1.  1 TEACHING PEDIATRIC PERITONEAL DIALYSIS THROUGH SERIOUS GAMING: DEVELOPMENT AND FORMATIVE EVALUATION OF AN ONLINE VIRTUAL SIMULATOR Aleksandra E Olszewski, B.S. a, Daniel Hames, M.D. b, Mignon McCulloch, M.D. c, Deborah Stein, M.D. d, Sharon Su, M.D. e, and Traci A. Wolbrink, M.D., M.P.H. a a Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Management, Children’s Hospital Boston and the Department of Anesthesia, Harvard Medical School, Boston, MA, USA, b Department of Pediatrics, Boston Children’s Hospital, Boston, c Departments of Nephrology and Paediatric Critical Care, Red Cross Children’s Hospital, Cape Town, d Department of Nephrology, Boston Children’s Hospital, Boston, e Department of Nephrology, Randall Children’s Hospital, Portland

2. Disclosures I have no financial relationships to disclose. 2

3. The context 3 Declining interest in nephrology 1 New generation of learners 2 Need for new teaching strategies 1.Rosner, M, Parker, M, Kohan, D. Nephrology as a career choice: A survey of medical students. J Am Soc Nephrol 2009;20:767A:SA-PO2867 2.Roberts, DH, Newman, LR, Schwartzstein, RM, Twelve tips for facilitating Millenials’ leanring. Med Teach 2012;34:274- 278.

4. Serious games: benefits 4 For the developer Scalability Distributability Relative cost Reusability of materials Mobile delivery For the educator Augmentation of reality Manipulation of time Standardization of content and assessment Automated assessment Opportunity to build on learning through discreet tasks and levels Incorporate adult learning principles For the learner Fun and interactive interface Engage through competition Practice of relevant skills in a safe way Accessibility when convenient and useful Capacity for repetition Self-pacing Immediate feedback Anonymity Expertise developed through levels

5. Development 5

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10. Quality Testing 10  Think Aloud Protocol testing  Likert scale system usability scale (SUS) surveys  Thirteen subjects : students, fellows, residents, attendings, and nurses

11. Quality Testing Results 11 Survey Results On a 5-point Likert scale, average ratings were: Usefulness: 4.885 Enjoyment: 4.538 Interest in future use: 4.923 Clarity of directions: 4.577 Utility of feedback: 4.692 Average System Usability Score (Standard Error) Round 175.833 (5.601) Round 294.583 (3.024) Round 394.167 (1.179) Round 494.375 (2.232)

12. Think Aloud Testing Results 12

13. Peritoneal Dialysis Simulator 13

14. Knowledge Guide 14

15. Tactics 15

16. Case Simulator 16

17. Feedback and Hints 17

18. Future Studies 18 The simulator will be published soon on: www.openpediatrics.org www.openpediatrics.org Embedded analytics will allow us to track usage, scores, and user actions, categorized and analyzed based on user profile. Qualitative data from surveys will also be collected. Ongoing work is necessary to conduct formal evaluation.

19. Thank you 19 To Paul Devlin and Robert Brecher of Genuine Interactive, for their creativity and hard work. To Traci Wolbrink, Daniel Hames, Mignon McCulloch, Deborah Stein, and Sharon Su, our global team of physicians, for their invaluable expertise and teaching. For more information, please contact: aleksandra.olszewski@childrens.harvard.edu. aleksandra.olszewski@childrens.harvard.edu