Featured Work: Large Scale Educational Game for Recognizing Disruptive Behavior in a Clinical Environment

Kirk DesRosier, an Instructional Designer at the Royal College of Physicians and Surgeons of Canada, recently shared an extraordinary educational game on our forums. The game is an “interactive simulation that puts you in the shoes of patient, resident trainee and physician.” 

We were really struck by what this narrative taught us about the inner workings of Hospitals. My knowledge of hospitals is extremely limited, and this project brought to the surface the range of interpersonal considerations that make a well-functioning hospital.  Beyond this insider’s view, a great deal can be learned from this project if you’re in the planning stage of a large scale educational or narrative-driven Hype project. The pacing and user interface design of this project is worth studying.

The project was created to help in recognizing and managing disruptive behavior in a clinical environment by taking the viewer through a medical case and viewing it from multiple perspectives. The educational game also seeks to poll its participants after completing the narrative which allows participants in a medical practice to earn MOC (Maintenance of Certification) points. Please check out the project here.  

As Tumult Hype has matured, we’ve seen larger and more complex projects where video, database integrations, and multiple modes of interactivity blend together to create a seamless experience. I asked Kirk a few questions about what it was like to produce something of this scale. Below we cover how Hype fit into this project, creating the user interface and interaction patterns, and some surprising results received from the poll data collected by the ‘players’.

Daniel Morgan: There’s a lot of elearning tools out there for producing narratives like this. How did you decide that Hype was a good fit for building out the framework?

Kirk DesRosier: It was an educated guess. We have the Adobe Creative Cloud here so I have access to whatever they called Flash now (Animate CC?) as well as Dreamweaver and a few other tools. Animate CC still kind of sucks. For a while they were working on Edge, but they killed it, took the name and merged flash into it. That’s when I found Hype. The new Animate CC is way too much tool for what I needed to do and a steep learning curve. I also found it buggy in the past and Adobe forums and support have never been that helpful to me when I do run into issues.  

I have about 15-20 years of experience building eLearning via various tools and I felt pretty confident Hype would let me do some things that I have not really seen or done before, like having the data visualizations and integrated discussions. I also wanted to go full screen and not many elearning development tools will let you do that.

I started using Hype a few projects ago and they got progressively bigger. I worked on a knowledge translation site where the doctor I worked with wanted to structure info on ‘Navigating Medical Emergencies’ into visual maps. Hype worked well organizing this information. Select any topic except for the drug summaries to see Hype content.

That was the first project where I actually researched what tools were available and Tumult Hype had very good reviews so I thought I’d give it a shot. It stood up well: no bugs, no crashes, great forums and support and I could see that I could go a lot further with it. My next project with Hype was a medical simulation project. That project incorporated video and a pop-up controller window to let an instructor manipulate a simulated patient on a second monitor while going through a critical care case and adjusting things in the case dynamically. Unfortunately I can’t share that document here. Hype worked really well for that project too and I became more familiar with it. I started integrating jQuery into projects to a greater extent.

For the Small Things project it was a natural progression and I did some searching on the forums to see whether there were limitations in size with Hype that might affect me. After some searching I realized it would work just fine. During development I ran into a couple of issues where looping animations were slowing things down but once I got those under control the performance of the project was great. I also had to eliminate a snowfall library I thought was super cool for the early December scenes because it really bogged processing down – not Hype’s fault though. Overall the Hype forums and documentation are great. The biggest issue I had was trying to keep my code concise. I ended up trying to call external functions that were in one .js file as much as possible versus having code attached to things all over the place. And duplicating chunks of code. It’s not that easy to pass variables to a function in Hype but some of that may also be my limited coding skills.

Daniel: Can you tell me a bit about how you decided to carry the narrative? You leveraged video, chat, and primary documents to take the viewer through the story. How did that planning process look on your end and what was this like structuring in Hype?

Kirk: Our unit does a lot of video based clinical learning scenarios so we have that skill in house. That being said, I have to say most of our projects are pretty dry and written in more of a textbook style. I wanted to try something more engaging for this given we wanted to get people to empathize with an entire patient journey and resident experience and the pressures of being part of the staff of a hospital. I did a few small samples of the journal approach and the team liked it so we spent time rewriting the narrative portion and creating journal entries.

