title: A serious game can be a valid method to train clinical decision-making in surgery.
abstract: BACKGROUND
  A serious game was developed to train surgical residents in clinical decision-making regarding biliary tract disease. Serious or applied gaming is a novel educational approach to postgraduate training, combining training and assessment of clinical decision-making in a fun and challenging way. Although interest for serious games in medicine is rising, evidence on its validity is lacking. This study investigates face, content, and construct validity of this serious game.
  
  
  METHODS
  Experts structurally validated the game's medical content. Subsequently, 41 participants played the game. Decision scores and decision speed were compared among surgeons, surgical residents, interns, and medical students, determining the game's discriminatory ability between different levels of expertise. After playing, participants completed a questionnaire on the game's perceived realism and teaching ability.
  
  
  RESULTS
  Surgeons solved more cases correctly (mean 77 %) than surgical residents (67 %), interns (60 %), master-degree students (50 %), and bachelor-degree students (39 % (p < 0.01). Trainees performed significantly better in their second play session than in the first (median 72 vs. 48 %, p = 0.00). Questionnaire results showed that educators and surgical trainees found the game both realistic and useful for surgical training. The majority perceived the game as fun (91.2 %), challenging (85.3 %), and would recommend the game to educate their colleagues (81.8 %).
  
  
  CONCLUSIONS
  This serious game showed clear discriminatory ability between different levels of expertise in biliary tract disease management and clear teaching capability. It was perceived as appealing and realistic. Serious gaming has the potential to increase adherence to training programs in surgical residency training and medical school.
authors.affiliation: Department of Surgery, Academic Medical Centre, PO Box 22600, Amsterdam, 1100 DD, The Netherlands.
authors.forename: Maurits
authors.initials: M
authors.lastname: Graafland
authors.forename: Maarten F
authors.initials: MF
authors.lastname: Vollebergh
authors.forename: Sjoerd M
authors.initials: SM
authors.lastname: Lagarde
authors.forename: M
authors.initials: M
authors.lastname: van Haperen
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: Marlies P
authors.initials: MP
authors.lastname: Schijven
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000601:surgery; D001662:Biliary Tract Surgical Procedures / Q000193:education*; D002983:Clinical Competence; D003657:Decision Making; D005260:Female; D005717:Games, Experimental; D006801:Humans; D007396:Internship and Residency; D008297:Male; D013337:Students, Medical; D066231:Surgeons; D011795:Surveys and Questionnaires; D018910:Video Games; D055815:Young Adult