Twine Open-Source Software as a Tool for Creating Serious Digital Games with Virtual Patient’s - Enhancing Undergraduate and Postgraduate Diabetes Education

Background Serious digital gaming, whereby clinical interactions are virtually played through by the user, is an evolving way of engaging healthcare professionals to learn in a safe environment. Using Twine opensource software, we created and piloted three games aimed at teaching undergraduates and postgraduates about diabetes acute care, which is an area of low confidence among junior doctors. Method Three digital games with virtual patients were developed using Twine open-source software, Wacom Intuous Pro, Camtasia Studio, Autodesk SketchBook, and simulated patient videos. Scenarios are played from presentation to resolution, with integrated chalk-talk explanations of important concepts. The scenarios reinforce themes of multi-professional care, multi-morbidity, poly-pharmacy, and safe insulin prescribing. A prototype was piloted by a small cohort of senior medical students and junior doctors and evaluated using levels one and two of the Kirkpatrick Model. Results Initial pilots with undergraduates and postgraduates have demonstrated high levels of engagement, acceptability, and overall satisfaction, as well as significant improvements in confidence and knowledge (p<0.05). Building on these pilot studies will involve testing the utility of our game in a larger cohort, as well as exploring cognitive load in individual and group-based settings. Conclusions Our pilot testing suggests that this novel pedagogical approach is acceptable, encourages user engagement, and increases levels of confidence and knowledge in acute diabetes care. Creating a Twine blueprint for virtual patient scenarios may be a way of easily integrating them into the undergraduate and postgraduate medical curricula to create safe, engaging, and realistic learning opportunities.