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“SURVIVOR” TORCHES “WHO WANTS TO BE A PHYSICIAN?”
IN THE EDUCATIONAL GAMES RATINGS WAR
Mary G. Howard, Heidi L. Collins, and Stephen E. DiCarlo
Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan 48201
W
ADV PHYSIOL EDUC 26: 30 –36, 2002;
10.1152/advan.00014.2001.
Key words: educational tool; collaborative learning; education; pulmonary physiology
Our goals as educators are to develop life-long learners and students who are capable of solving novel
problems. These are our goals because much of the
knowledge that will be employed in the students’
future career is not known today and therefore must
be learned after graduation (5). Furthermore, only a
small portion of the current body of medical knowledge can be taught in four years, and not all that is
taught is learned or remembered. Some of what is
taught is erroneous, and other material will soon be
obsolete (5). Therefore, students must be capable of
working together and gathering evidence, evaluating
it, and learning from it. However, much of what we
do in classes with large numbers of students conflicts
with our goals. These activities do not prepare students for solving novel problems because many of
these activities encourage memorization of detailed
information. As a result, retention of acquired knowledge is short lived, and grades do not correlate with
problem-solving abilities or retention of knowledge.
Educators are therefore challenged to develop activities that promote cooperative learning and recognize
the importance of developing a capacity for gathering
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e recently developed an educational game for reviewing respiratory
physiology in a large classroom. The “Who Wants to be a Physician?”
game encouraged medical students to be active participants in the
learning process. An evaluation of the game documented that students enjoyed the
active format, and the students reported that the game enhanced their ability to
understand and retain information. However, the evaluation also revealed that the
game had limitations. Specifically, the students recommended the use of multiplechoice questions to match the Medical Board Examination format and to speed up
the game (i.e., cover more topics). The students also wanted to increase their level
of participation and interaction. Finally, we wanted to emphasize the benefits of peer
instruction as a collaborative learning tool. To address these limitations, we designed
a new game, “Survivor.” Survivor incorporated multiple-choice questions and emphasized peer instruction and a capacity to gather information and solve novel
problems. In addition, participation was increased by including the student audience
in the game. Finally, an evaluation instrument was utilized to assess the effectiveness
of this instructional tool in an academic setting. As a result of these improvements,
the evaluation documents that the newly developed tool is a more effective educational game that couples fun and creative excitement with proven and effective
educational concepts.
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Suggestions for Play
To emphasize the benefits of peer instruction as a
collaborative learning tool, students who were interested in participating directly in the game were asked
to form tribes of three people. The tribe names were
placed into a hat, and three tribes were selected to
participate by drawing names out of the hat. At the
start, a question from the PowerPoint file was projected on the screen and directed to the first tribe.
The members of the tribe were encouraged to discuss
and formulate their answer. This method of conferring reinforced the principles of peer instruction, a
cooperative learning tool in which students work
together to solve problems and find solutions. After
deciding on the correct answer, the tribe answered
the question.
In an effort to enhance students’ attention as well as
increase class participation, the student audience also
participated in the game. Specifically, each student
audience member was given five colored sheets of
paper labeled A (red), B (white), C (blue), D (green),
and E (yellow). Once a tribe answered a question, the
student audience was encouraged to discuss the question and the answer. Subsequently, the student audience signaled, by using their colored letter, if the
answer was correct (2). That is, the student audience
used the colored letters to answer the question presented to the tribes. The student audience answered
the question by holding up the appropriate colored
letter. All members of the student audience held up
their choice of colored letter at the same time. These
procedures increased class participation as well as
allowing us to determine immediately, by observing
the sea of colors, whether the students understood a
particular concept. If the majority of students answered
correctly, we moved on. However, if a significant number of students answered incorrectly, the concept was
reviewed. Students enjoyed this activity and appreciated
the opportunity to assess their own understanding as
well as participate in the game. When the tribe answered the question correctly, the next tribe was presented a question. This continued until a tribe answered
the question incorrectly or a conflict in answers between the tribe and the student audience occurred. At
that time, a member of the audience displaying the
correct answer explained the correct concept.
MATERIALS AND METHODS
About the Game
The Survivor game was designed to be based loosely
on the popular television show Survivor. The game
was designed for first-year medical students who had
completed the pulmonary section of a medical physiology course.
