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medicine in a box

MEDICINE IN A BOX

 

Question Can social gaming support healthcare education?

 

The first of two interconnected pages on learning products and learning design. This page and the games and spaces it describes are the result of design research that emphasized a mix of contemporary anthropology together and historical literature review. It entailed empathetic listening to the words from students and educators from the past 100 years with emphasis on the modern learner. Although the literature was couched in scientific terms, these educators had really written a series of design manifestos that represent the best theoretical thinking of the time.  Current adult education practice is just beginning to employ this knowledge, so unfortunately, there is more redundant work and failed short term testing than meaningful listening, synthesis, prototyping and iteration. The games and environments described below, based on the principles and models described on the learning design page and in my other writings on learning, synthesize this knowledge and create processes rich with inspirational experiences and quantitative and qualitative data fundamental to education innovation.


Games

Medicine in a Box (MIAB) A core product that forms the basis for a high-value healthcare education. The conceptual boxes are both the key learning materials that can literally come in game boxes, as well as the digital and physical environments, in which the education takes place. MIAB is initially proposed as a series of authentic learning games that support high-volume deliberate practice in healthcare. They are a key component of a model for adult education founded on principles of high volume practice, psychological optimization and learner autonomy, and are conceptualized to provide delight, modularity, and ease-of-use in a variety of settings.

 

The problem Healthcare education is currently highly inefficient, toxically expensive and worst of all, generally suppresses curiosity, wonder, awe and the motivation to become disruptive life-long learners. The voices Students and faculty from multiple schools of medicine, as well as faculty, administrators, educational technologists and funders in education, patient care, and quality improvement. Additional research Childhood education literature, expertise and deliberate practice literature, organizational analysis literature. Synthesis Given educations challenges, what is the key first step to achieving a low-cost, high-quality health care education that inspires, while being efficient and effective? It needs to be easy to implement and provide a concrete product that can help faculty to communicate new learning design principles and rally support for education innovation. It should also provide meaningful data on student progress and program effectiveness, offer cost advantages, and train, at the minimum, at a non-inferior level to current methods based on existing assessment programs.

 

Prototype and iteration The project started with a new course curriculum and progressed to an online virtual clinic then to a physical game as we realized students learn best by high volume practice in intermittently social settings that enable cross level interactions. Authentic games provide assessment and feedback with real-world implications. They serve as low fidelity simulations, support informal collaboration, provide meaningful data-driven feedback and offer multiple learning opportunities.  Games will prove key components of future training environments and curricula. With them we demonstrate the power of inspiration, autonomy, and data driven feedback as precursors to mindfulness and quality deliberate practice.


This early whiteboard for the development of a series of surgical management and reasoning training experiences resulted in part from participating in the surgical clerkship at Stanford and talking with numerous residents, fellows, faculty and staff. Each box represents a game that will allow individuals to optimize their training. This ideation overview then propelled us back into the interview and definition phase for a deeper dive into Radiology and Surgical Reasoning games.

This early whiteboard for the development of a series of surgical management and reasoning training experiences resulted in part from participating in the surgical clerkship at Stanford and talking with numerous residents, fellows, faculty and staff. Each box represents a game that will allow individuals to optimize their training. This ideation overview then propelled us back into the interview and definition phase for a deeper dive into Radiology and Surgical Reasoning games.

Problem What are materials that will inspire and support quality deliberate practice, while decreasing cost and respect both teacher and student time?

Listening Four years of medical school gave me a chance to do an in depth, if informal, study of hundreds of students as we struggled to learn medicine as well as apply personal intuition from recent experience. From numerous interviews, the single favorite experience of Stanford medical students was the small group emergency medicine simulations. They were dynamic, chaotic, and engaging. More importantly, learning happened at an accelerated rate for everyone involved. Unfortunately, this experience was scheduled only once in four years due to cost constraints. Another favorite experience was the CPX exam, a half-day that used patient actors to simulate the clinic experience. While a stressful, type 2 fun, students came away from these situations saying things like, "If only I could do this weekly," and “I learned more here than my entire first two years.” Again, only once in four years. A key take away was that students were immediately inspired by both these experiences to do further work and learning.

 

Synthesis A low cost, automated approach to simulation is needed. An important realization from the definition phase of the design process was that the game mechanics and point system of the game must provide information about a real-world skill. Climbing gyms provided a good paradigm. By optimizing to different types and difficulties of climbs in a well-set gym, climbers can prepare for real-world outdoor climbing. The data is relevant. Games may or may not have that relevance. Tests as games, for the most part do, but are rarely used for self-assessment or are inspirational or fun. It would be our job to make sure that new learning games are fun, effective and authentic.

