Simulations and Serious Games | 21st Century Learning

Simulations and Serious Games | 21st Century Learning

Simulations and serious games share several of the same features and represent an emerging area of education: instructional design across a range of disciplines (Egenfeldt-Nielsen, 2010). They are typically used by educators for training from such well-funded areas such as the military, government agencies, medicine, and business to non-profit groups, religious groups and social activist groups (Michael & Chen, 2006).

The legitimacy of using simulations for learning has grown progressively over the last 20 years and has increased exponentially over the past decade (e.g., Prensky, 2005; Gee, 2003; Egenfeldt-Nielsen 2010; Michael & Chen, 2006). This has had an impact on mainstream education and training for both conventional and specialized programs, (e.g., Golze, 2004; Perla, 1990; Squire, 2004), and now serious games and simulations are becoming a vibrant and well-established industry.

Research has shown that simulations can be used to teach declarative, procedural, and conceptual knowledge to enhance existing and develop new cognitive skills such as problem solving and motor skills; change people’s attitudes or intrinsic motivations; and teach people to communicate and work together (Prensky, 2003; Ratan & Ritterfeld, 2009; Wouters et al, 2009; Sitzmann, 2011). Various investigations involving control groups and comparative studies have suggested that serious games have the real potential to result in improved learning in these areas.

There is however, as with any aspect of instructional design, a need to craft the learning experience. There have been examples in which the learning results from serious games have not been as good as anticipated (e.g., Jones, 2010).

Van der Spek (2011) has suggested that when this occurs, it has more to do with poor instructional design due to not taking into account the aspects of multimedia design (e.g., Chipperfield 2006; Paivo, 1986) rather than any inherent flaws of serious games or simulations.

Effective Instruction in the Field of Medicine

Few educators would disagree with the notion that effective instruction needs to be as authentic to the actual experience as possible (i.e. Lave & Wenger, 1991; Mezirow,2003). This need becomes more apparent when we start looking at instruction in the field of medicine.

Regular face-to-face classroom-based training is often very far removed from any recognizable arena or environment in which the skills and strategies of the subject can be applied. Not having the opportunity to apply this theoretical knowledge can result in poor application in real-life settings. (Clark & Mayer, 2003)

Learning how to perform a task or apply a skill in a classroom setting doesn’t always translate well to the work environment because of the dissonance experienced between disparate environments. Learning about a procedure in a classroom setting isn’t necessarily the best arena for this type of training due to the potential removal of immediacy and engagement of the subject.

The problem here, though, is that simulating and modeling the aspects of a patient presenting with a serious medical problem, and allowing members of the medical team to learn experientially from the situation would raise questions of appropriacy and ethics that would be beyond the remit of many training institutions. Simulation allows learners the opportunity to rehearse skills and apply knowledge in a realistic setting to simulate procedures and occurrences that would be virtually impossible to replicate in the real world. The benefits of this are immediately recognizable.

Practicing skills and concepts in an environment or setting closely approximating the actual setting minimizes cognitive overload and allows for a more effective transfer of knowledge to application. All major life and death training involves authentic rehearsal (Kapp & O’Driscoll, 2010).

Common, grounded pedagogical approaches for general education focus on situated learning (Lave & Wenger, 1991), socio-cultural theories (Vygotsky, 1978), action learning (e.g., Lizzio & Wilson, 2004), and task-based learning (Willis, 1996). It can be argued that these are all readily applicable to medical simulations.

Situated learning is learning that takes place in an approximation of the context in which the knowledge or skill will be applied. A main tenet of this theory is that learning should not be viewed as simply the transmission of abstract and decontextualized knowledge from one individual to another, but rather as a social process whereby knowledge is co-constructed. However, this is not always possible in life when trying to organize extensive training in a professional medical setting.

Experiential learning (as mentioned above) is learning through reflection on doing. This approach is most often contrasted with rote or didactic learning. Here, knowledge is discovered and reinforced firsthand through experience, experiments, and reflection instead of hearing or reading about others’ experiences.

The constructivist approach to learning revolves around the idea that learning occurs when a student is actively involved in a process of meaning and knowledge construction, through some form of guided discovery where the educator avoids direct instruction and attempts to lead the student through questions and activities to discover, discuss, appreciate, and verbalize the new knowledge.

Building on this, there are two terms often apparent in simulations that need to be looked at a little deeper. Although these are not necessarily essential, they do assist in learning and training, and should be aimed for in any good simulation learning design.


Fiero is what we feel after we triumph over adversity. You know it when you feel it–and when you see it. That’s because we almost all express fiero in exactly the same way: we throw our arms over our head and yell.

Fiero is important because it is the dopamine hook that keeps us coming back for more—which in this case, is to come back (willingly) for more learning (McGonigal, 2011).

The physical release is huge when it comes to these types of experiences, and moments like these—when you have fun—make the situation more memorable. You tell these stories to your friends and experience that same rush again—it keeps you wanting to play the game and return willingly. This feeling is something that clearly educators would clearly strive for in their training.



Flow Channel

From Flow: The Psychology of Optimal Experience

Flow is completely involved in an activity for its own sake. The ego falls away. Time flies. Every action, movement, and thought follows inevitably from the previous one . . .your whole being is involved, and you’re using your skills to the utmost (Csikszentmihalyi, 1990).

Flow is important for the simple reason that you are using your skills to the utmost of your ability – tested in a challenge that produces neither anxiety nor boredom – two things that, again, are aspects you would want to avoid in your trainees. Good simulations exhibit these qualities. Simulations allow professionals in the industry the opportunity to rehearse skills and apply knowledge in a realistic setting, simulating procedures and occurrences that would be virtually impossible to replicate in the real-world. Twenty-first century learning experiences need to reflect twenty-first century medical learners and professionals.


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