Emergency and critical care medicine require a mindful yet urgent approach to our patients and clinical thought process. Bringing education that engages the mind and body together stimulates memory, communication, and sensory integration.
We are transitioning from how we currently learn to how we want to learn. The days of listening to a lecture while watching static PowerPoint slides are ending, as we venture into engaging and interactive education. Knowledge is constructed and shaped by experience. By integrating emerging and existing concepts to activate sensory input, we combine unique pieces of past experiences, existing knowledge, and insights to elevate the established framework.  
 

Engage in hands-on activities

Learning is an active process and requires interaction to be constructive. Adults learn from each other by participating in social activities and working in groups. We tend to learn best when building upon items we already know. Igniting our minds is the first step; sparking the balance of engaging in hands-on activities and building on our experiences is the second. Proprioception, often referred to as the sixth sense that allows us to know where all of our body parts are in space, highlights why constructivism works, and explains why emerging technology like virtual reality is the future of education. 
Senses help transmit environmental information via sensory neurons and receptors in the body to the central nervous system, which elicits a response. Proprioception is the sense that tells your brain where all your body parts are, even if your eyes are closed. Your mind and body are working together, devising an adaptive response. Unknowingly, we utilize this sense every day, in our practice, in our skills, and at the patient bedside.

Application to medical education

How does this translate into our practice and our education? The passive education and lecture approach has deafened our desire to learn and dimmed our proverbial creative light. For significant learning, we need to revisit ideas to practice, apply and employ them. This cannot happen sitting in a lecture hall or at a table. Simulation, constructivism, and recent advances in augmented and virtual reality hardware have broadened education delivery modes to heighten our senses. If we reflect on anything we have learned, we realize that it is the end product of repeated exposure and thought. Profound insights can be traced back to significant periods of preparation, practice, and engaging application. These methods and interactions with clinical teammates have engaged their appetite for education while increasing critical care thought processes and clinical quality. 

Developing content, devising methods of engagement, and using constructivism are highlights of driving quality education. Perhaps more important is fostering a positive culture that is either established or needs to be built to facilitate learning. 

Isolated education, or driving the wand of negative feedback, does not produce positive results or embrace learning. As we have seen and been a part of, culture has drastically shifted, especially as we drive it forward from an educator and leadership standpoint. Creating the environment of understanding, debriefing, communication, and identifying what some might say are misadventures; all comes down to the ‘why’. Creating relevant content objectives, and incorporating this with foundation and understanding, builds concepts and behavior. Promoting the educational learning environment from an active process is vital; however, promoting it with educators as leaders who believe in the ‘why’, and developing fundamentals with support for growth, has resonated with our clinicians and brightened the culture of education and clinical quality. 

What is serious gaming?

The concept of serious gaming has been studied since the 1970s. In the last 20 years, it has grown into a multi-billion-dollar industry.

Serious games serve a primary purpose other than to entertain

Serious games serve a primary purpose other than to entertain. Although they share many of the same attributes as recreational games, the primary goal of serious games is teaching or practicing real-world skills that the learner will then be able to apply. Whereas traditional teaching focuses on memorization, serious gaming allows the learner to solve problems in an interactive format that provides feedback and competition. While it is easy to associate this with video games, it is essential to note that card games, board games, and competitive trivia are easily accessible approaches to serious gaming. Thus, the barrier to entry is limited more by creativity and imagination than available finances. 

Gamification as an engagement tool

Similarly, employers can deploy gamification in the air medical environment to drive results. Where serious games focus on creating content for education, gamification is adding game-like elements to existing processes. For example, implementing a weight-loss program for employees can be a sensitive topic and is often met with resistance. Gamification could be used by adding incentives and competition to encourage healthier habits among your team. By breaking employees into groups and challenging them to encourage each other while working towards a common goal of losing a higher percentage of starting body weight than others, you are applying game-like elements to an existing program as a way of incentivizing your staff. To use a more straightforward example with correlation to the air medical environment, you could incentivize employees by rewarding the crews with the fewest on-the-job injuries for a specific timeframe, or who collectively scores the highest on their annual evaluations. While we expect each employee to do their best, this adds an incentive for crews to help their co-workers towards a common goal; these simple incentives add a level of play to otherwise mundane tasks. 

The Air Methods approach

In 2021, Air Methods Corp. (AMC) has wholly redesigned its clinical education approach to embrace emerging technology and educational concepts. As part of this initiative, AMC’s clinical education team has moved away from pass / fail competency validation in favor of a team-based and employee-first approach. To maximize learning, training events are now designed around improving patient outcomes by focusing on problem-solving and communication while caring for simulated patients using a combination of high-fidelity human patient simulators and serious gaming activities. 
 

Serious games in air medical education

In 2020, Air Methods began working with California-based virtual reality developer SimX to create the first large-scale air medical virtual reality (VR) training program. Air Methods and SimX are developing a library of advanced clinical scenarios capable of having multiple players working together to treat patients in the virtual environment.

VR allows educators to address clinical trends anywhere in the country without the need for travel

VR allows educators to address clinical trends anywhere in the country without the need for travel. This is accomplished simply by allowing an educator to virtually join a flight crew and run them through high-acuity cases without leaving their home or office. 
Another new development is the popularity of recreational escape rooms throughout the US. These facilities use a series of clues to solve a mystery or escape a dire threat, usually while racing against the clock. In recent years, escape rooms have been adapted for use in clinical training, and Air Methods has brought this fun and entertaining teaching style into the air medical industry. A team of educators at Air Methods have developed an escape room that mixes clinical knowledge, pop-culture references, and good old-fashioned sleuthing into an interactive learning experience designed to better prepare clinicians to care for critical pediatric patients. Each step of patient care, such as accessing medications or locating lab values, requires the team to solve the previous clues. Three groups are pitted against each other each day to see who can figure out the patient’s condition and provide the most appropriate care in the shortest amount of time. 
An example of a lower-cost serious game currently in use at Air Methods is the constructivism game created to improve air medical crew communication while reinforcing the clinical team’s understanding of patient care guidelines. Air Methods used this concept to create a room-scale board game that requires four clinicians to work together to move diagonally across the board. Each move requires them to answer patient care-related questions before they can reveal their next move. The board is comprised of 64 squares with hidden instructions to move forward, backward, or start over at the beginning. As the team continues through the board, they must work together to answer the patient care questions and navigate the squares.

An invitation to learn

As we continue into the adventure of optimizing clinical education, technology has allowed us to incorporate concepts to engage clinicians with the want to learn. By employing high-fidelity simulation, constructivism, and serious gaming, the learning avenues are now endless. Clinicians are using their mind and body to ignite sensory input while participating in learning with meaning. These methods elevate clinicians to operate at their best while creating a culture that is inviting to learn.