Game Modification Project Discovering the Surgical Instrument Game by Transforming the Catan Marisa Tapia IT 5830 University of Colorado Denver March 8, 2012

Introduction:  Introduction: Can a game be changed to teach something? Yes. Through game modification techniques a game can be transformed into a purposeful subject specific learning opportunity. The purpose of this assignment is to transform or modify a current game-The Settlers of Catan-to teach a subject in my discipline or domain. Through simple or complex changes one can create and deliver a robust teaching tool that promotes fun, engagement, purpose and identified learning outcomes.

By embedding values such as collaboration, ownership, accountability and critical thinking the game is now being transformed into a usable tool to promote teaching and learning principles. The newly created game using the basic principles of The Settlers of Catan can be transferred and molded to promote surgical instrument identification and utilization in the surgical setting.

 

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The Mind Map Story: Establishing Ideas and Game Design Beginnings:

Getting started on this project was quite the tedious process. First, my fears about this class

were coming true as I am not a game person therefore my first challenge was overcoming my

obstacle of not liking games. Secondly, I had to re-program myself to step outside of my comfort

zone and dive into breaking down a game that I was not fond of. Lastly, I had to modify the game as

well as identify the game content that would be best suited to mold into the Settlers of Catan. This

was quite the challenge. I had numerous ideas with no significant direction. I was indifferent to

several options as far as content to mold into The Settlers of Catan.

I initially thought of a word game to assist with medical terminology but what fun is that? My

second attempt at modifying, designing or developing a game was the medication game but that

would be too vast and ever-changing as medications change rapidly for their intended purpose or for

the true realistic utilization of the medication. I then realized that I was wasting time by overthinking

the assignment and I needed to put thoughts into actions and develop a plan, below is the mind map

that assisted me in the modifications needed to develop the Surgical Instrument Game.

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Modification of the Settlers of Catan: The Surgical Instrument Game

1. I realized quickly that the most

important step in playing a game is building confidence among the players to entice participation and competitiveness with the ultimate goal of learning something. My initial challenge was how do I create this with the content I have? Do I keep the Catan structure? Do I stay true to the game rules or do I base the game on the premise of building onto something? Do I start from scratch or do I modify it to build skills that will transfer into the learning criteria through the analysis and synthesis of the current player’s knowledge base to the expected player’s achievable outcomes?

             2.

Why is the instrument game the content to use?

The most important and critical knowledge to fully integrate nursing skills in the operating room is to understand, identify, utilize and recognize what surgical instrumentation is needed for a specific surgical intervention.

Critical instrumentation needs in the operating room are essential to facilitate the surgical intervention in a timely manner to promote and insure patient safety needs. Such safety factors include but are not limited to the reduction of blood loss and the surgeon’s ability to attain visualization at the surgical site for the surgical intervention at hand.

The progression in learning instruments is quite grueling often tiresome and requires accuracy.

First, the student must learn the classifications of instruments, followed by what each instrument’s function and purpose. Next, the student must correctly identify which surgical tray or grouping the instrument belongs to. Finally, the student must identify which surgical tray correlates to which surgical intervention. As you can see, the learning is a series of steps in order for knowledge acquisition and ultimate competency.

3. Initially, I was going to use the original hexagonal diagram as the playing field for the game but decided to modify this element into a pyramid the player climbs. I created a stair like approach to reaching the top of the pyramid to encourage participation, skill acquisition and ultimately competency in achieving the peak of each achievement.

The game is simple as it builds on the player’s knowledge in surgical instrumentation know-how. Must be played with a minimum of 2 players with the maximum of 4.

The game takes the player from a novice to expert approach in mastering one set of skills from one level to the next by climbing the pyramid with the ultimate achievement of reaching “competency” in all components of surgical instrumentation skills and knowledge acquisition.

