title: A Virtual Emergency Telemedicine Serious Game in Medical Training: A Quantitative, Professional Feedback-Informed Evaluation Study.
abstract: BACKGROUND
  Serious games involving virtual patients in medical education can provide a controlled setting within which players can learn in an engaging way, while avoiding the risks associated with real patients. Moreover, serious games align with medical students' preferred learning styles. The Virtual Emergency TeleMedicine (VETM) game is a simulation-based game that was developed in collaboration with the mEducator Best Practice network in response to calls to integrate serious games in medical education and training. The VETM game makes use of data from an electrocardiogram to train practicing doctors, nurses, or medical students for problem-solving in real-life clinical scenarios through a telemedicine system and virtual patients. The study responds to two gaps: the limited number of games in emergency cardiology and the lack of evaluations by professionals.
  
  
  OBJECTIVE
  The objective of this study is a quantitative, professional feedback-informed evaluation of one scenario of VETM, involving cardiovascular complications. The study has the following research question: "What are professionals' perceptions of the potential of the Virtual Emergency Telemedicine game for training people involved in the assessment and management of emergency cases?"
  
  
  METHODS
  The evaluation of the VETM game was conducted with 90 professional ambulance crew nursing personnel specializing in the assessment and management of emergency cases. After collaboratively trying out one VETM scenario, participants individually completed an evaluation of the game (36 questions on a 5-point Likert scale) and provided written and verbal comments. The instrument assessed six dimensions of the game: (1) user interface, (2) difficulty level, (3) feedback, (4) educational value, (5) user engagement, and (6) terminology. Data sources of the study were 90 questionnaires, including written comments from 51 participants, 24 interviews with 55 participants, and 379 log files of their interaction with the game.
  
  
  RESULTS
  Overall, the results were positive in all dimensions of the game that were assessed as means ranged from 3.2 to 3.99 out of 5, with user engagement receiving the highest score (mean 3.99, SD 0.87). Users' perceived difficulty level received the lowest score (mean 3.20, SD 0.65), a finding which agrees with the analysis of log files that showed a rather low success rate (20.6%). Even though professionals saw the educational value and usefulness of the tool for pre-hospital emergency training (mean 3.83, SD 1.05), they identified confusing features and provided input for improving them.
  
  
  CONCLUSIONS
  Overall, the results of the professional feedback-informed evaluation of the game provide a strong indication of its potential as an educational tool for emergency training. Professionals' input will serve to improve the game. Further research will aim to validate VETM, in a randomized pre-test, post-test control group study to examine possible learning gains in participants' problem-solving skills in treating a patient's symptoms in an emergency situation.
authors.affiliation: Department of Communication and Internet Studies, Cyprus University of Technology, Limassol, Cyprus. iolie.nicolaidou@cut.ac.cy.
authors.forename: Iolie
authors.identifier: http://orcid.org/0000-0002-8267-0328
authors.initials: I
authors.lastname: Nicolaidou
authors.forename: Athos
authors.identifier: http://orcid.org/0000-0002-5789-5103
authors.initials: A
authors.lastname: Antoniades
authors.forename: Riana
authors.identifier: http://orcid.org/0000-0002-8311-3013
authors.initials: R
authors.lastname: Constantinou
authors.forename: Charis
authors.identifier: http://orcid.org/0000-0001-5998-2799
authors.initials: C
authors.lastname: Marangos
authors.forename: Efthyvoulos
authors.identifier: http://orcid.org/0000-0002-4589-519X
authors.initials: E
authors.lastname: Kyriacou
authors.forename: Panagiotis
authors.identifier: http://orcid.org/0000-0002-9936-5805
authors.initials: P
authors.lastname: Bamidis
authors.forename: Eleni
authors.identifier: http://orcid.org/0000-0002-2439-090X
authors.initials: E
authors.lastname: Dafli
authors.forename: Constantinos S
authors.identifier: http://orcid.org/0000-0003-1271-8151
authors.initials: CS
authors.lastname: Pattichis
mesh_terms: D000328:Adult; D000552:Ambulances; D001291:Attitude of Health Personnel; D002309:Cardiology / Q000193:education*; D004562:Electrocardiography; D016529:Emergency Nursing / Q000193:education*; D005246:Feedback; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D011340:Problem Solving; D017216:Telemedicine; D014584:User-Computer Interface; D018910:Video Games
keywords: emergency assessment and management; emergency telemedicine; medical education; professional feedback-informed evaluation; serious games; telemedicine; virtual patients