The map was a way to tie things together… I was worried that in the end it would look like a scrap-booking project gone mad but I think people bought into it. The final presentation format was an iterative process. We focused on just one point of view first (the patient’s) and I had the main layout with the journal entries ready before we shot video and photos. Some people in my organization were hesitant as to whether doctors would want to have a more game-like experience and there was some discussion about whether they would get the user interface.  It kind of came to me that even older people I know like my mother in-law figured out texting at the age of eighty six so why not focus the UI on texting, something everyone knows.


Hype was really great in some aspects in that I broke down my interface into object oriented components and was able to re-use each new widget I created pretty easily. It also allowed for rapid prototyping and the ability to adjust my images really quickly to tweak things in Hype. My initial vision was to make things totally responsive and Hype would have allowed for that too but I ran out of time. I wanted the phone version to be a complete phone conversation but we didn’t have enough time to set that up. I also really liked the flexibility that using external style sheets gave me. We had to change the handwriting fonts many times. It turned out the during usability testing I realized that a significant portion of the population can’t read cursive anymore so changing the font was super easy via the external style sheet and a few small tweaks in Hype.

Daniel: What were the most interesting or surprising results you received from the polling / Quickbase data?  

Kirk: The data is still coming in –as of today we have about 300 people that have participated and about 60 from our membership which is greater than 45,000 so a long way to go. There are quite a few surprises:

  • People are actually engaged and creating meaningful comments. Professionalism, bullying and harassment in healthcare can be attributed to huge societal problems and resident burnout, alcoholism and even suicide are real. We just had a visiting professor in at lunch today who mentioned that in the UK suicide is considered “just a job hazard” in medicine and that they are trying to change the culture there as well. I’m really surprised at the quality and quantity of comments so far.
  • We collect data about the number of years in practice and total usage span. I was really surprised to find no significant differences between usage spans across the board. By this I mean that people who have practiced for >20 years are using it about as long as people that are <5 and everything in between. I guess everyone likes to have fun.
  • Responses to the polled questions were also surprising. My colleague felt that everyone in healthcare was sick and tired and knew everything there was to know about “Just Culture”. As it turns out this was an overestimation. People seem to know very little going in.
  • People still want more instruction and to make it easier. But at the same time the same people are saying they loved it. Go figure.
  • We are also using a reflective pre-post evaluation to ask people about their knowledge gain in the topics, motivation to use what they learned and any barriers they foresee putting what they learned in action. In addition we have a 2 month follow-up (optional) to see how it went in practice. So far I am astonished at the positive gains people are reporting and the high level of motivation. It will be interesting to see the 2 month follow-up data. I don’t want to get long winded but if we can get enough people who work in healthcare to view this, we can expect some significant outcomes in terms of people being more aware of their behavior and maybe even treating people better…. Maybe even one less suicide.

Daniel: Any future projects planned like this for the hospital?

Kirk: The projects we do are targeted to our membership who work at hospitals throughout Canada and the world. Most of the topics are applicable to larger healthcare teams and International medical workers. There is nothing specific to Canada. The next project is about enhanced recovery techniques; if I can push for a game-like experience I would use Hype. It depends on the subject matter and I don’t know enough about it yet so tool selection is not determined yet.

 I’d definitely like to use Hype again if I can get the time commitment… Things I’d like to tackle are:

  • Integrating the xAPI standard into a Hype project so I can offload data storage, standardized tracking and deal with progress reinstatement more elegantly. You could probably make it a part of Hype’s export feature pretty easily.
  • Integrating AI and NLP. Our organization is responsible for accrediting Canadian Specialists and currently we do this by using standardized patients, essay based questions, multiple choice questions and other techniques that are manually reviewed and marked. I’d like to create a patient encounter that assesses skills and does not simplify things down to being multiple choice questions.
  • More visualization! Many experienced doctors I’ve met talk about a novice approach versus the approach of a more experienced clinician and there is no denying there are differences in skill level. I think being able to visualize those approaches could be very powerful. Imagine if you tried to tackle a simulated patient encounter and could then visually see how you approached it versus your peers or more experienced physicians…. That would be cool! Hype allows me to offload the more menial coding tasks so I can focus on advanced stuff so It’s a great platform.

Thanks for reading!