Die Bedeutung von und die Evaluation eines Serious Games für den Einsatz in der Ausbildung von Medizinstudierenden im 21. Jahrhundert

Hintergrund: Serious Games geraten zunehmend in der Lehrforschung als auch in der täglichen Ausbildung von angehenden Ärzten in den Fokus der Aufmerksamkeit. Dabei bieten sie den Lernenden die Möglichkeit, sich in einem geschützten Umfeld ohne die Gefährdung von echten Patienten zeit- und ortsunabhängig Fähigkeiten und Fertigkeiten anzueignen. Noch ist die Anzahl an Serious Games, die den Anforderungen der Lernenden im Bereich des Spieldesigns und der Spielmechanik wie auch der medizinisch korrekten Darstellung gerecht werden, stark begrenzt. Daher ist die Datenlage zu der Effektivität von Serious Games in der medizinischen Lehre uneindeutig und bedarf weiterer Untersuchungen. Zielsetzung: Ziel der vorliegenden Studie war es, das Serious Game „EMERGE“ hinsichtlich seines Nutzens in der Vermittlung von deklarativem und Prozedurenwissen sowie der Annahme durch die Studierenden im Rahmen einer ersten Machbarkeitsstudie zu evaluieren. Methode: Die vorliegende nicht-randomisierte Studie wurde an der Abteilung für Allgemein-, Viszeral- und Tumorchirurgie des Universitätsklinikums Köln durchgeführt. Insgesamt nahmen 140 Medizinstudenten im klinischen Teil ihrer Ausbildung (5. bis 12. Semester) an dieser experimentellen Studie auf freiwilliger Basis teil. Deklaratives Wissen (gemessen mit 20 Multiple-Choice-Fragen) und Prozedurenwissen (gemessen mit schriftlichen Fragen aus einer objektiv strukturierten klinischen Untersuchungsstation) wurden vor und nach der Arbeit mit EMERGE bewertet. Der Eindruck der Schüler über die Wirksamkeit und Anwendbarkeit von EMERGE wurde auf einer 6-Punkte-Likert-Skala gemessen. Ergebnisse: Ein Pretest-Posttest-Vergleich ergab einen signifikanten Anstieg des deklarativen Wissens. Der Prozentsatz der korrekten Antworten auf Multiple-Choice- Fragen stieg von vorher (Mittelwert 60,4, SD 16,6) auf nachher (Mittelwert 76,0, SD 11,6) durch das Spielen von EMERGE (P<.001). Der Effekt auf das deklarative Wissen war bei Studierenden in niedrigeren Semestern größer als bei Studierenden in höheren Semestern (P<.001). Darüber hinaus war der Gesamteindruck der Studenten von EMERGE positiv. Schlussfolgerung: EMERGE hat das Potential, das deklarative und Prozedurenwissen bei Studierenden signifikant anzuheben und kann als Ergänzung zum herkömmlichen medizinischen Unterricht in Betracht gezogen werden

Are gamers better laparoscopic surgeons? Impact of gaming skills on laparoscopic performance in Generation Y students

Background Both laparoscopic surgery and computer games make similar demands on eye-hand coordination and visuospatial cognitive ability. A possible connection between both areas could be used for the recruitment and training of future surgery residents. Aim The goal of this study was to investigate whether gaming skills are associated with better laparoscopic performance in medical students. Methods 135 medical students (55 males, 80 females) participated in an experimental study. Students completed three laparoscopic tasks (rope pass, paper cut, and peg transfer) and played two custom-designed video games (2D and 3D game) that had been previously validated in a group of casual and professional gamers. Results There was a small significant correlation between performance on the rope pass task and the 3D game, Kendall's tau(111) = -.151,P= .019. There was also a small significant correlation between the paper cut task and points in the 2D game, Kendall's tau(102) = -.180,P= .008. Overall laparoscopic performance was also significantly correlated with both the 3D game, Kendall's tau(112) = -.134,P= .036, and points in the 2D game, Kendall's tau(113) = -.163,P= .011. However, there was no significant correlation between the peg transfer task and both games (2D and 3D game),P= n.s.. Conclusion This study provides further evidence that gaming skills may be an advantage when learning laparoscopic surgery

Web-Based Immersive Patient Simulator as a Curricular Tool for Objective Structured Clinical Examination Preparation in Surgery: Development and Evaluation

