Influencing Influenza: Educational game for medical students -Arnold Bosman

1. Influencing Influenza
A game for Dutch medical students to learn about influenza epidemic control

2. Presentation Roadmap
Starting Point
Design & Mechanics
Results Live Game Play
Conclusions & Next steps

3. Starting point
Decision to Innovate:
• Julius Center (Utrecht University)
• Curriculum Communicable Disease Control
• Innovation of Outbreak Response Teaching
• Decision to introduce game for students
GameDevelopers:
• Jade Owl Studios
• Start-up Dutch Game Design company
• Focus on State-of-Art game design
• Transmissible
• International Public Health Support
• Experts in Communicable Disease
Control training

4. Learning Objectives
• Understand the roles of relevant organizations in outbreak response
• Local / regional: Public Health Services
• National Public Health Institute
• Animal Health Sector
• International Health Agencies
• Experience challenge of collaboration under time pressure
• Missing information
• Communication issues
• Different personalities

5. The Game
•Collaborative game for 5-6 players
•Hybrid: card game & computer-based, branching narrative
•Played in 5 rounds, each round:
• Team plays the role of 1 organisation
• Four phases, within 25 minutes:
1. Problem Description
2. Deciding on which information to collect
3. Spending resources to secure information
4. Deciding on best evidence-based intervention

6. The Scenario
•Severe influenza at a local school
•Epidemic expands to animal population
•Local, National health authorities & animal health sector involved
•ECDC acts when multiple countries are infected
•Scenario is programmed as a branching narrative in TWINE®

7. Game mechanics of each round
1. Context phase
a) Read narrative on screen
b) Discuss the problem
2. Outbreak File phase (stopwatch: 5 minutes)
a) Review & discuss 3 Information cards
b) Select most relevant information card to further study
c) Repeat a-b until stack is empty
3. Information Collection phase (stopwatch: 2 minutes)
a) Play resource cards to ‘pay’ for the Information card
b) Players may hold max 2 cards in hand
4. Interpretation & action phase
a) Enter codes of acquired information cards
b) Read detailed narrative information
c) Decide on best out of 4 actions

8. Experience from 3 live game applications
•February 2018: medical students Utrecht University
• 3rd year bachelor curriculum
• 4 groups of players (all recorded)
•June 2018: Netherlands School of Public Health Professionals
• Adult education in communicable disease control
• 3 groups of players recorded
•Juli 2018: medical students Utrecht University
• 3rd year bachelor curriculum
• 8 groups of players recorded

9. Outcomes game play - round 1
1
2
3
0
2
4
6
8
10
1.1 1.2 1.3 1.4
Students (12 groups), 2018
1
2
3
0
1
2
3
1.1 1.2 1.3 1.4
Public health (3 groups), 2018

10. Outcomes game play - round 1
1
2
3
0
2
4
6
8
10
1.1 1.2 1.3 1.4
Students (12 groups), 2018
1
2
3
0
1
2
3
1.1 1.2 1.3 1.4
Public health (3 groups), 2018
Study protocol with your team
Call lab for diagnostic details
Go to school and inspect

11. Outcomes game play - round 1
1
2
3
0
2
4
6
8
10
1.1 1.2 1.3 1.4
Students (12 groups), 2018
1
2
3
0
1
2
3
1.1 1.2 1.3 1.4
Public health (3 groups), 2018
Call national institute for advice
Investigate background
Family members

12. Outcomes game play - round 3
1
3
0
2
4
6
8
10
12
3.1 3.2 3.3 3.4 3.5
Scores round 3 - Students
(12 groups), 2018
1
3
0
1
2
3
3.1 3.2 3.3 3.4 3.5
Scores round 3 - Public Health
(3 groups), 2018
No clear preference: confusion on options Prefer risk factor study above case interviews

13. Outcomes game play - round 5
1
3
0
2
4
6
8
5.1 5.2 5.3 5.4 5.5 5.6
Scores round 5 - Students (12 groups), 2018
1
3
0
1
5.1 5.2 5.3 5.4 5.5 5.6
Scores round 5 - Public Health (3 groups), 2018
University assignment for mathematical model Virological study to inform
vaccine development

14. Performance of increasing difficulty levels
0%
20%
40%
60%
80%
100%
1 2 3 4 5
Information cards acquired
by player group (2018)
Students Public Health
Round Information
Cards
Resources
1 12 6
2 12 8
3 15 8
4 15 10
5 18 12

15. Feedback from player groups
• Students:
- Central time-keeping should be per group
- Scenario is realistic & challenging
- Game provides new knowledge on public health organisations
- More fun than expected (‘serious games’ are not always ‘serious’)
• Public Health Professionals:
- School of Public Health sees good match with curriculum
- Collaborative targets are appreciated
- Scenario is realistic, funny, and promotes discussion on good practice
- Scenario and game mechanics seen as superior to existing Dutch public health games
- Gameplay depends on team composition

16. Conclusions so far
• Greep op Griep performs as expected
• Game experience is positive & appreciated by players & trainers
• Players’ choices in branching narrative may reflect gaps in knowledge
• Public Health Professionals find game useful (unexpected)
• We need validated survey to measure learning effects of game

17. Next steps
• Complete validation of learning effect study instrument (with Julius Center)
• Continue in curriculum Utrecht University & Public Health Professionals
• Introduce game in other universities
• Netherlands
• Other European?
• Interested? Play the game in our booth!

18. Acknowledgements
• Authors:
• Arnold Bosman (Transmissible)
• Jeremy Falger (Jade Owl Studios)
• Milan Lefferts (Jade Owl Studios)
• Vincent van Gils (Jade Owl Studios)
• Contributors
• Nienke van den Berg (Julius Center)
• Marielle Jambroes (Julius Center)
• Tom IJdema (Jade Owl Studios),
• Nanne Jansen (Julius Centrum)
• Ecca Berhitu (Education centre UMC Utrecht)