Hello there, my name is Jon Hilton I am currently a T-year medical student at St George’s, University of London and my project has been short listed in the innovation in education category. My project is to introduce a new style of problem based learning (PBL) that is based around interactive fiction (IF).
PBL places the medical student in the role of a doctor, however one of the most difficult aspects of being a doctor is skipped. At each twist in the story the student is presented with a list of choices, deciding what goes on that list is more important than actually picking a choice from that list. I noticed this problem recently when I started clinical placements, I am frequently asked what tests I would like to do or which treatments I would like to give but I lack the ability to come up with a list of choices and justify them.
Interactive fiction (IF) is essentially a computerised version of those “Choose your own adventure” books you read as a kid, the sort that said things like:
You are in a forest, there are exits NORTH and SOUTH. Which way would you like to go?
NORTH go to page 135.
SOUTH go to page 71.
and then you would flick to that page but always keeping a finger in the page you came from just in case things went wrong. This loose structure can be found in problem based learning (PBL) which is the teaching style of choice at St George’s. The benefit of IF over the PBL/Choose your own adventure style writing is that the reader/player has to decide what to do, there might be hints at what to do next but the reader/player will never be presented with a binary decision like seen above and nor will the reader/player be presented with mutually exclusive choices – as can currently happen in PBL cases and a personal dislike of mine of the PBL system.
I’ll be writing this medical IF game/story using Inform 7, this uses a natural language syntax which means I can type in proper sentences to create the story and saves me the hassle of learning a proper coding language. Utilising the fantastic work done by the Parchment Project my creations will be playable in any web browser with Javascript support. IF is a unique medium with its own strengths and weaknesses, IF is good at stories/games about props and settings, about investigation and exploration and about mechanics and systems. I could not think of a better medium for medical education.
My idea would initially help medical students by forcing them to create the choices themselves. With further input there is no reason why the system couldn’t be adapted to post-grad training or the training of other healthcare professionals.
Logical clinical reasoning is one of the most important skills a foundation doctor can possess and PBL does a lot to prepare students for when they become a foundation doctor. However, through the inherent structure of PBL vital steps in the decision making process are missed. PBL cases often take place in isolation, there is no need for time management and there is no need for patient prioritisation; both of which are key when working on the wards. PBL cases are like being on a train, you have no control over where you go and don’t have to make many choices. IF is like being in a car, you can go wherever you want and you’re forced to make all of the choices.
The biggest issue IF PBL cases would have is teaching students how to use it and updating old cases/writing new ones.
IF based PBL cases will work alongside and could even replace standard PBL cases. With minimal changes standard PBL cases can be converted to interactive fiction based PBL cases. IF PBL cases will push students further, will provide detailed feedback upon completion and can be accessed from any computer at any time of day.
Click here to have a go prescribing down in A&E. That’s the start of what will be the code for the top 100 most prescribed drugs by foundation doctors. To demonstrate the drugs coded so far it is set in A&E with just two patients who have both taken overdoses. You can examine the patients with the command “examine [patient]“. You can prescribe drugs using “prescribe [drug] to [patient]“. So far only 4 of the top 100 have been coded, which means I have just 96 to go. You’ll notice that you can’t prescribe anything orally until you stop your patient vomiting so perhaps an anti-emetic might be a good idea. To check that your patients have actually improved make sure you examine them both before and after prescribing your medications.
I suppose it would be harsh of me not to tell you which 4 drugs have actually been coded… naloxone, acetyl cysteine, domperidone and activated charcoal should do wonders for your patients.
Click here to have a go at asking some questions to a patient who has been referred to your GI outpatient’s clinic by her GP. You can use the command “ask about [topic]” to ask her questions. You should ask about the pain, her stools, her diet, her medical history all those sorts of things. Make sure you examine her as that might give you something else to ask her about.
In this example you are an F2 in A+E but you are presented with two patients and you have to pick which to treat. For the first time I’ve included a help file which includes useful actions and explains which drugs can be prescribed in this particular case.
This case merges the work from the Top 100 drugs and the questions and answers cases to create something that actually resembles [hopefully] a PBL case. The case is heavily based on a case I did earlier this year so don’t go praising me for the writing.
As you can see the code is very rough at this early stage but I will be writing more over the coming weeks, so head over to jonhilton.wordpress.com for updates.
Interactive Fiction PBL by Jon Hilton is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