To match the Medical Board Examination format and
to speed up the game (i.e., cover more topics), 108
multiple-choice questions in the area of pulmonary
physiology were developed. The questions were then
entered into a PowerPoint file. Once the files were
constructed, slides for each question were created.
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evidence, evaluating it, and learning from it. To this
end, we recently developed an educational tool for
reviewing pulmonary physiology in a large classroom.
The “Who Wants to be a Physician?” game encouraged students to be active participants in the learning
process (3). An evaluation of the game documented
that students enjoyed the active format, and the students reported that the game enhanced their ability to
understand and retain information. However, the
evaluation also revealed that the game had limitations.
Specifically, the students recommended the use of
multiple-choice questions to match the Medical Board
format and to speed up the game (i.e., cover more
topics). The students also wanted to increase their
level of participation and interaction. Finally, we
wanted to emphasize the benefits of peer instruction
as a collaborative learning tool. Peer instruction has
been shown to promote critical-thinking, problemsolving, and decision-making skills (4). Therefore, we
designed a new game, “Survivor,” based loosely on
the popular television show. Survivor used multiplechoice questions and emphasized peer instruction
and a capacity to gather information and solve novel
problems. In addition, student participation was increased by including the student audience in the
game. As a result of these improvements, we believe
that the newly developed game Survivor is a more
effective educational tool, which couples fun and
creative excitement with proven and effective educational concepts.
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addition, a general comment section was included for
any additional suggestions or comments.
To couple fun and creative excitement with a proven
and effective educational concept, a member of the
tribe was voted off the tribe when a tribe failed to
answer a question correctly. Specifically, when the tribe
answered a question incorrectly, members of that tribe
voted one of their own members off the tribe. The
member voted off the tribe joined the student audience.
When a tribe was down to two members and an incorrect response was given, the student audience voted a
member off the tribe. The game was concluded when
only one member remained. The last person to survive
was declared the winner of the game and was awarded
a certificate of achievement (Fig. 1).
RESULTS
Approximately 72% of the students attended and participated in the Survivor game. This reflects an increased
attendance over the number of students who had attended and participated (50%) in the Who Wants to Be
a Physician? game (3). It should be noted that this attendance is also considerably higher than the attendance at
traditional review sessions offered by other sections of
medical physiology. This increased attendance may be
due to several reasons: prior encouragement by instructors, formatting of class lectures, and feedback from
previous years’ game participants.
Evaluation
To determine the effectiveness of the game as an
educational tool, we used a survey (Table 1) as the
evaluation instrument (1, 3). All students were encouraged to complete the survey after playing the
game. Twenty-seven statements were employed to
evaluate five general areas: 1) goals and objectives, 2)
participation, 3) content, 4) components and organization, and 5) summary and recommendations. Students were asked to evaluate the extent to which they
agreed with the statements on a scale from 1 to 5 (1,
strongly disagree; 2, tend to disagree; 3, neither disagree nor agree; 4, tend to agree; 5, strongly agree). In
At the completion of the game, students were given
the survey to evaluate the effectiveness of the game as
an educational tool. One hundred seventy-nine students returned the evaluation. This is an increase of
70 students who returned the evaluation form over
the number of students who returned the evaluation
form for the Who Wants to Be a Physician? game (3).
This also represented a 100% response rate of those
attending the session. The evaluation survey and the
responses of the students are presented in Table 1.
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FIG. 1.
Certificate of achievement awarded to the winner of the Survivor game.
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Table 1.
Evaluation of instructional materials on pulmonary physiology
Results
Goals and objectives
1.
2.
3.
4.
The purpose of and rationale behind the materials are fully explained.
The goals and objectives of the materials are clearly identified.
The content of the materials is directed to the achievement of the stated goals and objectives.
The assessment techniques that measure student achievement of the goals and objectives are included in the
materials.
4.6 ⫾ 0.05
4.6 ⫾ 0.05
4.7 ⫾ 0.04
4.5 ⫾ 0.05
Participation
How would you characterize your involvement in the game?
There was much opportunity for participation.
*See below
The amount of collaboration was sufficient.
The collaboration facilitated my understanding of respiratory physiology.
3.8 ⫾ 0.08
4.3 ⫾ 0.06
4.4 ⫾ 0.06
4.4 ⫾ 0.06
Content
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
The questions were clear.
The answers to questions were clear.
