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Serious game development involves a multidisciplinary team of teachers and computer scientists. But the difference in computer competencies between the team members is a recurring difficulty in this collaboration. Authoring tools, which provide interfaces adapted to users' competencies, are promising solutions to overcome this difficulty. However, existing authoring tools are either limited in their functionalities (not powerful) or too complex for non-computer scientists (not usable). A comprehensive set of design principles to address this limitation does not yet exist. The objective of this research was to define a set of design principles for the development of powerful and usable authoring tools. To achieve this objective, we first defined a set of design principles. We then developed an authoring tool corresponding to these principles. Finally, we carried out test uses of that tool through the development of twelve serious games. Results show that this authoring tool enabled the development of a wide variety of serious games (powerful) by teams with heterogeneous computer skills (usable). Design principles defined in this research integrate and extend previous works. They allow to overcome the dilemma between the power and usability of authoring tools. This could unlock new possibilities for collaborative approaches in serious games developments.

Background: Emergency room nurse triage entails complex clinical decision making under stress and time constraints. Workplace distractors, such as noise and task interruptions, have been pointed to as possible reasons for triage inaccuracy, though studies have not borne this out. To train nurses to perform the task, a serious game was developed to simulate the triage process and environment. A pilot study was undertaken to evaluate the acceptability and feasibility of the serious game and to collect preliminary data on the effects of two distractors—noise and task interruptions—on emergency room nurse triage accuracy. Methods: A 2 × 2 factorial randomized controlled trial was designed for the study. A sample of 70 emergency room nurses was randomly assigned to four groups: three experimental groups exposed to different distractors (noise, task interruptions, and both) and one control group exposed to none. The nurses in each group had two hours to complete a series of 20 clinical vignettes where they had to establish a chief complaint and assign an emergency level. Their responses were then compared against a gold standard predetermined by experts. Results: Among 70, 55 nurses completed about 15 vignettes each in the allotted time. No inter-group differences emerged in terms of triage performance. Only a few minor technical issues arose during the sessions. Nurses had a very favorable appreciation of the serious game on triage as measured through a semantic differential scale. Conclusions: Results show that both the structure of our study and the serious game on triage can be used to carry out a future RCT on a larger scale. Two minor technical bugs were identified and corrected, the series of vignettes to complete in two hours must be shortened to 15, and the test should be held during work hours to support recruitment and reduce the possible impact of nurse fatigue on triage performance. The absence of a distractor effect raises questions about whether distractors have an effect and at what frequency and intensity of noise and task interruptions might have an impact on triage performance and whether this dose is realistic.

While many studies have been published about project management serious games, most of them mainly describe characteristics and features of the games themselves. In those studies, little is found on the pedagogical imple- mentation of serious games and on how they have impacted project management education. In this article, we both discuss how serious games have impacted project management education and how they are implemented from a pedagogical perspective. We used an empirical research approach, based on qualitative observations. Observations included authors’ own usages of a project management serious game (the PM-Game) com- plemented with a synthesis of 10 years of observations and discussions with other teachers who had used this same PM-Game. Results showed that serious games may lead to educational changes such as moving toward active pedagogies, developing new competencies such as soft skills, and changing teachers-students relationship. For the pedagogical implementation, results showed that the serious game was implemented as an integrated concept including hybrid simulation modalities, and combining virtual and augmented learning aspects. In conclusion, serious games have the potential to trigger a change in project management education. But to fully benefit from the potential advantages of this change, they have to be designed, developed and implemented as an integrated gaming and learning concept.

