Teaching and learning matters: Designing a serious game with adaptive expertise in electrolyte cases

Adaptive expertise, or the ability to apply knowledge in unfamiliar, complex situations, is essential for pharmacists. Novel instructional methods have been developed to within pharmacy education, such as serious games, which add game-like elements. The serious game was designed to promote adaptive expertise by simulating changes in the patient's condition to encourage students to practice productive failure and consider how treatment may change with contrasting cases.

An electrolyte disorder serious game was created for second-year pharmacy students at Virginia Commonwealth University School of Pharmacy (VCU SOP). Students worked in small groups to complete three patient cases, guided by a peer facilitator. At key decision points, dice rolls introduced random patient-specific changes to simulate clinical variability. Originally designed for in-person delivery, the game was adapted to a synchronous Zoom.

Of the 85 students, 42 students completed a pre-survey (49.4% response rate) and 17 students completed at least 93% of the post-survey. The total knowledge score significantly improved from 60.6% to 75.3%, and self-rated confidence increased for all five learning objectives. Most students reported positive perceptions of the learning activity, including "The serious game encouraged me to think about materials in a new way." However, some noted difficulty focusing due to stress.

Activity objectives and study measures were mapped to the ACPE Educational Outcomes, EPA Patient Care Provider Domain, and PPCP for increases in student knowledge and confidence, but did not capture adaptive expertise skill changes in the cohort. While student knowledge and confidence increased and student perception of the activity was positive, some stress was reported; the lack of data to capture the impact of the adaptive experience is the limitation, which makes this an ideal piece for the Teaching and Learning Matters manuscript category to introduce the activity and the concept while considering the study design limitations.