Pharmacy Students' Perception Of A Serious Game Prototype For Teaching And Learning Of Clinical Reasoning In Symptom Assessment And Triage

• By: YAP, Kai Zhen (Singapore)
• Co-author(s): Dr Kai Zhen Yap (National University Of Singapore, Singapore, Singapore)
  Ms Wan Lin Poh (National University Of Singapore, Singapore, Singapore)
  Ms Shumin Zeng (National University Of Singapore, Singapore, Singapore)
  
• Abstract:

  Background: Clinical Reasoning (CR) in assessment and triage of patients’ symptoms is an essential cognitive skill for pharmacists. Sound CR underpins the comprehensive yet efficient information gathering and processing required for accurate identification of the clinical problem and triage decisions for effective and safe care of the patient.
  
  Although CR is introduced to pharmacy students during pre-clinical years, patient encounters and practices are limited by timetable and resource constraints. Hence, students struggle to apply CR during objective standardised clinical exams under time pressure or when facing real patients. While CR could be honed through experiential learning during clinical years, the pressure and stress associated with high-stake real-world clinical environments may pose a steep learning curve and hinder learning. A serious game (SG) was thus designed to enhance the teaching and learning of CR for pharmacy undergraduate students.
  
  Purpose: This mixed-method study aimed to evaluate students’ perception of an SG prototype comprising of three interactive game scenarios of increasing difficulty level, on assessment and triage of “chest pain” in a community pharmacy setting.
  
  Methods: Nine Bachelor of Pharmacy (Year 2) students at the National University of Singapore volunteered for a one-hour gameplay session in February 2023, where they followed a CR framework (embedded within the game scenarios) to select relevant questions for history-taking and identify the likely differential and triage decision for the “patient” avatar. Faculty-led debrief was provided at the end of the session to clarify learning points relating to the clinical cases.
  
  Quantitative responses pertaining to the Game Evaluation Questionnaire (GEQ) and confidence in CR were captured via a set of pre-and-post self-administered hardcopy survey. Qualitative feedback was captured via individual semi-structured qualitative zoom follow-up interviews.
  
  Results: The participants were mostly male (n=6), studied 5-6 hours per day (n=5), had additional clinical attachment/exposure besides the usual in-course experiential learning (n=5), and played computer/mobile games (n=7).
  
  Higher confidence levels in aspects of “Ruling In”, “Ruling Out”, and “Planning the Next Course of Action” within the CR framework were reported after the gameplay (p<0.05). Of the 11 GEQ domains assessed, participants were “Extremely Satisfied” with the prototype’s learning effectiveness and utility, and “Somewhat Satisfied” on domains of enjoyment, visual adequacy, relevance, clarity of goals and feedback.
  
  During the follow-up interviews (n=3), participants emphasised the SG’s value in guiding students through triage decision-making process, with suggestions for more prompts and explanations on the selection of questions for history-taking. While physical formative individual role-play assessments would not be replaceable (as human interactions cannot be fully simulated), learning through gameplay was deemed more enjoyable and less stressful. Furthermore, the summary notes within each game scenario were self-sufficient for learning, without the need for faculty-led debrief. Hence, with more scenarios related to the curriculum, the SG can serve as a supplementary e-learning resource for more practices on CR in students’ own time.
  
  Conclusion: Overall, the SG prototype was favourably perceived by students for enhancing CR training. Further evaluation of the fully developed SG involving longer gameplay exposure is warranted to determine its benefits and limitations.