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4 Serious Games

Serious games usually refer to games developed for user training and education. In 2005 Stokes [3] defined serious games as: “games that are designed to entertain players as they educate, train, or change behaviour”. They are designed to run on personal computers or videogame consoles. Today they can be played also on smartphones.

Serious games provide an high fidelity simulation of particular environments and situations that focus on high level skills that are required in the real world. They present situations in a complex interactive context coupled with interactive elements that are designed to engage the trainees.

Strengths and weaknesses of videogames are also transferred to serious games. Further benefits of serious games include improved self-monitoring, problem recognition and solving, improved short-and long-term memory, increased social skills and increased self-efficacy [4].

In contrast to traditional teaching environments whereby the teacher controls the learning (teacher centered), the serious games present a learner centered approach to education in which the trainee controls the learning through interactivity.

Serious game engagement may allow the trainee-player to learn via an active, critical learning approach. Game-based learning provides a methodology to integrate game design concepts with instructional design techniques with the aim to enhance the educational experience.

Virtual environments and videogames offer students the opportunity to practice their skills and abilities within a safe learning environment, leading to a higher level of self-efficacy when faced with real life situations where such skills and knowledge are required.

Serious games should provide a balanced combination between challenge and learning. Playing the game must excite the user, while ensuring that the primary goal (acquiring knowledge or skills) is reached seemingly effortlessly, thus creating a 'stealth mode' of learning. Players are challenged to keep on playing to reach the game's objective.

Although game-based learning is becoming a new form of healthcare education, scientific research in this field is limited.

Dental Implant Training Simulation [11], developed for the Medical College of Georgia and funded through a grant by Nobel Biocare, is a groundbreaking project created to better teach and train dental school students and dental professionals on patient assessment and diagnosis protocol and to practice dental implant procedures in a realistic, 3D virtual environment. The game-based simulation has the aim to improve dental student learning outcomes in the area of diagnostics, decision-making and treatment protocols for enhanced patient therapy outcomes and risk management.

Total knee arthroplasty [12] is a commonly performed surgical procedure whereby knee joint surfaces are replaced with metal and polyethylene components that serve to function in the way that bone and cartilage previously had. The serious game has been designed to train orthopedic surgical residents on surgical procedures, and to gauge whether learning in an online serious gaming environment will enhance complex surgical skill acquisition.

Qin et al. [13] realized a serious game to train blood management in orthopaedic surgery context to orthopaedic surgeons. The serious game uses two haptic interface for the user interaction and comprises two practice games where the player develop the required hand-eye coordination using the haptic interface. In the third game the user play as a surgeon and three modality were provided: training mode, time-attack mode and collaborative mode. The game uses a Mass-Spring model for tissue deformation modeling and a blood flow distribution model based on human physiology.

Cowan et al. developed a serious game for off-pump coronary artery bypass grafting cardiac surgical procedure (OPCAB) training [14]. In the game the player is placed in the operating room with the role of cardiac surgeon and must execute surgical procedure.

Qin et al. presented another serious game [15] to train radiologist in the ultrasoundguided needle placement procedure. They used a block based construction scheme in order to generate game scenarios and a novel texture-based image synthesis technique in order to simulate corresponding ultrasound images. The game was evaluated over a group of 21 participants and this study shows that the serious game approach is useful for surgical skills teaching to surgical novices.

Serious gaming can be used to enhance surgical skills. Ideally, these training instruments are used to measure certain parameters and to assess the trainees' performance. In these games, strict requirements should be met and the interpretation of the game metrics must be reliable and valid. Games used to train medical professionals need to be validated before they are integrated into teaching methods and applied to surgical training curricula [17].

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