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   Through the use of a theoretical framework and a nursing model I derived the board game, which was the first step in the modification process. The theoretical framework I chose was Maslow’s Hierarchy of Needs and the nursing model I chose is Patricia Benner’s From Novice to Expert. Below are the two pyramids depicting the concepts of the theory and model and how they can both be utilized into deriving teaching and learning constructs to build on the player’s knowledge base.

Incorporating a theory and a model into the game in the shape of a pyramid

Transforming the Board Game

Novice:  Learn  rule  and  no  experience    

Advanced  Beginner:  Guided  Behavior  

Competent  Conscious  Planning      

Proficient:  Experienced  

Expert:  Intuitive  Judgment  

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The Game Board:

I initially wanted the game board to stay as is, but after careful

consideration I decided on the pyramid.

Both the theory and model identify that reaching the peak only establishes more learning to be accomplished as well as growth. In order to be a nurse in the operating room setting, basic skills must be met prior to integrating other aspects of instrumentation know-how. Building on the knowledge from one level to the next promotes a successful transition from novice to expert.

The player(s) will climb the pyramid during each level of the process of:

1. Instrument identification and classification

2. Instrument sterilization

3. Instrument utilization

4. Instrument tray recognition

5. Type of tray for specific

surgery

6. Sterile technique skills

7. Putting it all together:

scenario based question

Example:  

Doyan  Retractor  

1. The  instrument  classification  is  a  retractor  The  identification  is  the  name  of  the  retractor  (Doyan  Retractor).  

2. Sterilization  methods  include:  autoclave  steam,  Ethylene  Oxide  Gas  (ETO)  as  well  as  Hydrogen  Peroxide  Gas  Plasma  

3. Utilization:  used  for  visualization  of  organs  during  surgery  4. The  above  set  is  a  plastic  surgery  set  which  includes  this  

instrument    5. This  tray  would  be  used  in  a  minor  abdominal  or  breast  surgery.      6. Sterile  technique  related  question  to  surgical  table  set-­‐up  7. Scenario  based  question  to  promote  expertise  and  peak  

performance  

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Settler’s  of  Catan  Original  Tiles   Tiles  and  Resources  Cards   Cards:    Development  Cards,  Resource  Cards,  Special  Cards  and  Victory  Point  Cards    

Adaptation  of  the  New  Game  

 

Each  resource  card  is  color  

coded  to  determine  the  learning  

level  in  a  novice  to  expert  with  

the:  

Blue  and  Green:    Novice  

Purple  and  Brown:  Advanced  Beginner  

Orange:      Competent  

Yellow:  Proficient  

Red:    Expert  

 

 

 

 

           In  the  Surgical  Instrument  Game  the  Development  Cards  stay  the  same  as  the  original  game  in  which  they  provide  progression.    As  the  player  climbs  the  pyramid  starting  with  the  blue  level  and  progressing  to  the  top  or  the  red  level  they  automatically  will  be  allowed  a  “re-­‐do”  or  a  second  chance  to  progress  when  they  draw  this  card.    The  Resource  cards  are  an  opportunity  to  use  a  resource  to  look  up  information.    Special  cards  are  “chance”  cards  that  allow  the  player  to  go  straight  to  the  top  and  risk  everything.    Victory  Points  Cards  allow  the  player  to  double  their  score  regardless  of  level.      

Original  Game  Board  Configuration  

New  Tiles  

Hills:  Bricks   Blue:  Instrument  Class  and  ID    

Pasture:  Woods   Green:  Sterilization  Method  

Mountains:  Ore    

Purple:  How  the  instrument  is  used  

Fields:  Grain   Brown:  ID  of  instrument  tray  

Forest:    Lumber   Orange:  Types  of  surgical  procedure  that  would  use  this  surgical  instrument  tray  

Desert:  Nothing   Yellow:  Sterile  Technique  question  

  Red:  Scenario  Based  Question  

 

   

Scoring:

Through the use of a dice, the number displayed on the dice determines which level you start on in

a blue to red progression

BONUS:

Additionally, if a player is awarded the QA Card they have the opportunity to ask the opponent a

question regarding sterile technique.