Background: Objective Structured Clinical Examination is a standard method of testing declarative and process knowledge in clinical core competencies. It is desirable that students undergo Objective Structured Clinical Examination training before participating in the exam. However, establishing Objective Structured Clinical Examination training is resource intensive and therefore there is often limited practice time. Web-based immersive patient simulators such as ALICE (Artificial Learning Interface of Clinical Education) can possibly fill this gap as they allow for the training of complex medical procedures at the user's individual pace and with an adaptable number of repetitions at home. ALICE has previously been shown to positively influence knowledge gain and motivation. Objective: Therefore, the aim of this study was to develop a Web-based curriculum that teaches declarative and process knowledge and prepares students for a real Objective Structured Clinical Examination station. Furthermore, we wanted to test the influence of ALICE on knowledge gain and student motivation. Methods: A specific curriculum was developed in order to implement the relevant medical content of 2 surgical Objective Structured Clinical Examination stations into the ALICE simulator framework. A total of 160 medical students were included in the study, where 100 students had access to ALICE and their performance was compared to 60 students in a control group. The simulator performance was validated on different levels and students' knowledge gain and motivation were tested at different points during the study. Results: The curriculum was developed according to the Kern cycle. Four virtual clinical cases were implemented with different teaching methods (structured feedback, keynote speech, group discussion, and debriefing by a real instructor) in order to consolidate declarative and process knowledge. Working with ALICE had significant impact on declarative knowledge gain and Objective Structured Clinical Examination performance. Simulator validation was positive for face, content, construct, and predictive validity. Students showed high levels of motivation and enjoyed working with ALICE. Conclusions: ALICE offers Web-based training for Objective Structured Clinical Examination preparation and can be used as a selective didactic intervention as it has positive effect on knowledge gain and student motivation

Serious Games in Surgical Medical Education: A Virtual Emergency Department as a Tool for Teaching Clinical Reasoning to Medical Students

Background: Serious games enable the simulation of daily working practices and constitute a potential tool for teaching both declarative and procedural knowledge. The availability of educational serious games offering a high-fidelity, three-dimensional environment in combination with profound medical background is limited, and most published studies have assessed student satisfaction rather than learning outcome as a function of game use. Objective: This study aimed to test the effect of a serious game simulating an emergency department (EMERGE) on students' declarative and procedural knowledge, as well as their satisfaction with the serious game. Methods: This nonrandomized trial was performed at the Department of General, Visceral and Cancer Surgery at University Hospital Cologne, Germany. A total of 140 medical students in the clinical part of their training (5th to 12th semester) self-selected to participate in this experimental study. Declarative knowledge (measured with 20 multiple choice questions) and procedural knowledge (measured with written questions derived from an Objective Structured Clinical Examination station) were assessed before and after working with EMERGE. Students' impression of the effectiveness and applicability of EMERGE were measured on a 6-point Likert scale. Results: A pretest-posttest comparison yielded a significant increase in declarative knowledge. The percentage of correct answers to multiple choice questions increased from before (mean 60.4, SD 16.6) to after (mean 76.0, SD 11.6) playing EMERGE (P<.001). The effect on declarative knowledge was larger in students in lower semesters than in students in higher semesters (P<.001). Additionally, students' overall impression of EMERGE was positive. Conclusions: Students self-selecting to use a serious game in addition to formal teaching gain declarative and procedural knowledge

Dnmt1 has de novo activity targeted to transposable elements

DNA methylation plays a critical role during development, particularly in repressing retrotransposons. The mammalian methylation landscape is dependent on the combined activities of the canonical maintenance enzyme Dnmt1 and the de novo Dnmts, 3a and 3b. Here, we demonstrate that Dnmt1 displays de novo methylation activity in vitro and in vivo with specific retrotransposon targeting. We used whole-genome bisulfite and long-read Nanopore sequencing in genetically engineered methylation-depleted mouse embryonic stem cells to provide an in-depth assessment and quantification of this activity. Utilizing additional knockout lines and molecular characterization, we show that the de novo methylation activity of Dnmt1 depends on Uhrf1, and its genomic recruitment overlaps with regions that enrich for Uhrf1, Trim28 and H3K9 trimethylation. Our data demonstrate that Dnmt1 can catalyze DNA methylation in both a de novo and maintenance context, especially at retrotransposons, where this mechanism may provide additional stability for long-term repression and epigenetic propagation throughout development.ISSN:1545-9993ISSN:1545-998