Tanner B. Branched Path Learning and Gamification for Student Training in Health and Medicine. Presented at the 2016 Serious Play Conference; 2016 July 26-28; Chapel Hill, NC.

1. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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BRANCHED PATH LEARNING
AND GAMIFICATION
for Student Training in Health and Medicine
T. Bradley Tanner, MD (Clinical Tools, Inc.)
SERIOUS PLAY CONFERENCE 2016 | UNC, Chapel Hill, NC

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
SUMMARY
The talk highlights how educators in the health sciences and
health professions can successfully create and deploy
branched-path learning and gamification elements. Attendees
will gain practical advice on how create educational
experiences that enhance interest and relevance and that
target successful attainment of clinical skills

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Objectives: The attendee will be able to:
●
Apply knowledge of branched-path learning to the
process of creating an educational experience for
students in health science, medical, and health
professions.
●
Identify elements of gamification that will enhance
learner interest and participation and that match the
needs of future clinical care.
●
Calculate the challenge of creating an educational
experience using branched-path learning and
gamification so educators can determine its
appropriate use in their organization

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Disclosure: About Me and Clinical Tools
Tanner: President of Clinical Tools Inc.,
Board Certified in Psychiatry and in
Obesity Medicine. Past stops at UVA, Pgh
Company: CTI is a small R&D company
located in Chapel Hill, NC specializing in
software and curriculum development

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
WHO ARE YOU
Health Care Provider
Health Care related employment

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
WHO ARE YOU
Health Care Provider
Health Care related employment
Care about Health Care
Provision?

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
The Need Vision and Goal
●
Need: Do providers have all the skills they need?
Can current education can fill in all those gaps?
●
Vision: Together, branched-path learning and
gamification can create scalable and easily
alterable training for today’s and future health
and medical students
●
Goal: Outline how we can best use the potential
of gamification to enhance the provision of
health care

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
WHY GAMES
Why is this talk not a game?

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
WHY GAMES
Why is this talk not a game?
Money?. $100K/40 minutes,
Time? 3 months

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
WHY GAMES
Why is this talk not a game?
Scalability: We need a huge audience to
justify that expense.
A marketplace to buy sell this lecture
(think android store/iphone store

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
OK. Let’s throw in some Gamification
●
I'll go too fast.
●
Too slow;
●
Go backwords.
●
Skip slides.
●
Put some confusing slides with pictures that
make no sense.
●
Create some hard to read slides with errors so we
introduce the "what is he trying to do?" game

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
THE ANATOMY COLORING BOOK
Games don't work?
Games have to be in sync?
Perhaps what (or how) we
are teaching is wrong?

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
How to implement: Cognitive
●
Meeting a Greater Purpose Meaning.
Professionalism.
●
Challenge;
●
Competence: Task Accomplishment.
●
ACGME Competencies: Personal Development.

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Cognitive: Challenge
●
Games are hard.
●
Anxiety is good ... when it isn't.
●
Branched Paths.

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Cognitive: Challenge Branched Path→
●
What are they?
●
Development.
●
Models. 3x3 model, 3x3x3, What about software driven
experience? AI?
●
Use: Do people do more than one – 50/50? Use is
asymmetric. Clearly "wrong" paths are rarely chosen - but
is it worth it?
●
Preference: Do users want points for successful choices -
No Feedback is enough (except perhaps "patient health"
points. Timed - yes, adds realism. "hints" rarely - want this
to be real

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
How to implement: Emotional
●
Enabling Creativity and supporting Autonomy
●
Social Connections - Health professional
students want a system that rewards
cooperation, improvement, and group success
●
Failure NOT! - In medicine "Losing" often
means mortality or morbidity.
●
Unpredictability and Variation

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
WHAT IS THE NEED?
“Clinical skills' training is arguably the weakest point in
medical schools' curriculum. We need to bring back into the
medical curriculum and clinical practice the art of
observation, listening, clinical reasoning, and focused and
targeted clinical examination of the patient.”
(Shelley BP. Wither clinical skills and humanism? . Arch Med Health Sci 2014;2:1-3)

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Case-Based Branched Learning
Problem: New medical education
standards require clinical skills training,
but lectures aren’t interactive and
simulations are expensive
Solution: Branched-learning scenarios
where students experience
✔ Real-world environments
✔ Outcomes of their decisions

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Simulated 3D Patient Interaction
Medical Education Training
Case-based branched learning
Case In Development Case Rendered In Tablet App

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
SIMULATES A REAL WORLD
PATIENT ENCOUNTER

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Full Patient Encounter Presented
✔History
✔Physical Exam
✔Screening
✔Brief Interventions
✔Referral and Treatment
✔Follow-Up

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
CREATED VIA BRANCHED
LEARNING TOOL

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Uses Online Case-Building Tool
●
Cases written
online in Twine
framework
●
Visual layout of
case available as
you go

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
CASE FILES TRANSLATED TO AN
INTERACTIVE APP
App Will be Available Free of Charge Initially!

