Game-based Learning in Eye Health Education - The Developmental Challenges of E-learning Games

Introduction

Game-based education^1,2 involves crafting products and services through the application of new technology to theoretical learning. Thus, fusing the two fields, technology and education, has given us what is popularly called game-based learning (GBL), which is popular for its high educational value. The blend of game, technology, and learning creates an engaging and immersive educational experience that can enhance cognitive processes, such as memory, attention, and spatial abilities.³

In response to the evolving landscape of technology and educational paradigms, educators are increasingly adopting innovative pedagogical approaches, including the systematic integration of active learning strategies into mainstream curricula. Although GBL, as one of the active learning tools, seems promising for its educational value, the development of effective e-learning games for eye health education poses significant challenges. The design of such games requires a careful balance of educational content and engaging game elements.⁴ Tan et al identified lacunae with most game models in incorporating learning behaviour into game design and proposed that game designers could leverage pedagogical components such as the story, challenge, goals, and objectives in designing GBL. Addressing this gap, studies^2,5–8 have proposed guidelines and principles for designing effective educational computer games. These include incorporating clear learning objectives, aligning game mechanics with educational goals, providing adaptive and personalized learning experiences, and leveraging the principles of game design.

The incorporation of game-based learning into eye health education has garnered significant attention in recent years.^9–12 This emerging discipline has been extensively studied for its benefits and pitfalls.^2,5,13 Researchers have emphasized the potential of educational digital games in contributing to an interactive and dynamic learning process, leading to a clearer and more functional understanding of various scientific concepts and phenomena.

Driven by a commitment to optimize learning outcomes through active learning strategies, a team at a leading eye care centre embarked on developing gamified e-learning modules for their course curriculum. This multi-disciplinary team comprised subject matter experts, educators, administrators, game developers, and design specialists. The team adopted a multidisciplinary approach to develop game prototypes suitable for a course design and a set of learners. The key aspects of the gamification process included our thorough review of the curriculum, mapping learner competencies, data collection for designing e-learning games, the scope of resources, and team collaboration. In this paper, we aim to explore the developmental challenges of creating e-learning games for eye health education and propose strategies to overcome them

Methods

Ethical approval for this qualitative study was obtained from the Institutional Review Board of L V Prasad Eye Institute Ethics Committee (IRB Approval No. LEC-BHR-P-05-22-847). Verbal informed consent was obtained from all participants prior to participation, and the study was conducted in accordance with the principles of the Declaration of Helsinki.

Focus group discussions

Qualitative data were collected from three focus group discussions¹⁴ involving all the collaborators and the technical and instructor teams. A total of 3 FGDs were conducted, and the mean age of participants was 33 ± 5.24 years.

The objective of the FGDs was to consolidate different challenges encountered by team members at different stages of game development. Prior to conducting the FGDs, the educator, the technical team representative, and a study moderator connected through a virtual meeting to structure the discussions. The different phases of game development were identified and labelled.¹⁵ Further field work for each phase included the formulation of open-ended questions¹⁵ by involving the study moderator and game-developer team. Inputs were collected, and further iterations were performed.

The duration of each focus group discussion was approximately one to two hours. The FGDs were designed and moderated by a third person, the study moderator (RKP), who was not a direct participant in game development. The Zoom Platform for videoconferencing was used to conduct and record the FGDs. Given that the FGDs were conducted and recorded online, a research assistant was not required for notetaking. The study moderator initiated the discussion by asking phase-specific open-ended questions to capture participants’ experience in the selected topic of game development. The audio version was transcribed by the study moderator, and the data were analysed with reference to the phase of the game development identified. We used a deductive thematic analysis approach¹⁶ to analyse qualitative data from the focus group discussions. A priori themes were developed based on the study objectives and used to guide the FGD questions. Data were collected under each predefined theme and subsequently analysed to identify key reflections on the challenges encountered at different stages of game development.¹⁵ This structured, theme-based approach facilitated systematic comparisons across focus groups. Figure 1 captures the adopted framework and summarizes the developmental challenges.

Figure 1. Summary of developmental challenges in game development.

Comprehensive list of challenges encountered during each phase of the game development process.

Results

Discussion

Our experiences in developing e-games echoed the common challenges¹⁷ reported in the literature, including limited technical skills, time constraints, inadequate infrastructure, poor communication, and negative educator attitudes. Several studies have proposed strategic approaches to address these barriers and support effective gamification implementation.^17–20 This section presents our strategic approach to addressing the challenges encountered, along with a proposed framework to guide game developers and educators in effective implementation.

Our journey revealed crucial insights throughout the game development process. Notably, the establishment of a robust user feedback loop emerged as a critical step before finalizing the game. Stakeholders, including content creators who identified key information, educators who defined functional needs, and learners who provided user-centric perspectives, all played vital roles in shaping the game. However, user requirements pertaining to the desired level of complexity, implementation strategies, and feedback mechanisms often remained ambiguous. The development team sometimes gravitated towards advanced functionalities, and initially, readily available game platform templates with “plug-and-play” features were viewed favourably. However, custom-built games that demanded coding expertise presented significant cost and development hurdles. Faculty and educators needed to prioritize concepts requiring gamification and carefully map learning objectives to corresponding cognitive skills.

Gamification impacts the motivation, cognition, emotion, and sociality of players.^21,22 To cultivate an engaging learning experience, we incorporated visible game mechanics like scoring and progress indicators, along with the ability to track player metrics. Notably, we consciously avoided implementing punitive measures such as negative grading for incorrect choices. In retrospect, a more structured approach would have been beneficial. Scoping the project upfront, ensuring alignment between requirements and available resources, and setting realistic goals could have streamlined the development process. Our experience emphasizes the importance of iterative course correction, leading to successful project completion. The early recognition of the value of project scoping and the visualization of final deliverables were key takeaways from this endeavour.

Conclusion

Gamification facilitates cognitive learning, serving the broader purpose of conventional teaching and assessment methods. Setting expectations about the use of the final product could help teams make the e-learning game user-friendly. Given that gaming is an active learning tool, gamification can only supplement the traditional modes of instruction and learning. We fulfilled the objective of our project by bringing in fun, making it interactive, and developing a failsafe learning approach to creating games. Given the variety of games available, realistic selection from a predesigned game platform may prevent over engineering to match various levels of user learning. Finally, in medical education, sophistication in digital gaming is best avoided in the interest of learning per se. The two aims of participating in games, achieving players’ focused attention and their playing with great team spirit, must be served well in gamification and game-based learning.