 

Additional listening As we turned toward games, we assessed existing materials, student and faculty requests, as well as played numerous board and card gamers to understand the intellectual and imaginative values players brought to bear and the value different games provided in terms of story telling, atmosphere, physical engagement and game mechanics.


Prototype An initial study for a card-based radiology game.

 

Outcome Ongoing. From the beginning work on this individual game, the concept of lo-fi, lo-tech simulation emerged as a large cost win. When we realized that we could develop paper based games prior to digitizing, we created all the benefits of a tactile and social experience with none of the drawn out development time and costs associated with software. It has also become apparent there are a large amount of legacy media that could be licensed to create such games.

 

Virtual clinic prototype faculty requested a design for a simple virtual clinic that would allow students to practice clinical reasoning.

Outcome served as a useful set of resources for communicating the idea of high-volume deliberate practice with data rich feedback and stands ready for future implementation.


Environments

A draft program for a two-story Medical Studio as a precision learning environment. It is a space ready for digitally enhanced collaborative learning and utilizes low cost and recyclable materials. It also provides open spaces informal interactions, smaller rooms for both lo-fi and higher fidelity simulation as well as variable seating, lighting, and projection technology; all to power the variety of use cases that will propel modern education. Erica Nobori, Min | Day Architects.

A draft program for a two-story Medical Studio as a precision learning environment. It is a space ready for digitally enhanced collaborative learning and utilizes low cost and recyclable materials. It also provides open spaces informal interactions, smaller rooms for both lo-fi and higher fidelity simulation as well as variable seating, lighting, and projection technology; all to power the variety of use cases that will propel modern education. Erica Nobori, Min | Day Architects.

Problem Current learning environments do not seem to support 21st century learning. Current healthcare training environments are not suited to autonomous, social, and individualized learning. Design Research Students are passive in lecture halls, are low energy with rooms with too many projection screens but without windows, are creatively stifled in spaces with low ceilings, are hushed or loud, interactive or distracted depending on acoustics. Theory supports the primary effect of environment on learning. Synthesis Teachers can best see their role as effecting the environment, such that, when students explore, they are learning. This concept is born out in numerous examples of fast paced learning such as climbing gyms and MMOGs (massively multiplayer online games) where learning is largely independent of a formal teacher. Ideation Along with updating the materials for learning, we need new spaces. In this, training gyms, design studios, early education spaces, and music schools are far superior to most adult learning spaces. The built environment must consider both the digital and physical. The two important aspects of the digital environment is a network of learning coaches of all levels that can be used efficiently and effectively. Learners in an autonomous learning environment must be able to access the necessary expertise in a timely manner, and experts must be used only as needed. The digital environment should also create zones of proximity between the various levels of expertise as they train, so there can be ongoing interaction and junior learners can “peer over the shoulder” of stronger practitioners. This takes place in the hospital environment, but should be an aspect of all training.

 

Combining Games and Environments: The Medical Studio

 

Need The world needs more and more broadly trained healthcare providers. A strong and growing healthcare workforce is critical to health outcomes as well as social, economic and political stability in developing and developed countries. It advances local economies and builds a stable middle class, returning initial investments many times over. Unfortunately, many places in the world lack the training capacity to supply an adequate health care workforce.

 

Simultaneously, the quality of US medical education has been stagnant. While the conditions have become more humane, there has been little change in the basic approach to medical education since the 2010 Flexner report.

 

Approach The solution to both problems is to build a network of medical education studios, i.e. precision learning environments, that can efficiently and effectively train new generations of doctors, nurses and associated healthcare providers. Advances in our understanding of learning, training and skill acquisition, improved learning technologies, increased access to computing, and assessment data-enabled regulatory compliance now make it possible to provide innovative and high quality healthcare education at low cost. A network of low-cost, efficient and high-quality education studios utilizing a technology enhanced, high volume, deliberate practice-based curriculum to educate the next generation of innovative and compassionate health care providers and grow the global healthcare workforce is now possible.

 

The Medical Studio represents a retooling of Maria Montessori’s classroom for the adult learner and is a lean and elegant education, designed from the ground up to meet the needs and demands of the 21st century learner and workforce by streamlining information delivery and quality improvement, increasing learning efficiency and making the highest quality education available anywhere there is need. From Stanford to Rosebud to Rwanda, these networked and modular studios could redefine individual and collaborative learning while ending disparities in access to the best possible healthcare education.