The validation of a serious game for teaching ultrasound skills

In total, 18 Experts and 24 novices were included, of which the demographics are shown in Table 1.

Table 1 Demographics of participants

Participants played the same level of the game, representing the same hiding places and number of coins. Due to technical failure of equipment, three participants were unable to finish the game and one participant stopped due to inability to collect the fifth coin. All participants completed the questionnaire.

Content validity

In general, participants were positive about the serious game (Table 2).

Table 2 Content validity of the serious game “UnderWater”

The purpose of the game was clear, it was fun to play, and also challenging. The majority felt skillful while playing the game, which suggests that handling the controller is easy to learn. Participants were able to make suggestions for improvement of the game through open questions. One important improvement in the game design could be that the cursor in the game field holds its position if the probe is lifted from the tablet instead of centering it. In addition, the game is probably not challenging enough if played for a longer time period. This may be addressed by adding several levels in the future or other gaming elements instead of collecting coins. Some participants got frustrated if they were not able to collect a coin. The game design may help by adding tips or the possibility to proceed to the next coin without collecting the difficult one.

Face validity

The majority of participants indicated that the 3D-printed game probe feels realistic compared to a real ultrasound probe and that the movement of the probe resembles the movement in real life practice including the movement of the cursor on the screen (Table 3).

Table 3 Face validity of the serious game “UnderWater”

This means that making a specific movement with the probe and thereby moving the cursor in a specific direction, resembles the same way of “looking around” with real ultrasound movements. The game probe is ergonomically comparable with the real probe. Participants highly value the potential of the game for training eye–hand coordination and stability of probe handling, two very important skills in performing ultrasound in real practice. However, following the results of the open questions, the design of the game probe needs improvement: it should be made more realistic. This means increasing its weight compared to a real probe and providing a better and larger contact area of the probe with the tablet. In addition, a direction marker on the probe would be useful to make it resembling real-life probes.

Construct validity

Several parameters were calculated during the game, including total time played, average number of attempts per coin, time spent in bubble, probe distance, probe speed, loss of contact from tablet, and final score. Only time spent in bubble (cursor is in vicinity of the coin and coin is visible for participant) was slightly lower in the novices group (Table 4) but this difference disappears when adjusting for total playing time. Other parameters were not significantly different.

Table 4 Construct validity of the serious game “UnderWater”Educational tool

We asked the participants what parts of the game, probe or scores they thought were crucial for using the game “UnderWater” as an educational tool. A substantial portion of the participants (40%) had no specific opinion, but for the others most items were crucial or at least useful. Most participants valued this game as an educational tool, especially for evaluating and training probe-handling (Table 5).

Table 5 “UnderWater” as an educational tool

They indicate this may be a cost-effective alternative to traditional bedside teaching. For example, the use of obstacles, searching for coins to challenge probe movements, and calculating scores compared to the ideal path were most valued (Table 6).

Table 6 Crucial elements of the serious game “UnderWater” according to experts

Using probe speed or probe distance was considered least important as a scoring item and lifting of the probe from the tablet. Finally, the experts stated that the game is best used prior to bedside teaching or concurrent with bedside teaching and especially suited for novices. Only one participant felt this game is of little added value.

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