Abstract:

Background:
Games can be highly absorbing: by definition, people who play them have chosen to try to overcome unnecessary obstacles in order to achieve uncertain outcomes. The attributes of digital games that generate this behaviour are of considerable interest to educators, because the motivation to play and to persist in trying to improve scores that is characteristic of game-playing is rarely found in digital learning. It is assumed that incorporating game features into digital learning will improve engagement, but there is little empirical support for this claim. No conclusions about the effectiveness of game-based learning could be drawn from at least three recent, published systematic reviews, and most primary studies are under-theorised.

Methods and Results:
Design research is promoted as a method to test and build theory while developing learning materials. We report the use of design research to build and analyse a learning game that was designed to support the development of clinical reasoning skills in senior medical students transitioning to professional practice. The design passed through three iterations, using two different platforms and basing the design of new prototypes on user feedback from the previous iteration. The last iteration used interactive story telling software to develop a small html file that could be opened in a browser without the need for log-ins. The story telling software allowed the development of quite complicated branching scenarios, and the game attributes of meaningful choice, safe failure, the development of a valued identity, and learning in the zone of proximal development were successfully instantiated. The two cognitive processes of clinical reasoning: generating a shortlist of reasonable hypotheses and then adjudicating between options, were also represented in the final iteration. However, while a small number of incentivised research participants found the game realistic and offered glowing feedback, no potential user engaged with the game outside the research setting.

Conclusions:
Our work did not support the argument that learning games increase engagement and it raised questions about the perceived value of new medical student learning apps in an already crowded market. Design research is promoted as a method that builds theory during a design process, but quite how theory should be built is debated. In practice, we found that design research has limited potential to build theory because it is not powered to test links between individual design features, mechanisms and outcomes. This means that it can only determine that a design works in a particular context, not how it works and this limits the transferability of findings.

Keywords:

Game-based learning, Design Research, Medical Students.