Structuring Game Design with Active Learning Benefits: Insights from Logistical Skills Training in Managing an Emergency Department.

Competency is central to a sustainable and resilient emergency department. Decision-makers, including clinicians, managers, and developers, would benefit from meaningful simulated scenarios in which their skills are trained. Among the various types of skills, non-technical skills are prioritized because the failure to communicate, coordinate and cooperate effectively are common contributing factors to adverse events and involving patients at the ‘sharp-end’ of the health system. For active learning of non-technical skills, simulation and gaming have been frequently used. From the methodology point of view, there is a need to clarify these two methods in order to improve their value in training and learning. This contribution presents the reflective methodology as an option of structuring game design compared to the mainstream service system modeling. The reflective methodology starts with the underlying assumption that it is still possible to achieve gaming effectiveness, even though the baseline layer is a simulation model instead of the service system. Based on a questionnaire investigating the activation of learning of logistical skills in managing an emergency department, results are illustrative of that active learning is much improved and is moving closer to achieving intended outcomes. Analyzing results from logistical experiments in the form of a statistical summary motivates to explore the middle ground of game design and gamification further, especially when the simulation model is the steering layer in scenario generations and debriefing. This aspect might have been less supervised in the philosophy of game science, let alone the application of simulation game for human resource management in emergency department logistics.