SBIR-STTR Award

Serious Game-based Development of Obesity Intervention Skills Intended Impact: Medical students are not adequately prepared with the clinical skills they need to intervene with overweight or obese patients in order to help curtail the epidemic of obesity in the United States. The ObesityTxChallenge project addresses this practice and training gap via novel tablet and web-based training of medical students. The project strives to improve the assessment and intervention skills of medical students by modifying our unique Clinical Encounters 3D-Patient Training Environment, developed for our Pain Tx Challenge product with to deliver an enhanced serious game-based simulation. The curriculum will be based on a modification of our 10 hour obesity training for practicing doctors, located at ImpactObesity.com. To reach our goal of improving outcomes of patients with overweight or obesity, via Obesity Tx Challenge, students will conduct interviews and examine virtual (e.g., computer-generated) patients and receive differing simulated patient responses (e.g., acceptance, confusion, refusal, suspicious behavior). Via the product's unique branched path learning and time pressure, students will make choices and see the results later in the experience. Multiple paths (and outcomes) enhance realism, enthusiasm, changes in attitude, and educational effect. Virtual preceptors identify students' incorrect or less than optimal clinical choices and decisions and weak patient-provider interaction skills and provide feedback. The complex biological basis of obesity medicine is taught via a Unity 3D-based "breakout" learning experience to provide a basic science foundation for the clinical knowledge. Learners select physical exam components to fully investigate weight status as well as select and interpret diagnostic tests. Player students categorize overweight and obesity via standard measures (weight, BMI, abdominal circumference) to establish a diagnosis of obesity or assess overweight. They develop an evidence-based comprehensive treatment plan that includes lifestyle modification, inter-professional collaboration, such as with dietitians, counselors, or weight loss programs, appropriate use of medications and weight loss surgery, motivational interventions, follow-up recommendations, and referral as necessary. Game points and visual rewards reinforce best practice choices and enhance student engagement. The game's deliberate practice efficiently provides a wide variety of clinical experiences over time and an opportunity to develop useful skills as students work with the 2/3rds of adult patients who are overweight or obese. The training offers an opportunity to establish lifelong practice patterns that will assist in stemming the obesity epidemic. Phase I will specifically demonstrate product feasibility and acceptability by completing: 1) needs analyses and preference testing with target audience students and faculty; 2) a training framework and game design document; 3) a semi-functional, interactive prototype of the planned training with realistic computer-generated patients and explanatory biological animations, using Unity 3D which can be delivered in 2D (standard monitors) and 3D contexts, such as Oculus VR; 4) assessments to be used in the Phase II evaluative study of the product; and 5) alpha/usability testing of the prototype with medical students and assessment of preference, acceptability and effectiveness of the animation presentations. Phase II will complete the ObesityTxChallenge product, produce the ObesityTxChallenge Implementation Guide for faculty preceptors and training directors to implement the game, and evaluate the game's effectiveness with a population of medical students. A robust evaluation of the game will assess learner response to this novel approach in terms of acceptance, enthusiasm, and impact on skills, confidence and attitude via a randomized, cross-over, wait list control, pre-test/post- test design. It will compare change in target clinical skills and core competencies related to overweight and obesity assessment and intervention. The robust assessment of ObesityTxChallenge informs our own environment and provides guidance to other researchers and educators regarding the ability of game-based training to instill clinical skills and behaviors in students.

Public Health Relevance Statement:
PUBLIC HEALTH RELEVANCE STATEMENT Overall Impact: The personal, financial and other costs of obesity to society are well known, yet tomorrow's medical students are still unprepared to time-efficiently assess and intervene with patients who are overweight or obese. The ObesityTxChallenge project builds upon our existing Clinical Encounters 3D- Patient Training Environment, and our ImpactObesity.com training for practicing doctors, to create a challenging 3D game and learning experience to be mastered. Medical students experience the real-world challenges of patient care including time-pressure, the need to make assessment and intervention decisions, and exposure to the effect of those decisions on their patients. By engaging and challenging medical students to improve their overweight and obesity assessment and intervention skills, they can effectively and actively intervene with the 2/3rds of adult patients who struggle with overweight or obesity and improve the health outcomes of those patients.

