Background: Although gamification increases user engagement, its effectiveness in point-of-care ultrasonographic training has yet to be fully established. This study was conducted with the primary outcome of evaluating its effectiveness in point-of-care ultrasonographic training as compared to conventional approach. Methods: Participants consisting of junior doctors were randomized into either the (1) gamified or the (2) conventional educational approach for ultrasonographic training. Results: A total of 31 junior doctors participated in this study (16 participants in gamified arm, 15 in the conventional arm after one participant from the conventional arm dropped out due to work commitment). Twoway mixed ANOVA test showed that there was no statistically significant interaction between the types of educational approach and time of testing (pre-test, post-test, 2 months post-training) for both theoretical knowledge score and practical skills score, with F(2, 58) = 39.6, p < 0.001, partial η 2 = 0.4 and F(2, 58) = 3.06, p = 0.06, partial η 2 = 0.095, respectively. For theoretical knowledge score, pairwise comparisons showed that the mean 2 months post-training scores (20.28 +/− 0.70, 95% CI 18.87-21.69) and mean post-test scores (20.27 +/− 0.65, 95% CI 18.94-21.60) were better than the pre-test scores (12.99 +/− 0.50, 95% CI 11.97-14.00) with p-values < 0.001 for both comparisons respectively. Similarly, for practical skill score, pairwise comparisons showed that the mean 2 months post-training scores (20.28 +/− 0.70, 95% CI 18.87-21.69) and mean post-test scores (20.27 +/− 0.65, 95% CI 18.94-21.60) were also better than the pre-test scores (12.99 +/− 0.50, 95% CI 11.97-14.00) with p-values < 0.001 for both comparisons respectively. Participants in the gamification arm generally perceived the various game elements and game mechanics as useful in contributing and motivating them to learn ultrasonography. Conclusions: Gamification approach could be an effective alternative to conventional approach in point-of-care ultrasonographic training.

Background: Pain is a leading cause of visits to any emergency department (ED) and a large percentage of it is primarily caused by musculoskeletal trauma, however there has been a lack of use of analgesia in a large proportion of these patients. Tramadol is a common choice among emergency residents due to the rare incidence of respiratory depression during its administration, low incidence of cardiac depression, and the incidence of dizziness and drowsiness is lower than when morphine is administered. We aim to determine whether subcutaneous tramadol administration has a lower incidence of adverse events and pain score associated with administration in comparison to intravenous tramadol. Methods: Single-center randomized parallel group trial of subcutaneous (S/C) versus intravenous (IV) tramadol as analgesia for extremities injuries with moderate pain. Both groups received a single dose of 50 mg tramadol and reassessed at 15, 30, 45, 60 minutes. Results: A total of 232 patients were studied, and divided into group A (IV tramadol) and group B (S/C) (). There was higher incidence of adverse events in the IV group at 0, 15 and 30 minutes of administration and higher mean pain score associated with administration in the IV group. These adverse effects include nausea, vomiting, giddiness, dizziness, and allergic reactions. The total number of patients developing adverse effects was 34 of 112 patients in the intravenous group as compared to 14 of 120 patients in the subcutaneous group (). Conclusion: S/C tramadol has less adverse effects and causes less pain as compared to IV tramadol in managing moderate pain with extremities injuries and could be considered for pain relief in mass casualty incidents.

Background: Although gamification increases user engagement, its effectiveness in point-of-care ultrasound training may yet to be fully established. This study was conducted with the primary outcome of evaluating its effectiveness in point-of-care ultrasound training workshop as compared to conventional face-to-face learning. Methods: Participants (who were junior doctors between 2 – 4 years of clinical experience) were randomized into either the (1) gamification or the (2) face-to-face learning arms. Similar educational intervention was implemented to participants in both arms but the in-gamification arm, the theory assessment was administered in the form of live quizzes with real time leaderboards, and the practical assessment was administered in the form of 3 games, i.e., ultrasound minefield, ultrasound pong and ultrasound game. Pre-test, post-test and 2 months post-training theory and practical assessments were conducted. Results: A total 32 junior doctors participated in this study (16 participants in each arm). For theory assessment, paired student’s t-test showed significant improvement in both face-to-face learning (pre-test score: 12.38 vs post-test score: 19.88; 95% CI [5.35, 9.65] p < 0.001) and gamification arms (pre-test score: 13.38 vs post-test score: 20.81; 95% CI [5.93, 8.94] p < 0.001). For the practical assessment, paired student’s t-test showed significant improvement in gamification arm (pre-test score: 12.56 vs post-test score: 18.13; 95% CI [2.44, 8.69] p<0.001) but not the in the face-to-face learning arm (pre-test score: 16.00 vs post-test score: 18.38; 95% CI [-0.17, 4.92] p<0.065). When re-tested 2 months post-training, both face-to-face learning and gamification arms showed significant improvement for both theory and practical assessment. Conclusions: Gamification approach could be an effective alternative or more effective than face-to-face learning in point-of-care ultrasound training.

Background: Although gamification increases user engagement, its effectiveness in point-of-care ultrasonographic training has yet to be fully established. This study was conducted with the primary outcome of evaluating its effectiveness in point-of-care ultrasonographic training as compared to conventional approach. Methods: Participants consisting of junior doctors were randomized into either the (1) gamified or the (2) conventional educational approach for ultrasonographic training. Results: A total of 31 junior doctors participated in this study (16 participants in gamified arm, 15 in the conventional arm after one participant from the conventional arm dropped out due to work commitment). Two-way mixed ANOVA test showed that there was no statistically significant interaction between the types of educational approach and time of testing (pre-test, post-test, 2 months post-training) for both theoretical knowledge score and practical skills score, with F(2, 58) = 39.6, p < 0.001, partial η2 = 0.4 and F(2, 58) = 3.06, p = 0.06, partial η2 = 0.095, respectively. For theoretical knowledge score, pairwise comparisons showed that the mean 2 months post-training scores (20.28 +/- 0.70, 95% CI 18.87-21.69) and mean post-test scores (20.27 +/- 0.65, 95% CI 18.94-21.60) were better than the pre-test scores (12.99 +/-0.50, 95% CI 11.97-14.00) with p-values <0.001 for both comparisons respectively. Similarly, for practical skill score, pairwise comparisons showed that the mean 2 months post-training scores (20.28 +/- 0.70, 95% CI 18.87-21.69) and mean post-test scores (20.27 +/- 0.65, 95% CI 18.94-21.60) were also better than the pre-test scores (12.99 +/-0.50, 95% CI 11.97-14.00) with p-values <0.001 for both comparisons respectively. Participants in the gamification arm generally perceived the various game elements and game mechanics as useful in contributing and motivating them to learn ultrasonography.Conclusions: Gamification approach could be an effective alternative or more effective than face-to-face learning in point-of-care ultrasonographic training.