Impact of co-designed game learning on cultural safety in colombian medical education: Protocol for a randomized controlled trial

Abstract

Background: Cultural safety encourages practitioners to examine how their own culture shapes their clinical practice and to respect their patients'worldviews. Lack of cultural safety in health care is linked to stigma and discrimination toward culturally diverse patients. Training in cultural safety poses considerable challenges. It is an unappealing subject for medical students and requires behavioral changes in their clinical practice. Game jams - collaborative workshops to create and play games - have recently shown effectiveness and engaging potential in university-level education. Objective: The trial aims to determine if medical students' participation in a game jam to design an educational game on cultural safety is more effective than a standard lesson on cultural safety in terms of change in the students' self-reported intended patient-oriented behavior. Methods: A parallel-group, 2-arm randomized controlled trial with a 1:1 allocation ratio will randomize 340 medical students and 60 medical interns (n=400) at the Faculty of Medicine at La Sabana University, Colombia (170 students and 30 medical interns to each arm). The intervention group will participate in an 8-hour game jam comprising (1) a preliminary lecture on cultural safety and game design, (2) a game building session where groups of students will create educational games about cultural safety, and (3) a play-test session in which students will play and learn from each other's games. The control group will receive a standard lesson, including a 2-hour lecture on cultural safety, followed by a 6-hour workshop to create posters about cultural safety. Web-based self-administered 30-item Likert-type questionnaires will assess cultural safety self-reported intended behavior before, immediately after, and 6 months after the intervention. An intention-to-treat approach will use a t-test with 95% CIs to determine the significance of the effect of the intervention, including within- and between-group comparisons. The qualitative most significant change technique will explore the impact of the intervention on the clinical experience of the students. Results: Study enrollment began in July 2019. A total of 531 students completed the baseline survey and were randomized. Data collection is expected to be complete by July 2020, and results are expected in October 2020. The study was approved by the institutional review board of the Faculty of Medicine at McGill University (May 31, 2017) and by the Subcommittee for Research of the Faculty of Medicine at La Sabana University (approval number 445). Conclusions: The research will develop participatory methods in game-based learning co-design that might be relevant to other subjects. Ultimately, it should foster improved cultural safety skills for medical students, improve the quality of health services for diverse cultural groups, and contribute to enhanced population health. Game learning may provide an innovative solution to a long-standing and neglected problem in medical education, helping to meet the educational expectations and needs of millennial medical students. © Juan Pimentel, Anne Cockcroft, Neil Andersson.

Antecedentes: La seguridad cultural anima a los profesionales a examinar cómo su propia cultura da forma a su práctica clínica y a respetar la visión del mundo de sus pacientes. La falta de seguridad cultural en la atención médica está relacionada con el estigma y la discriminación hacia pacientes culturalmente diversos. La formación en seguridad cultural plantea desafíos considerables. Es una materia poco atractiva para los estudiantes de medicina y requiere cambios de comportamiento en su práctica clínica. Los game jams (talleres colaborativos para crear y jugar juegos) han demostrado recientemente eficacia y potencial atractivo en la educación a nivel universitario. Objetivo: El ensayo tiene como objetivo determinar si la participación de los estudiantes de medicina en un game jam para diseñar un juego educativo sobre seguridad cultural es más efectiva que una lección estándar sobre seguridad cultural en términos de cambio en el comportamiento orientado al paciente autoinformado por los estudiantes. . Métodos: Un ensayo controlado aleatorio de grupos paralelos, de 2 brazos con una proporción de asignación de 1:1 asignará al azar a 340 estudiantes de medicina y 60 pasantes médicos (n=400) en la Facultad de Medicina de la Universidad La Sabana, Colombia (170 estudiantes y 30 pasantes médicos a cada brazo). El grupo de intervención participará en un game jam de 8 horas que comprenderá (1) una conferencia preliminar sobre seguridad cultural y diseño de juegos, (2) una sesión de creación de juegos donde grupos de estudiantes crearán juegos educativos sobre seguridad cultural y (3) un Sesión de prueba de juego en la que los estudiantes jugarán y aprenderán de los juegos de los demás. El grupo de control recibirá una lección estándar, que incluye una conferencia de 2 horas sobre seguridad cultural, seguida de un taller de 6 horas para crear carteles sobre seguridad cultural. Los cuestionarios tipo Likert de 30 ítems autoadministrados basados ​​en la web evaluarán el comportamiento previsto autoinformado de seguridad cultural antes, inmediatamente después y 6 meses después de la intervención.