LIVE. DIE. REPEAT: a novel instructional method incorporating recursive objective-based gameplay in an emergency medicine simulation curriculum

Sunga, Kharmene L.; Sandefur, Benjamin J.; Asirvatham, Usha; Cabrera, Daniel

doi:10.1136/bmjstel-2016-000128

Cited by 4 publications

(6 citation statements)

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“…Simulation-based education (SBE) has been widely adopted as a learning method for health professional education and may also be enhanced by the integration of educational games - ‘an instructional method requiring the learner to participate in a competitive activity with preset rules’ 2. In their ‘Live.Die.Repeat’ (LDR) study, Sunga et al designed a simulation scenario that incorporated gameplay to teach the management of emergent pulmonary conditions to postgraduate emergency medicine trainees 1. The design was based on recursive objective-based gameplay—‘a serious-game scheme in which participants are allowed infinite lives so that they can achieve predetermined criteria for progression through multiple levels of increasing difficulty’ 1…”

Section: Introductionmentioning

confidence: 99%

“…In their ‘Live.Die.Repeat’ (LDR) study, Sunga et al designed a simulation scenario that incorporated gameplay to teach the management of emergent pulmonary conditions to postgraduate emergency medicine trainees 1. The design was based on recursive objective-based gameplay—‘a serious-game scheme in which participants are allowed infinite lives so that they can achieve predetermined criteria for progression through multiple levels of increasing difficulty’ 1…”

Section: Introductionmentioning

confidence: 99%

“…The ‘Live.Die.Repeat’ (LDR) format for simulation-based education (SBE) involves repetition of scenario segments until adequate learner performance is achieved and emphasises repetitive practice over prolonged postscenario reflective debriefing 1. We incorporated the LDR format into our medical student simulations and suggest that it can be a useful element in a programmatic simulation curriculum, with appropriate preparation for learners and faculty.…”

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confidence: 99%

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‘Live Die Repeat’ simulation for medical students

2019

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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‘Live Die Repeat’ simulation for medical students

2019

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“…Previously, it was unknown whether LDR, which was developed with the explicit aim to teach procedural and intervention-based resuscitation, would be applicable in a palliative end-of-life care situation. Sunga et al [ 12 ] evaluated the effectiveness of LDR and found the format achieved level 1 using the Kirkpatrick Model for evaluation of training methods, indicating learners found the gaming simulation format engaging and relevant. This was thought to be due to multiple factors such as gamification qualities, inherently fatalistic approach alleviating learner self-doubt, and opportunity for stress inoculation and deliberate practice [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…The short debriefings are intended to provide performance feedback and offer an immediate opportunity to apply the concepts learned during the debriefing. This integrates the idea of deliberate practice, an established method to achieve superior performance through recognition of defined measurement standards, rote experience, analysis of behaviors, and repetition of skills [ 10 , 12 ]. A critical aspect of the LDR framework is the usage of Kolb experiential model loops intertwined between the levels and the debriefing [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Teaching Palliative Care to Emergency Medicine Residents Using Gamified Deliberate Practice-Based Simulation: Palliative Gaming Simulation Study

Stanich¹,

Sunga²,

Loprinzi-Brauer³

et al. 2023

JMIR Med Educ

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Background Emergency departments (EDs) care for many patients nearing the end of life with advanced serious illnesses. Simulation training offers an opportunity to teach physicians the interpersonal skills required to manage end-of-life care. Objective We hypothesized a gaming simulation of an imminently dying patient using the LIVE. DIE. REPEAT (LDR) format, would be perceived as an effective method to teach end-of-life communication and palliative care management skills. Methods This was a gaming simulation replicating the experience of caring for a dying patient with advanced serious illness in the ED. The scenario involved a patient with pancreatic cancer presenting with sepsis and respiratory distress, with a previously established goal of comfort care. The gaming simulation game was divided into 4 stages, and at each level, learners were tasked with completing 1 critical action. The gaming simulation was designed using the LDR serious game scheme in which learners are allowed infinite opportunities to progress through defined stages depicting a single patient scenario. If learners successfully complete the predetermined critical actions of each stage, the game is paused, and there is a debriefing to reinforce knowledge or skills before progressing to the next stage of the gaming simulation. Conversely, if learners do not achieve the critical actions, the game is over, and learners undergo debriefing before repeating the failed stage with an immediate transition into the next. We used the Simulation Effectiveness Tool–Modified survey to evaluate perceived effectiveness in teaching end-of-life management. Results Eighty percent (16/20) of residents completed the Simulation Effectiveness Tool–Modified survey, and nearly 100% (20/20) either strongly or somewhat agreed that the gaming simulation improved their skills and confidence at the end of life in the following dimensions: (1) better prepared to respond to changes in condition, (2) more confident in assessment skills, (3) teaching patients, (4) reporting to the health care team, (5) empowered to make clinical decisions, and (6) able to prioritize care and interventions. All residents felt the debriefing contributed to learning and provided opportunities to self-reflect. All strongly or somewhat agree that they felt better prepared to respond to changes in the patient’s condition, had a better understanding of pathophysiology, were more confident on their assessment skills, and had a better understanding of the medications and therapies after the gaming simulation. A total of 88% (14/16) of them feel more empowered to make clinical decisions. After completing the gaming simulation, 88% (14/16) of residents strongly agreed that they would feel more confident communicating with a patient and prioritizing care interventions in this context. Conclusions This palliative gaming simulation using the LDR format was perceived by resident physicians to improve confidence in end-of-life communication and palliative care management.

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Live, die, repeat: a simulation-based education perspective. Comment on Br J Anaesth 2022; 129: e12–e13

Aldridge

Purdell-Lewis

2022

British Journal of Anaesthesia

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LIVE. DIE. REPEAT: a novel instructional method incorporating recursive objective-based gameplay in an emergency medicine simulation curriculum

Cited by 4 publications

References 4 publications

‘Live Die Repeat’ simulation for medical students

‘Live Die Repeat’ simulation for medical students

Teaching Palliative Care to Emergency Medicine Residents Using Gamified Deliberate Practice-Based Simulation: Palliative Gaming Simulation Study

Live, die, repeat: a simulation-based education perspective. Comment on Br J Anaesth 2022; 129: e12–e13

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