Table 2

Summary of evidence-based serious games

GameStudyParticipantsMethodologyOutcomesLimitationsConclusion
NRP eSimUmoren et al,27 2019255 NRP providers recruited from four US institutions.NRP providers randomised into a pre-NRP course preparation intervention group: (1) eSim plus NRP textbook and online MCQ examination (n=167) or (2) NRP textbook only and online MCQ examination (n=88). After completing the in-class portion, participants’ performance as team leader during a standardised neonatal resuscitation simulation was video recorded and evaluated.eSim+NRP textbook NRP providers performed certain steps of the NRP algorithm more correctly than the textbook-only group, including: initial set-up, initial steps, mask adjustment and reposition airway; ECG leads before chest compressions, and correct epinephrine order. There was no difference between the groups in time to perform key NRP steps (ie, PPV started, ET intubation, chest compressions started, UVC placed, intravenous epinephrine requested, intravenous epinephrine given, chest compressions stopped).Improved performance could be contributed to more time overall spent training by the eSim+textbook group, rather than use of the eSim specifically. The study was funded by the AAP which hosts the eSim.Preparation for the in-class portion of the NRP provider course with the eSim+NRP textbook improved NRP provider performance on several key steps during an in-person neonatal resuscitation simulation, compared with textbook preparation alone.
RETAIN board gameCutumisu et al,28  201930 NRP providers recruited from the Royal Alexandra Hospital (Edmonton, Alberta, Canada).Experienced NRP providers completed a written pretest of an open-answer neonatal resuscitation scenario, tutorial and three rounds of RETAIN as team leader (guided by a facilitator). Participants repeated the same written scenario as a post-test, and performance was scored and analysed for knowledge retention.NRP providers experienced a 12% increase in performance between the pre-test and post-test scores (49%–61%, respectively). The most improvements in knowledge retention were made in temperature management (14%–46% from pre-test to post-test), attaching pulse oximeter (57%–77%, respectively), ECG leads (47%–73%, respectively) and admission to the NICU (0%–47%, respectively).There was a negative effect on the task of assessing breathing between the pre-test and post-test (mean=0.70, SD=0.47 compared with mean=0.50, SD=0.51, respectively), and the study used a small sample size (n=30).Playing the RETAIN board game improved NRP providers’ performance on a written neonatal resuscitation scenario and improved knowledge retention of the NRP algorithm.
The Neonatology GameSwiderska et al,29 201367 undergraduate medical students from the University of Glasgow (Scotland, UK).Students during their neonatal placement week were cluster randomised into a teaching stream of either normal course content plus an additional 1 hour session to play the game (n=31) or normal course content alone (n=36). Participants’ performance on a final examination of 50 true or false questions was recorded.Students in the board game group had a mean post-test score of 4.15 (95% CI –0.88 to 9.17; p=0.09) points higher compared with the group that received course content only (64.65% compared with 60.5%, respectively, ICC=0.05). Students evaluated the game well, and there were no negative attitudes reported towards the game.There was no pre-test for baseline comparison of improved performance. Improved performance could be contributed to receiving one additional hour of teaching, and exposure to practice examination questions, which the control group may not have received.Playing The Neonatology Game improved some medical students’ performance on their neonatology final examination. The summary cards provided in the game were evaluated as a useful study resource by students.
Neonatal Emergency Trivia GameGordon and Brown, 30 199510 NRP-certified nurses recruited from a level III NICU.Nurses independently completed a written test consisting of all the game questions. Seven of the 10 nurses recruited repeated the same test after 2 weeks. Participants were not given any feedback or additional education between the test timepoints.The test–retest reliability for the Neonatal Emergency Trivia Game questions was moderately strong (mean for both test timepoints=73%, r=0.76).There was a small sample size and participant retention. The interval between the pre-test and post-test may not have been long enough to assess independent performance at each timepoint.The questions used in the Neonatal Emergency Trivia Game were reliable, as evaluated by experienced NRP providers.
Gordon and Brown, 30 199512 neonatal nurses recruited during an obstetrics conference.Nurses played a trial game at the end of a conference day to review and reinforce the knowledge they had learnt. 11 out of 12 participants completed a Likert-scale evaluation.Questions included: (1) clear game instructions, (2) clinically applicable questions, (3) helpful review tool, (4) comparison of game to lecture/video presentations and (5) recommend the game to other HCPs. All questions had a mode of 5, except question (4) with a mode of 4.The game was not evaluated as favourably compared with traditional teaching methods. Demographic information was not collected which may have moderated this evaluation.After playing the Neonatal Emergency Trivia Game, experienced neonatal HCPs had overall positive attitudes toward the game.
NeonopolySwingler, 30 199499 midwives recruited from South Africa.Midwives who had previously received the Neonopoly game were mailed a follow-up questionnaire to observe usage and attitudes toward the game. 79 of 99 completed surveys were returned.84.8% of respondents had used the game before the survey. 86.6% of participants found the game easy to learn, 94.0% enjoyed playing and 98.5% intended to use the game again. 98.5% of participants indicated a need for similar games addressing other subjects. The number of question cards provided were evaluated as insufficient.15% of respondents had not actually played the game before completing the survey.After receiving the Neonopoly game, midwives had overall positive attitudes toward the game.
RETAIN video gameCutumisu et al,1 201850 HCPs recruited from the Royal Alexandra Hospital (Edmonton, Alberta, Canada).Experienced NRP providers completed a tutorial, three rounds of the RETAIN game and a postgame questionnaire to assess growth mindset out of 10.Participants reported high levels of growth mindset (mean=9.17). Participants made fewer mistakes in the game if they endorsed a higher level of growth mindset.No results reported on how training with RETAIN may improve performance or education outcomes.HCPs’ performance on RETAIN was moderated by self-reported growth mindset levels.
eBabyFonseca et al,40 201514 nursing students recruited from Coimbra School of Nursing (Coimbra, Portugal).Nursing students completed a demographic and digital technology usage questionnaire. After using eBaby for 2 weeks at their discretion, students provided quantitative and qualitative feedback toward the game.72% of participants totally agreed that they were motivated to use eBaby and that the game was useful for their learning. 57% of participants totally agreed the game was easy to use. 71% of participants disagreed that the game could replace their teachers.No self-report measure reported of how long participants actually used the eBaby over the 2-week period.Playing the eBaby game was easy, useful and motivating for nursing students based on self-report.
eHBBUmoren et al,27 201924 HCPs recruited from the National Hospital (Abuja, Nigeria).After playing a pilot version of the VR game, HCPs completed usability surveys, observations and focus group discussions.Participants reported they were highly likely to use the game to practise HBB skills (mean=4.3, SD=0.7) and highly likely to recommend the game to others (mean=4.5, SD=0.6). Overall, eHBB was evaluated as interesting, educational and enabled learning without stress.The eHBB VR game was evaluated positively overall by HCPs in a resource-limited setting.
  • AAP, American Academy of Pediatrics; eHBB, Electronic Helping Babies Breathe; ET, endotracheal tube; HCP, healthcare professional; ICC, intraclass correlation coefficient; MCQ, multiple-choice questions; NICU, neonatal intensive care unit; NRP, Neonatal Resuscitation Program; PPV, positive-pressure ventilation; RETAIN, REsuscitation TrAINing for healthcare professionals; UVC, umbilical vein catheterization; VR, virtual reality.