Contents lists available at ScienceDirect Nurse Education Today journal homepage: www.elsevier.com/locate/nedt Using a videogame to facilitate nursing and medical students' first visit to the operating theatre. A randomized controlled trial ☆ Ángel del Blanco a , Javier Torrente a , Baltasar Fernández-Manjón a , Pedro Ruiz b , Manuel Giner b,⁎ a Department of Software and Artificial Intelligence, School of Informatics, Complutense University of Madrid, 28040 Madrid, Spain b Department of Surgery, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain ARTICLE INFO Keywords: Videogames Simulation Nursing education Medical education Surgery Operating theatre Novices Stress ABSTRACT Background: First experiences in the operating theatre with real patients are always stressful and intimidating for students. We hypothesized that a game-like simulation could improve perceptions and performance of novices. Methods: A videogame was developed, combining pictures and short videos, by which students are interactively instructed on acting at the surgical block. Moreover, the game includes detailed descriptive information. After playing, students are given feedback on their performance. A randomized controlled trial was conducted with 132 nursing and medical students with no previous experience in surgery. Sixty two (47.0%) were allocated to a control group (CG) and 70 (53.0%) to an experimental group (EG). Subjects in EG played the game the day prior to their first experience in the theatre; CG had no access to the application. On the day after their experience at surgery, all students filled in a questionnaire in a 7-point Likert format collecting subjective data about their experience in the surgical block. Four constructs related to students' feelings, emotions and attitudes were measured through self-reported subjective scales, i.e. C1: fear to make mistakes, C2: perceived knowledge on how to behave, C3: perceived errors committed, and C4: attitude/behaviour towards patients and staff. The main research question was formulated as follows: do students show differences in constructs C1–C4 by exposure to the game? Results: EG reported statistically significant higher scores on the four aspects measured than CG (p < 0.05; Mann-Whitney U tests; Cohen's d standardized effect size d1 = 0.30; d2 = 1.05; d3 = 0.39; d4 = 0.49). Conclusions: Results show clear evidence that the exposure to the game-like simulation had a significant positive effect on all the constructs. After their first visit to the theatre, students in EG showed less fear (C1) and also perceived to have committed fewer errors (C3), while they showed higher perceived knowledge (C2) and a more collaborative attitude (C4). 1. Introduction First experiences of nursing and medical students in the operating theatre (OT) with real patients are always stressful and intimidating. Novices, without a defined role, feel the high-pressure of such a dynamic environment with many health professionals working at once. The student, conscious that he or she may compromise patient's safety, tends to remain passive to avoid making mistakes. As a result, novices feel they are unproductive with a possible negative impact on their future career decisions. While in the surgical block, students have to learn through three domains, (Lyon, 2003), i.e. i) managing the demands of the working environment, ii) the educational tasks, and iii) the learning and social relations of the operating theatre. Students able to successfully manage these will have an enhanced experience. Novice's knowledge, skills and attitudes may be improved imple- menting an OT induction curriculum, as shown by Patel et al. (2012) who compared the results of implementing a didactic lecture, an online Second Life operating room, or a simulated operating suite. This study was the first to address primary exposure of novices to the OT. Novices' knowledge, skills and attitudes were assessed using a behavioural observation scale and a self-report scale, as well as a multiple-choice questions test. The introduction of an OT induction curriculum demonstrated a significant improvement in novices' performance, regardless of the methodology used. The use of a simulated operating suite has been demonstrated to be the most expensive of these training interventions. The use of a didactic lecture displayed promising results. However, it would be necessary to repeat the lecture several times to http://dx.doi.org/10.1016/j.nedt.2017.04.026 Received 26 October 2016; Received in revised form 21 March 2017; Accepted 28 April 2017 ☆ Registered at ISRCTN with number 65353263 (ref: CCT-NAPN-24700; http://controlled-trials.com/ISRCTN65353263). ⁎ Corresponding author. E-mail address: manginer@med.ucm.es (M. Giner). Nurse Education Today 55 (2017) 45–53 0260-6917/ © 2017 Elsevier Ltd. All rights reserved. MARK