NIH Spending Category:
Bioengineering; Clinical Research; Nutrition; Obesity; Prevention

Project Terms:
Abdomen; Address; Adult; animation; Attitude; bariatric surgery; base; Basic Science; Behavior; Behavior Therapy; Biological; Biology; Body Weight decreased; Brain; Brain Part; Clinical; Clinical Skills; Collaborations; Complex; computer generated; Confusion; Control Groups; cost; Data Analyses; design; Development; Device or Instrument Development; Diagnosis; Diagnostic tests; Dietitian; E-learning; Educational Curriculum; Educational process of instructing; Effectiveness; Enrollment; Environment; Epidemic; Evaluation; evidence base; evidence based guidelines; experience; Exposure to; Faculty; Feedback; follow-up; Foundations; Genetic Crossing Over; Goals; Grant; Health; heuristics; Hour; improved; instrument; Intervention; Interview; Knowledge; Learning; Medical; medical schools; Medical Students; Medicine; Methodology; Modeling; Modification; Monitor; motivational intervention; novel; novel strategies; Obesity; obesity treatment; Outcome; Overweight; Pain; Patient Care; Patient Education; Patients; Pattern; Pharmaceutical Preparations; Phase; phase 2 study; Population; Pre-Post Tests; preference; pressure; Professional counselor; programs; Protocols documentation; prototype; Provider; public health relevance; Publications; Randomized; Recommendation; Recruitment Activity; Reporting; Research Design; Research Personnel; response; Rewards; simulation; skills; Societies; Staging; Standards of Weights and Measures; stem; Students; Surveys; Tablets; Testing; three-dimensional modeling; Time; tool; Training; treatment planning; United States; United States National Institutes of Health; usability; virtual; virtual reality; Visual; Waiting Lists; Weight; Weight maintenance regimen; Work

Serious Game-based Development of Obesity Intervention Skills Intended Impact: Medical students are not adequately prepared with the clinical skills they need to intervene with overweight or obese patients in order to help curtail the epidemic of obesity in the United States. The ObesityTxChallenge project addresses this practice and training gap via novel tablet and web-based training of medical students. The project strives to improve the assessment and intervention skills of medical students by modifying our unique Clinical Encounters 3D-Patient Training Environment, developed for our Pain Tx Challenge product with to deliver an enhanced serious game-based simulation. The curriculum will be based on a modification of our 10 hour obesity training for practicing doctors, located at ImpactObesity.com. To reach our goal of improving outcomes of patients with overweight or obesity, via Obesity Tx Challenge, students will conduct interviews and examine virtual (e.g., computer-generated) patients and receive differing simulated patient responses (e.g., acceptance, confusion, refusal, suspicious behavior). Via the product's unique branched path learning and time pressure, students will make choices and see the results later in the experience. Multiple paths (and outcomes) enhance realism, enthusiasm, changes in attitude, and educational effect. Virtual preceptors identify students' incorrect or less than optimal clinical choices and decisions and weak patient-provider interaction skills and provide feedback. The complex biological basis of obesity medicine is taught via a Unity 3D-based "breakout" learning experience to provide a basic science foundation for the clinical knowledge. Learners select physical exam components to fully investigate weight status as well as select and interpret diagnostic tests. Player students categorize overweight and obesity via standard measures (weight, BMI, abdominal circumference) to establish a diagnosis of obesity or assess overweight. They develop an evidence-based comprehensive treatment plan that includes lifestyle modification, inter-professional collaboration, such as with dietitians, counselors, or weight loss programs, appropriate use of medications and weight loss surgery, motivational interventions, follow-up recommendations, and referral as necessary. Game points and visual rewards reinforce best practice choices and enhance student engagement. The game's deliberate practice efficiently provides a wide variety of clinical experiences over time and an opportunity to develop useful skills as students work with the 2/3rds of adult patients who are overweight or obese. The training offers an opportunity to establish lifelong practice patterns that will assist in stemming the obesity epidemic. Phase I will specifically demonstrate product feasibility and acceptability by completing: 1) needs analyses and preference testing with target audience students and faculty; 2) a training framework and game design document; 3) a semi-functional, interactive prototype of the planned training with realistic computer-generated patients and explanatory biological animations, using Unity 3D which can be delivered in 2D (standard monitors) and 3D contexts, such as Oculus VR; 4) assessments to be used in the Phase II evaluative study of the product; and 5) alpha/usability testing of the prototype with medical students and assessment of preference, acceptability and effectiveness of the animation presentations. Phase II will complete the ObesityTxChallenge product, produce the ObesityTxChallenge Implementation Guide for faculty preceptors and training directors to implement the game, and evaluate the game's effectiveness with a population of medical students. A robust evaluation of the game will assess learner response to this novel approach in terms of acceptance, enthusiasm, and impact on skills, confidence and attitude via a randomized, cross-over, wait list control, pre-test/post- test design. It will compare change in target clinical skills and core competencies related to overweight and obesity assessment and intervention. The robust assessment of ObesityTxChallenge informs our own environment and provides guidance to other researchers and educators regarding the ability of game-based training to instill clinical skills and behaviors in students.