BACKGROUND Multidisciplinary collaboration is essential to the successful development of serious games, albeit difficult to achieve. In a previous study, the co.LAB serious game design framework was created to support collaboration within serious game multidisciplinary design teams. Its use has not yet been validated in a real usage context. OBJECTIVE The objective of this study was to perform a first assessment of the impact of the co.LAB framework on collaboration within multidisciplinary teams during serious game design and development. METHODS A mixed methods study was conducted, based on 2 serious game design projects in which the co.LAB framework was used. The first phase was qualitative and carried out using a general inductive approach. To this end, all members of the first serious game project team who used the co.LAB framework were invited to take part in a focus group session (n=6). In a second phase, results inferred from qualitative data were used to define a quantitative instrument (questionnaire) that was designed according to the Checklist for Reporting Results of Internet E-Surveys. Members of both project teams (n=11) were then asked to answer the questionnaire. Quantitative results were reported as median (Q1, Q3), and appropriate nonparametric tests were used to assess between-group differences. Finally, results gathered through the qualitative and quantitative phases were integrated. RESULTS In both phases, the participation rate was 100% (6/6 and 11/11). Verbatim transcripts were classified into 4 high level themes: (1) influence on collaborative dimensions; (2) impact on project course, monitoring, and efficiency; (3) qualitative perceptions of the framework; and (4) influence of team composition on the use of the framework. The web-based questionnaire was then developed according to the 7 dimensions of collaboration by Burkhardt et al. In both projects, the co.LAB framework had a positive impact on most dimensions of collaboration during the multidisciplinary design and development of serious games. When all collaborative dimensions were aggregated, the overall impact of the framework was rated on a scale from –42 to 42 (very negative to very positive). The overall median score was 23 (Q1, Q3: 20, 27), with no significant difference between groups (P=.58). Most respondents also believed that all serious game design teams should include a member possessing significant expertise in serious game design to guide the development process. CONCLUSIONS The co.LAB framework had a positive impact on collaboration within serious game design and development teams. However, expert guidance seems necessary to maximize development efficiency. Whether such guidance can be provided by means of a collaborative web platform remains to be determined.

The knowledge and the implementation of patients' rights are fundamental in health professional practices. Courses for healthcare students are often taught using a lecture format. Yet, students find it difficult to understand the importance of legal concepts and apply it to their future practice. In order to promote learner centered teaching practices and encourage knowledge acquisition and practical skills development, the “Patient's Rights & Innovative Teaching Strategy (PRITS)” project aimed at developing a serious game dedicated to patients' rights education. To design and develop this serious game and the associated learning concept, we set up a multidisciplinary team of experts from the fields of healthcare, law, education and engineering. A collaborative methodology was used to ensure the coherent development of all games and learning elements. The PRITS serious game integrates knowledge about patients' rights into dialogues with virtual patients. It also provides additional resources and exercises related to the topics. The learning experience intends to challenge students' mental models and support a transition from “quality of care only” to “quality of care and respect of patients' rights”.

BACKGROUND Serious games offer teachers the opportunity to create meaningful learning scenarios and are increasingly used at all levels of education. Designing efficient and engaging serious games is a difficult process which requires a collaborative approach. Many design frameworks have been described, most of which are dedicated to the development of specific types of serious games. OBJECTIVE Our aim was to create a general serious game design framework which could be adapted to all kinds of serious games and implemented in a collaborative web platform. METHODS We combined the results of a literature review with our experience in serious game development to determine the basic building blocks of a design framework. We then organized these building blocks into categories and determined the features that a generic design framework should include. Finally, based on the paradigm of complex systems and systemic modelling, we created the co.LAB generic design framework and specifications to allow its implementation in a collaborative web platform. RESULTS Based on a total of 10 existing design methodologies or frameworks, 23 building blocks were identified and represent the foundation of the co.LAB framework. These blocks were organized into five categories: "context and objectives", "game design", "mechanics", "learning design" and "assessment". The arrangement by categories provides a structure which can be visualized in multiple and complementary ways. The classical view links game and learning design while other views offer project, systemic and process visualizations. For the implementation of the co.LAB framework in a web platform, we propose to convert the building blocks into “cards”. Each card would constitute a collaborative working space for the design of the corresponding block. To make the framework adaptive, cards could be added, adapted or removed according to the kind of serious game intended. Enhancing the visualization of relationships between cards should support a systemic implementation of the framework. CONCLUSIONS By offering a structured view of the fundamental design elements required to create serious games, the co.LAB framework can facilitate the design and development of such games by virtue of a collaborative, adaptive and systemic approach. The different visualizations of the building blocks should allow for a shared understanding and a consistent approach throughout the design and development process. The implementation of the co.LAB framework in a collaborative web platform should now be performed and its actual usability and effectiveness tested.

