Bradley Tanner, President, Clinical Tools Inc. This presentation was given at the 2016 Serious Play Conference, hosted by the UNC Kenan-Flagler Business School. The talk highlights how educators in the health sciences and health professions can successfully create and deploy branched-path learning and gamification elements. Attendees will gain practical advice on how create educational experiences that enhance interest and relevance and that target successful attainment of clinical skills.

1. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
©Clinical Tools, Inc. (ClinicalTools.com) 1 / 54
BRANCHED PATH LEARNING
AND GAMIFICATION
for Student Training in Health and Medicine
T. Bradley Tanner, MD
(Clinical Tools, Inc. -
http://clinicaltools.com)
SERIOUS PLAY CONFERENCE 2016 | UNC, Chapel Hill, NC
http://docs.clinicaltools.com/conference/2016-SeriousPlay/SeriousPlayTalk-Tanner-2016-07-26-01bt.pdf

2. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
©Clinical Tools, Inc. (ClinicalTools.com) 2 / 54
C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
SUMMARY
The talk highlights how educators in the health sciences and
health professions can successfully create and deploy branched-
path learning and gamification elements. Attendees will gain
practical advice on how create educational experiences that
enhance interest and relevance and that target successful
attainment of clinical skills

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Objectives: The attendee will be able to:
 Apply knowledge of branched-path learning to
the process of creating an educational
experience for students in health science,
medical, and health professions.
 Identify elements of gamification that will
enhance learner interest and participation and
that match the needs of future clinical care.
 Calculate the challenge of creating an
educational experience using branched-path
learning and gamification so educators can
determine its appropriate use in their
organization

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Disclosure: About Me and Clinical Tools
Tanner: President of Clinical Tools Inc.,
Board Certified in Psychiatry and in Obesity
Medicine. Past stops at UVA, Pgh
Company: CTI is a small R&D company
located in Chapel Hill, NC specializing in
software and curriculum development

5. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
©Clinical Tools, Inc. (ClinicalTools.com) 5 / 54
C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
WHO ARE YOU
Health Care Provider
Health Care related employment

6. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
WHO ARE YOU
Health Care Provider
Health Care related employment
Care about Health Care
Provision?

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
The Need Vision and Goal
 Need: Do providers have all the skills they need?
 Can current education can fill in all those gaps?
 Vision: Together, branched-path learning and
gamification can create scalable and easily
alterable training for today’s and future health
and medical students
 Goal: Outline how we can best use the potential
of gamification to enhance the provision of health
care

8. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
WHY GAMES
Why is this talk not a game?

9. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
WHY GAMES
Why is this talk not a game?
Money?. $100K/40 minutes,
Time? 3 months

10. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
©Clinical Tools, Inc. (ClinicalTools.com) 10 / 54
C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
WHY GAMES
Why is this talk not a game?
Scalability: We need a huge audience to
justify that expense.
A marketplace to buy sell this lecture (think
android store/iphone store

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
OK. Let’s throw in some Gamification
 I'll go too fast.
 Too slow;
 Go backwords.
 Skip slides.
 Put some confusing slides with pictures that
make no sense.
 Create some hard to read slides with errors so we introduce
the "what is he trying to do?" game

12. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
THE ANATOMY COLORING BOOK
Games don't work?
Games have to be in sync?
Perhaps what (or how) we are
teaching is wrong?

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
How to implement: Cognitive
 Meeting a Greater Purpose Meaning.
Professionalism.
 Challenge;
 Competence: Task Accomplishment.
 ACGME Competencies: Personal Development.

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Cognitive: Challenge
 Games are hard.
 Anxiety is good ... when it isn't.
 Branched Paths.

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Cognitive: Challenge → Branched Path
 What are they?
 Development.
 Models. 3x3 model, 3x3x3, What about software
driven experience? AI?
 Use: Do people do more than one – 50/50? Use
is asymmetric. Clearly "wrong" paths are rarely
chosen - but is it worth it?
 Preference: Do users want points for successful
choices - No Feedback is enough (except
perhaps "patient health" points. Timed - yes,
adds realism. "hints" rarely - want this to be real

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
How to implement: Emotional
 Enabling Creativity and supporting Autonomy
 Social Connections - Health professional
students want a system that rewards
cooperation, improvement, and group success
 Failure NOT! - In medicine "Losing" often
means mortality or morbidity.
 Unpredictability and Variation

17. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
WHAT IS THE NEED?
“Clinical skills' training is arguably the weakest point in medical
schools' curriculum. We need to bring back into the medical
curriculum and clinical practice the art of observation, listening,
clinical reasoning, and focused and targeted clinical examination
of the patient.”
(Shelley BP. Wither clinical skills and humanism? . Arch Med Health Sci 2014;2:1-3)

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Case-Based Branched Learning
Problem: New medical education
standards require clinical skills training, but
lectures aren’t interactive and simulations
are expensive
Solution: Branched-learning scenarios
where students experience
Real-world environments
Outcomes of their decisions

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Simulated 3D Patient Interaction
Medical Education Training
Case-based branched learning
Case In Development Case Rendered In Tablet
App

20. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
©Clinical Tools, Inc. (ClinicalTools.com) 20 / 54
C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
SIMULATES A REAL WORLD
PATIENT ENCOUNTER

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Full Patient Encounter Presented
History
Physical Exam
Screening
Brief Interventions
Referral and
Treatment
Follow-Up

22. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
©Clinical Tools, Inc. (ClinicalTools.com) 22 / 54
C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
CREATED VIA BRANCHED
LEARNING TOOL

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Uses Online Case-Building Tool
 Cases written
online in Twine
framework
 Visual layout of
case available as
you go

24. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
©Clinical Tools, Inc. (ClinicalTools.com) 24 / 54
C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
CASE FILES TRANSLATED TO AN
INTERACTIVE APP
App Will be Available Free of Charge Initially!