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Reflection:  Design  Process  

Step 1:

Establishing ideas and generating a plan of action for this game was the most frustrating process

as I lack the gaming experience and ingenuity to create a game-and as a friend told me, that “if you

can think it, it has probably already been done”, which was disappointing to hear since he is a

devoted gamer and my partner in crime with all the games with Friends that I play. Next, I drew out

the sketch to a possible game, and then another and another, with no success. Finally, I decided on

using a mind map. Through the use of a mind map, I was able to identify the direction and the goals

of the game that would be relevant in my domain/discipline as well as the applicability to the teaching

and learning perspective.

Step 2:

I did an internet search on “healthcare games”, “nursing games” and “surgical instrument games”.

None of these games captured my attention nor did they capture “a true method to learning

something”. These games only identified a method to perform item recognition while using the word

“game” to depict this. I felt that in order for my game to be effective I had to bring it back to theories

and models to figure it all out. I chose Maslow’s Hierarchy of Needs and Patricia Benner’s model,

From Novice to Expert (1984) to mold something that could take a player’s knowledge base and build

on this to effectively provide the care necessary and safely to the patient undergoing an operative or

invasive surgical intervention. I thought to also use Bloom’s Taxonomy but it did not mold quite as

well as Benner’s nursing model, which most nurses are familiar with.

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Reflection:  Modification  and  Learning  Outcomes  

Step 3:

When creating this game, I had no idea I would change it so much from its original state, but it

made sense, as I wanted to create a purposeful game for nurses learning surgical instrumentation

and its many layers of information that the nurse should know. As nurses we collectively lack

expertise in other disciplines such as education, training and technology. Through the use of

theoretical frameworks and nursing models the most effective learning into practice is developed

and achieved.

Maslow’s Hierarchy of Needs depicts levels of a pyramid in which needs are met ranging from

the most basic to the more complex (bottom to top). An individual will seek out the most basic

needs first prior to progressing to the next level. Upon reaching self-actualization, the individual will

attain this level for a brief moment and the progression begins anew starting from the bottom and

working oneself towards the peak of self-actualization.

Transcendence occurs throughout the learning process for nurses and is thought to be critical in the caring for self and others and often takes place during self-actualization.

 

 

Play  Testing:            During  the  playtesting  component  of  this  project  and  through  the  use  of  the  internet  I  dabbled  in  the  games  out  there  related  to  surgical  instruments  as  well  as  contrasting  it  with  the  Settlers  of  Catan.    The  games  available  were  quite  non-­‐descript  and  only  emphasized  name  recognition  of  instruments  and  lacked  the  critical  thinking  component  that  I  wanted  to  generate  with  my  game.                  As  with  the  Settlers’  of  Catan  there  was  a  thought  process  involved  in  which  an  individual  player  strategically  planned  thing  out  in  order  to  progress  and  attain  land.    In  my  game  I  wanted  the  progression  to  mean  something  and  to  have  not  only  a  sense  of  accomplishment  in  reaching  the  top  but  to  ultimately  learn  and  practice  safely.                  When  would  I  introduce  this  game  to  student?    The  most  assumed  schedule  would  be  during  the  time  they  are  introduced  to  surgical  instruments  however,  I  would  introduce  the  game  after  each  lesson  related  to  the  given  topic  in  an  effort  to  promote  learning  progression  and  as  a  method  for  the  player  or  student  to  determine  their  own  distinct  learning  needs.      

Step 4:

In looking into what works in nursing education Benner’s Model: From Novice to Expert always

comes to mind. This model identifies the progression of learning among nurses-or better said, how

nurses learn to be nurses. This model is based on Dreyfus’ model of skill acquisition. This model

provides the foundation for the learning to occur and the plan for the player’s success in the game

and in learning something through the use of progressing or climbing the pyramid.