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Inviting Visual Interface On App
●
Students see rendering of patient on app
●
Visual interface makes real-world connections

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
REALISTIC DIALOGUE ENHANCES
COMMUNICATION SKILLS

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Simulated Patient Conversations
✔ Models ideal conversation approaches
✔ Emphasizes patient-centered treatment

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
USER CHOICES CREATE
INDIVIDUALIZED EXPERIENCE

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Multilevel Choice Pathways
●
User choices lead to decision-outcomes
●
Individualized experiences based on pathways

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
INTERACTIVITY: CHOICES
FEEDBACK

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Outcome Of Choices Explained
●
Chapters end with summary of student choices
●
Both ideal and non-ideal choices summarized

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
HOW CAN I LEARN MORE?

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Branched Simulated Patient Interaction
Medical Education Training
Clinical Tools has over 20 years
experience in medical student and
continuing medical education training.
Fill out our survey on ClinicalTools.com
to keep up to date on our
development!
Currently free of charge!
ClinicalTools.com
feedback@clinicaltools.com

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C E : C A S E B U I L D I N G E N G I N E
LET US INTRODUCE YOU TO
ANOTHER APPROACH TO CASE
SIMULATION….

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C E : C A S E B U I L D I N G E N G I N E
Clinical Encounter
Case Building Engine
Build cases
for a
simulation
app!
Developed by

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C E : C A S E B U I L D I N G E N G I N E
WHAT IS THE CASE BUILDING
ENGINE?

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C E : C A S E B U I L D I N G E N G I N E
Case Building Engine
What Does It Do?
✔ A tool to create cases for
clinical encounter simulation
✔ Uses an online form
✔ Renders in a clinical
simulation app
✔ App helps develop medical
skills
✔ Currently free of charge!
Internal page from clinical simulation app:

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C E : C A S E B U I L D I N G E N G I N E
WHAT ARE THE INTENDED GOALS?

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C E : C A S E B U I L D I N G E N G I N E
Case Building Engine Goals
1) Create cases using
Case Building Engine
2) Share completed cases
with others
3) Learn by creating,
reviewing, interacting
with cases
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
— Goethe

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C E : C A S E B U I L D I N G E N G I N E
HOW DOES THE CASE
BUILDING ENGINE WORK?

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C E : C A S E B U I L D I N G E N G I N E
Users Create Cases for
App Using an Online Form
Online Webform Case App
For Skills Training

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C E : C A S E B U I L D I N G E N G I N E
Form Prompts You For Information
✔ History
✔ Evaluation
✔ Diagnosis
✔ Brief Interventions
✔ Referral and
Treatment
✔ Follow-Up

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C E : C A S E B U I L D I N G E N G I N E
HOW IS THE CASE RENDERED?

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C E : C A S E B U I L D I N G E N G I N E
In An Interactive App: Clinical Encounter
Developed by

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C E : C A S E B U I L D I N G E N G I N E
Multiple Completed Cases to Choose From

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C E : C A S E B U I L D I N G E N G I N E
Rendered in a Simulated EHR*
*EHR = Electronic Health Record

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C E : C A S E B U I L D I N G E N G I N E
Timer Increases Challenge of Game

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C E : C A S E B U I L D I N G E N G I N E
INTERACTIVITY:
CHOICES/FEEDBACK

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C E : C A S E B U I L D I N G E N G I N E
Make Clinical
Choices
Get
Feedback

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C E : C A S E B U I L D I N G E N G I N E
INTEGRATION INTO MEDICAL
EDUCATION

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C E : C A S E B U I L D I N G E N G I N E
Case Building Engine in the Classroom
We envision scenarios like this one:
Students use the Case Building Engine to
create cases about any of today’s most
common medical problems.
They work in pairs and come up with cases.
Then they share their cases with each other.

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C E : C A S E B U I L D I N G E N G I N E
HOW CAN I LEARN MORE?

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C E : C A S E B U I L D I N G E N G I N E
Clinical Encounter:
Case Building Engine
Clinical Tools has over 20 years
experience in medical student and
continuing medical education training
Fill out our survey on ClinicalTools.com
to keep up to date on our development!
Currently Free of Charge!
ClinicalTools.com
feedback@clinicaltools.com

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CASE-BASED BRANCHED LEARNING
FOR MEDICAL STUDENTS WITH 3D IMAGES
T. Bradley Tanner, MD (Clinical Tools, Inc.)
Serious Play Conference 2016
UNC, Chapel Hill, NC
Clinical Encounter: Alcohol (Branched Learning)
Clinical Encounter: Case Building Engine
More information available on ClinicalTools.com
THANK YOU!