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Inviting Visual Interface On App
 Students see rendering of patient on app
 Visual interface makes real-world connections

26. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
REALISTIC DIALOGUE
ENHANCES
COMMUNICATION SKILLS

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Simulated Patient Conversations
Models ideal conversation approaches
Emphasizes patient-centered treatment

28. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
USER CHOICES CREATE
INDIVIDUALIZED EXPERIENCE

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Multilevel Choice Pathways
 User choices lead to decision-outcomes
 Individualized experiences based on pathways

30. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
INTERACTIVITY: CHOICES
FEEDBACK

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Outcome Of Choices Explained
 Chapters end with summary of student choices
 Both ideal and non-ideal choices summarized

32. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
©Clinical Tools, Inc. (ClinicalTools.com) 32 / 54
C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
HOW CAN I LEARN MORE?

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C A S E - B A S E D B R A N C H E D L E A R N I N G F O R M E D I C A L S T U D E N T S
Branched Simulated Patient Interaction
Medical Education Training
Clinical Tools has over 20 years
experience in medical student and
continuing medical education training.
Fill out our survey on ClinicalTools.com
to keep up to date on our development!
Currently free of charge!
ClinicalTools.com
feedback@clinicaltools.com

34. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
©Clinical Tools, Inc. (ClinicalTools.com) 34 / 54
C E : C A S E B U I L D I N G E N G I N E
LET US INTRODUCE YOU TO
ANOTHER APPROACH TO CASE
SIMULATION….

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C E : C A S E B U I L D I N G E N G I N E
Clinical Encounter
Case Building Engine
Build cases
for a
simulation
app!
Developed by

36. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
©Clinical Tools, Inc. (ClinicalTools.com) 36 / 54
C E : C A S E B U I L D I N G E N G I N E
WHAT IS THE CASE BUILDING
ENGINE?

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C E : C A S E B U I L D I N G E N G I N E
Case Building Engine
What Does It Do?
 A tool to create cases for
clinical encounter simulation
 Uses an online form
 Renders in a clinical
simulation app
 App helps develop medical
skills
 Currently free of charge!
Internal page from clinical simulation app:

38. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C E : C A S E B U I L D I N G E N G I N E
WHAT ARE THE INTENDED
GOALS?

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C E : C A S E B U I L D I N G E N G I N E
Case Building Engine Goals
1)Create cases using Case
Building Engine
2)Share completed cases
with others
3)Learn by creating,
reviewing, interacting with
cases
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
— Goethe

40. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C E : C A S E B U I L D I N G E N G I N E
HOW DOES THE CASE
BUILDING ENGINE WORK?

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C E : C A S E B U I L D I N G E N G I N E
Users Create Cases for
App Using an Online Form
Online Webform Case App
For Skills Training

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C E : C A S E B U I L D I N G E N G I N E
Form Prompts You For Information
 History
 Evaluation
 Diagnosis
 Brief Interventions
 Referral and
Treatment
 Follow-Up

43. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C E : C A S E B U I L D I N G E N G I N E
HOW IS THE CASE RENDERED?

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C E : C A S E B U I L D I N G E N G I N E
In An Interactive App: Clinical Encounter
Developed by

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C E : C A S E B U I L D I N G E N G I N E
Multiple Completed Cases to Choose From

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C E : C A S E B U I L D I N G E N G I N E
Rendered in a Simulated EHR*
*EHR = Electronic Health Record

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C E : C A S E B U I L D I N G E N G I N E
Timer Increases Challenge of Game

48. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C E : C A S E B U I L D I N G E N G I N E
INTERACTIVITY:
CHOICES/FEEDBACK

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C E : C A S E B U I L D I N G E N G I N E
 Make Clinical
 Choices

 Get
 Feedback

50. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
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C E : C A S E B U I L D I N G E N G I N E
INTEGRATION INTO MEDICAL
EDUCATION

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C E : C A S E B U I L D I N G E N G I N E
Case Building Engine in the Classroom
We envision scenarios like this one:
Students use the Case Building Engine to
create cases about any of today’s most
common medical problems.
They work in pairs and come up with cases.
Then they share their cases with each other.

52. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
©Clinical Tools, Inc. (ClinicalTools.com) 52 / 54
C E : C A S E B U I L D I N G E N G I N E
HOW CAN I LEARN MORE?

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C E : C A S E B U I L D I N G E N G I N E
Clinical Encounter:
Case Building Engine
Clinical Tools has over
20 years experience in
medical student and
continuing medical
education training
Fill out our survey on
ClinicalTools.com to
keep up to date on our
development!

54. Funded by the NIH & NIAAA grants #1R43AA020456-01A1 and #2R44AA020456-02
©Clinical Tools, Inc. (ClinicalTools.com) 54 / 54
CASE-BASED BRANCHED LEARNING
FOR MEDICAL STUDENTS WITH 3D IMAGES
T. Bradley Tanner, MD (Clinical Tools, Inc.)
Serious Play Conference 2016
UNC, Chapel Hill, NC
Clinical Encounter: Alcohol (Branched Learning)
Clinical Encounter: Case Building Engine
More information available on ClinicalTools.com
THANK YOU!