational efficacy of a computer game for teaching PCPs about insulin therapy in DM. We describe the development criteria used for creating InsuOnline. Evaluation of the game using a randomized controlled trial design will be done in future studies.
  
  
  CONCLUSIONS
  We demonstrated that the design and development of a game for PCPs education on insulin is possible with a multidisciplinary team. InsuOnline can be an attractive option for large-scale continuous medical education to help improving PCPs´ knowledge on insulin therapy and potentially improving DM patients´ care.
  
  
  BACKGROUND
  Clinicaltrials.gov: NCT01759953; http://clinicaltrials.gov/show/NCT01759953 (Archived by WebCite at http://www.webcitation.org/6Dq8Vc7a6).
authors.affiliation: Departamento de Clínica Médica, Centro de Ciências da Saúde (CCS), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil. drgaucho@yahoo.com.
authors.forename: Leandro Arthur
authors.identifier: 0000-0002-9958-7213
authors.initials: LA
authors.lastname: Diehl
authors.forename: Rodrigo Martins
authors.initials: RM
authors.lastname: Souza
authors.forename: Juliano Barbosa
authors.initials: JB
authors.lastname: Alves
authors.forename: Pedro Alejandro
authors.initials: PA
authors.lastname: Gordan
authors.forename: Roberto Zonato
authors.initials: RZ
authors.lastname: Esteves
authors.forename: Maria Lúcia Silva Germano
authors.initials: ML
authors.lastname: Jorge
authors.forename: Izabel Cristina Meister
authors.initials: IC
authors.lastname: Coelho
keywords: Continuing Medical Education; Diabetes Mellitus; Educational Technology; Insulin; Medical Education; Video Games