Public Health Relevance Statement:
PUBLIC HEALTH RELEVANCE STATEMENT Overall Impact: The personal, financial and other costs of obesity to society are well known, yet tomorrow's medical students are still unprepared to time-efficiently assess and intervene with patients who are overweight or obese. The ObesityTxChallenge project builds upon our existing Clinical Encounters 3D- Patient Training Environment, and our ImpactObesity.com training for practicing doctors, to create a challenging 3D game and learning experience to be mastered. Medical students experience the real-world challenges of patient care including time-pressure, the need to make assessment and intervention decisions, and exposure to the effect of those decisions on their patients. By engaging and challenging medical students to improve their overweight and obesity assessment and intervention skills, they can effectively and actively intervene with the 2/3rds of adult patients who struggle with overweight or obesity and improve the health outcomes of those patients.

NIH Spending Category:
Behavioral and Social Science; Bioengineering; Clinical Research; Nutrition; Obesity; Prevention

Project Terms:
Abdomen; Address; Adult; animation; Assessment tool; Attitude; bariatric surgery; base; Basic Science; Behavior; Behavior Therapy; Biological; Biology; Body Weight decreased; Brain; Clinical; Clinical Skills; Collaborations; Complex; computer generated; Confusion; Control Groups; cost; Data Analyses; design; Development; Device or Instrument Development; Diagnosis; Diagnostic tests; Dietitian; E-learning; Educational Curriculum; Educational process of instructing; Effectiveness; Enrollment; Environment; Epidemic; Evaluation; evidence base; evidence based guidelines; experience; Exposure to; Faculty; Feedback; follow-up; Foundations; Genetic Crossing Over; Goals; Grant; Health; heuristics; Hour; improved; improved outcome; instrument; Intervention; Interview; Knowledge; Learning; Medical; medical schools; Medical Students; Medicine; Methodology; Modeling; Modification; Monitor; motivational intervention; novel; novel strategies; Obesity; obesity treatment; Outcome; Overweight; Pain; Patient Care; Patient Education; Patients; Pattern; Pharmaceutical Preparations; Phase; phase 2 study; Population; Pre-Post Tests; preference; pressure; Professional counselor; programs; Protocols documentation; prototype; Provider; public health relevance; Publications; Randomized; Recommendation; Recruitment Activity; Reporting; Research Design; Research Personnel; response; Rewards; simulation; simulation game; skills; Societies; Staging; Standards of Weights and Measures; stem; student participation; Students; Surveys; Tablets; Testing; three-dimensional modeling; Time; tool; Training; treatment planning; United States; United States National Institutes of Health; usability; virtual; virtual reality; Visual; Waiting Lists; Weight; Weight maintenance regimen; Work