Using Twine Open-Source Software to Create Serious and Entertaining Digital Games - Enhancing Doctor and Patient Management of Diabetes

Background: Diabetes management is a complex learning process for patients and an area of low confidence amongst junior doctors. Serious digital games allow healthcare professionals to simulate clinical interactions in a safe environment. Many facets of diabetes management, such as carbohydrate counting, also lend themselves to gamification. Our work utilises Twine open-source software to create digital games that facilitate patient and healthcare professional education in diabetes management. Method: Three serious digital games with virtual patients were developed using Twine open-source software, Wacom Intuous Pro, Autodesk SketchBook, Camtasia Studio, and simulated patient videos. Chalk-talk explanations of key concepts are integrated into these cases. A prototype was piloted by a small cohort of medical students and junior doctors and evaluated using the Kirkpatrick model. A detective-themed game was also developed using the aforementioned technology to enable diabetic patients to engage in aspects of management in a safe environment. Results: Pilots with senior medical students and junior doctors have demonstrated high levels of engagement, as well as significant improvements in confidence and knowledge (p<0.05). Larger cohort analysis will subsequently be performed, with a view to incorporating games into undergraduate and postgraduate curriculums. The utility of our patient-orientated game will be tested in a similar way. Conclusion: Twine software can be used to create serious digital games that enhance the confidence and knowledge of medical students and junior doctors in diabetes management. It may also represent an opportunity to create games that enable patients to practise diabetes management in a safe and engaging environment.