Game-based assessment of first aid and resuscitation skills

Abstract

Aim

Effective assessment of motor skills in large-size classes is a challenge in medical education. This case-study investigates whether a game can be considered a valid tool for the summative assessment of first aid and basic life support skills.

Methods

Using a traditional exam as bench-mark, a board game format was experimentally trialed to assess students’ competency after taking a first aid course. Fifty-five students were randomly assigned to two groups. Two assessments, a game-based assessment and a traditional test, consisting of a paper-and-pencil test in combination with a skill assessment, were applied to both groups in opposite order. In both formats students acted as judges of other students’ efforts. In the game, the student's outcome was equal to the number of cards collected by answering questions correctly as deemed by peers. Similarities between both assessment types included individual testing, type of assessor (peers), content, type of questions and demonstrations, and the use of checklists for skill assessment. The assessment methods differed in format (written or oral test, both in combination with skill assessment) and feedback availability.

Results

Both groups performed equally in the game-based assessment as well as in the traditional test, in spite of the opposite order of the assessments. No significant difference was found between the mean scores on the game-based assessment and the traditional test.

Conclusions

These data suggest that use of a game format for assessment purposes may provide an effective means of assessing students’ competence at the end of a practical course.

Introduction

Most cardiac arrests occur outside the hospital setting where, in most cases, the general public will be responsible for providing initial basic life support (BLS). Incorporating BLS training in the school curriculum would maximize the number of potential cardiopulmonary resuscitation (CPR) providers in the community.1, 2, 3, 4, 5 Studies have shown that teachers are able to train pupils successfully in CPR.⁶ With this in mind, training the whole school population can be considered a feasible option for disseminating the importance of acquiring CPR skills.

In designing a first aid training, one major challenge is the assessment of competency (knowledge, skills and attitudes (KSA)). Testing technical skills requires methods and assessment instruments that are somewhat different than those used for cognitive skills.7, 8 Regarding the assessment of technical skills, simulations – manikin simulations,⁹ standardized patient simulations10, 11 and computer-based simulations¹² – are increasingly being used in medical education to ensure that examinees can demonstrate integration of prerequisite KSA in a realistic setting.¹³ However, a major drawback of computer-based simulations is that in most cases they do not provide the opportunity to conduct a real physical examination or demonstrate motor skills, such as first aid.14, 15 Complex manikins are used to realistically simulate clinical cases, but here users are restricted to conducting physical examinations other than those for which the manikins are designed for.¹⁶ Specially trained actors – referred to as “Standardized Patient” (SP) – portray patients with particular health concerns and are able to answer the full spectrum of questions about their condition.¹⁷ However, because of the high costs for training, students are not exposed to a large number of cases and the encounters are often only used for summative assessment and not as formative learning activities.¹⁸ As a consequence, alternative training and assessment methods that are economically and logistically feasible need to be explored.

Peer assessment is a process wherein peers evaluate each other's work, usually along with, or in place of, an expert marker.¹⁹ Peer assessment can be used as a tool for social control, for assessment, for active participation, as learning aid for how to assess.²⁰

Using peer assessment has potential benefits for the assessee and the assessor, for instance sharing the observation or reading burden among multiple assessors since students are considered to be ‘surrogate’ or ‘assistant’ teachers.²¹ Concerns however exist on the validity and reliability of peer-generated grades. Over 70% of the studies find the reliability and the validity of the peer assessment adequate as compared to expert graders,22, 23 whereas a minority find them variable.19, 24 Nevertheless, several studies conclude that concerns about peer evaluation reliability and validity should not be a barrier to implementing peer evaluations, provided that appropriate scaffolds are applied, e.g. providing guidelines, checklists, or other tangible scaffolding to students, introducing decision making by teams instead of individual peers, etc.24, 25, 26, 27

Peer assessment can also prove to be helpful in terms of providing feedback. Peer feedback can confirm existing information, add new information, identify errors, correct errors, improve conditional application of information, and aid the wider restructuring of theoretical schemata.²⁸ Although peers are not experts in the domain, their feedback can be a trade-off against expertise in terms of being understandable, timely, frequent, extended, individualized and reassuring.²⁹

In general, summative assessment induces a high degree of stress/anxiety, which may have debilitating health, emotional and educational effects.³⁰ To overcome these issues game approaches may be used. Games are interactive, motivating and challenging.26, 31 They provide an opportunity to integrate and demonstrate knowledge and skills, and they give direct feedback. To date, researchers tend to concentrate on the use of games to enhance student learning and delivery of courses.32, 33, 34 Studies have been focused on using games as formative assessment instruments.³⁵ Little research exists on the use of games as a summative assessment tool.

The research question in this study was: Can a board game serve as a valid alternative tool for the summative assessment of first aid competence?