Background: Patient safety is a top priority of the health professions. In emergency departments, the clinical decision making of triage nurses must be of the highest reliability. However, studies have repeatedly found that nurses over- or undertriage a considerable portion of cases, which can have major consequences for patient management. Among the factors that might explain this inaccuracy, workplace distractors have been pointed to without ever being the focus of specific investigation, owing in particular to the challenge of assessing them in care settings. Consequently, the use of a serious game reproducing a work environment comprising distractors would afford a unique opportunity to explore their impact on the quality of nurse emergency triage. Methods/Design : A factorial design will be used to test the acceptability and feasibility of a serious game created to explore the primary effects of distractors on emergency nurse triage accuracy. A sample of 80 emergency nurses will be randomised across three experimental groups exposed to different distractor conditions and one control group not exposed to distractors. Specifically, experimental group A will be exposed to noise distractors only; experimental group B to task interruptions only; and experimental group C to both types combined. Each group will engage in the serious game to complete 20 clinical vignettes in two hours. For each clinical vignette, a gold standard will be determined by experts. Pre-tests will be planned with clinicians and specialised emergency nurses to examine their interaction with the first version of the serious game. Discussion : This study will shed light on the acceptability and feasibility of a serious game in the field of emergency triage. It will also advance knowledge of the possible effects of exposure to common environmental distractors on nurse triage accuracy. Finally, this pilot study will inform planned large-scale studies of emergency nurse practice using serious games.

At patient intake in emergency departments, triage is a key step in ensuring optimal patient care and good use of hospital resources. Triage nurses must be able to make correct clinical judgements and triage decisions despite extremely stressful working conditions including noise and task interruptions. This article presents a new serious game designed to closely reproduce the conditions of a typical emergency department. Its purpose is to provide a generic testbed both for teaching and for research, notably in order to enable studying the impact of stressors on the quality of decisions made. A study involving 49 professional triage nurses shows that, despite its relatively modest technological requirements, this serious game is considered by the participants as highly attractive and very close to their professional experience.

In the last decade, the use of serious games as a teaching and learning tool has steadily increased in many disciplines. Nevertheless, serious games are still facing crucial challenges, such as their integration in the global learning process. On the other hand, with the increased adoption of online applications and courses, it is becoming possible to collect and centralize large amounts of trace data generated by players. Such data may be used to produce statistics on students’ behaviors inside pedagogical serious games, both as individuals and aggregated as groups (e.g., classrooms). In this paper we propose a classification of potential uses of statistics in serious games and give new insights into how statistical analysis of groups’ behavior may impact positively on the learning process. We also present experimental results obtained during a large-scale game deployment using the Wegas platform, our open source platform for game authoring and execution.

In the last decades, Natural Language Processing (NLP) has obtained a high level of success. Interactions between NLP and Serious Games have started and some of them already include NLP techniques. The objectives of this paper are twofold: on the one hand, providing a simple framework to enable analysis of potential uses of NLP in Serious Games and, on the other hand, applying the NLP framework to existing Serious Games and giving an overview of the use of NLP in pedagogical Serious Games. In this paper we present 11 serious games exploiting NLP techniques. We present them systematically, according to the following structure: first, we highlight possible uses of NLP techniques in Serious Games, second, we describe the type of NLP implemented in the each specific Serious Game and, third, we provide a link to possible purposes of use for the different actors interacting in the Serious Game.