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Reflection:  Reflect  on  the  modification  process  as  a  means  of  better  understanding  content    Q:    How  did  the  modification  exercise  assist  in  learning  more  about  the  learning  domain?                   During  this  treacherous  process  to  take  apart  a  game  and  modify  it  to  meet  the  needs  of  my  discipline  in  the  context  of  a  learning  domain  was  grueling,  however,  as  the  adult  pessimist  that  I  have  become,  I  did  not  see  the  use  of  a  game  in  an  effort  to  learn  something  beyond  medical  terminology.    This  project  was  useful  in  identifying  goals  and  outcomes  for  learning  through  the  use  of  a  game,  whether  it  was  modified  or  not.         Nursing  practice,  nursing  theory  and  nursing  education  is  not  something  that  is  uncommon  to  me,  however,  best  practices  in  learning,  training  and  technology  are  novice  topics  in  my  current  professional  circles.    Utilization  of  a  game  to  learn  something  was  an  unforeseen  outcome  based  on  my  past  experience  in  nursing  education  and  nursing  best  practices  related  to  learning.    This  project  allowed  me  to  mold  or  modify  a  game  to  an  identified  topic  related  to  the  discipline  I  practice.    This  project  also  provided  me  the  opportunity  to  step  out  of  my  comfort  zone  and  take  a  “deep  dive”  approach  to  creating  a  game  that  was  useful,  hopefully  fun,  increases  a  player’s  /student’s  knowledge  base  and  build  up  their  confidence  to  competency  and  achieve  expertise.              

 

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Resources:

Photographs:

All photographs were obtained from the internet via Snagit during March 1-10, 2012.

Benner’s Model retrieved March 10, 2012.

http://www.sld.demon.co.uk/dreyfus.pdf

Maslow’s Pyramid 1990’s version. Retrieved March 7, 2012. http://badidumariam.blogspot.com/2010/02/maslows-hierarchy-of-needs.html

Settlers of Catan retrieved March 1, 2012 image and board game http://www.google.com/imgres?q=settlers+of+catan&um=1&hl=en&sa=N&biw=1369&bih=726&tbm=isch&tbnid=nrplnA1uHl7pFM:&imgrefurl=http://www.amazon.com/Mayfair-Settlers-Catan-Board-Game/dp/B00001ZT4D&docid=QLbUzgWJZ7b3RM&imgurl=http://ecx.images-amazon.com/images/I/61rdJSX5fdL._SL500_AA300_.jpg&w=300&h=300&ei=V8NdT7SnIuSyiQKVgOGtCw&zoom=1&iact=hc&vpx=654&vpy=181&dur=1675&hovh=225&hovw=225&tx=109&ty=168&sig=100759130507373249911&page=1&tbnh=157&tbnw=157&start=0&ndsp=15&ved=1t:429,r:2,s:0

Tapia, M. Personal photographs of instruments.

The Thinker retrieved March 9, 2012.

http://www.google.com/imgres?q=the+thinker&num=10&um=1&hl=en&biw=1369&bih=726&tbm=isch&tbnid=Cr_tu8KoPV4Z8M:&imgrefurl=http://craptoseintolerance.blogspot.com/2011/12/is-thinker-tebowing_16.html&docid=q2e50kNdPONsCM&imgurl=http://2.bp.blogspot.com/-bS4NeBoaHDw/Tutrm1cJm2I/AAAAAAAAFws/A55FtE7nk7c/s1600/the_thinker.jpg&w=459&h=600&ei=gcRdT63hHpHRiAKQmOWLCw&zoom=1&iact=hc&vpx=727&vpy=169&dur=27&hovh=257&hovw=196&tx=128&ty=107&sig=100759130507373249911&sqi=2&page=1&tbnh=164&tbnw=125&start=0&ndsp=23&ved=1t:429,r:4,s:0