Contains challenging and motivating materials for this subject matter.
Teaches basic information which must then be integrated to understand broader concepts and mechanisms.
The game was free of confusing or conflicting concepts and mechanisms.
There was sufficient elaboration/discussion of respiratory concepts in answers.
The materials clearly identify major points of understanding.
There is a thematic organization of content to develop higher level thinking skills.
I found the questions interesting and stimulating.
The overall material presented in the game was challenging but appropriate for my level of education.
4.3 ⫾ 0.05
4.2 ⫾ 0.06
4.5 ⫾ 0.05
4.4 ⫾ 0.06
4.2 ⫾ 0.06
4.3 ⫾ 0.06
4.6 ⫾ 0.05
4.4 ⫾ 0.06
4.4 ⫾ 0.05
4.5 ⫾ 0.05
Components and organization
20.
21.
22.
23.
The materials were clear, concise and easily understood.
The materials were not too lengthy or complex in their format.
The structure and layout of material facilitated learning and did not distract from the information being presented.
An opportunity to assess an individual’s understanding through questions and answers was provided.
24.
25.
26.
27.
28.
These materials fulfill the goals and objectives as stated in the introduction.
This method of presenting material was as effective an any other I have encountered.
These materials were educationally attractive due to the novelty of their style and format.
The interactive nature of these materials facilitated my learning of this content area.
I would recommend the development and utilization of similar materials for other content areas.
4.4 ⫾ 0.05
4.3 ⫾ 0.07
4.5 ⫾ 0.05
4.5 ⫾ 0.05
Summary and recommendations
4.6 ⫾ 0.05
4.4 ⫾ 0.06
4.6 ⫾ 0.05
4.6 ⫾ 0.05
4.5 ⫾ 0.05
Evaluation instrument designed to assess the educational tool, including results expressed as means ⫾ SE. Students responded to the
following. The following statements evaluate specific components of the educational tool on a scale of 1 to 5. Circle the number that most
accurately defines the way you feel regarding each statement. Scale 1, strongly disagree; 2, tend to disagree; 3, neither agree nor disagree; 4,
tend to agree; 5, strongly agree. * Please note that the evaluation instrument was used for both “Survivor” and “Who Wants to Be
a Physician?” educational games. Comment 7, however, addressed a component that was used exclusively in “Who Wants to Be
a Physician?” (e.g., lifelines). Line 7 was left in so that direct comparisons between the two evaluation instruments for the
remaining components could be made.
Category Responses
The evaluation instrument was divided into five
general categories. The mean response for each of
these categories is summarized in Fig. 2. Overall,
the responses were very positive and were signifi-
cantly higher than the scores received for the Who
Wants to Be a Physician? game (3). The goals and
objectives category and the summary and recommendations category were rated the highest, with a
mean score of 4.58 ⫾ 0.03 (vs. 4.53 ⫾ 0.03 for the
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5.
6.
7.
8.
9.
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Who Wants to Be a Physician? game) and 4.55 ⫾
0.02 (vs. 4.48 ⫾ 0.02 for the Who Wants to Be a
Physician? game), respectively. The lowest-scoring
category was participation, with a mean score of
4.21 ⫾ 0.04 (vs. 3.92 ⫾ 0.05 for the Who Wants to
Be a Physician? game). The content category received a score of 4.38 ⫾ 0.02 (vs. 4.28 ⫾ 0.03 for
the Who Wants to Be a Physician? game), and the
components and organization category received a
score of 4.41 ⫾ 0.03 (vs. 4.26 ⫾ 0.03 for the Who
Wants to Be a Physician? game).
Who Wants to Be a Physician? game (3). Similarly,
statement 6, “There is much opportunity for participation,” received a score of 4.3 ⫾ 0.06 (vs. 3.9 ⫾ 0.1
for the Who Wants to Be a Physician? game). Finally,
statement 27, “The interactive nature of these materials facilitated my learning of this content area,” received a score of 4.6 ⫾ 0.05 (vs. 4.4 ⫾ 0.09 for the
Who Wants to Be a Physician? game). Thus these
scores document that the new game increased participation and interaction.
We also changed the questions from short answer to
multiple choice to match the Medical Board Examination format and cover more material. The students
responded favorably to this change. For example,
statement 18, “I found the questions interesting and
stimulating,” received a score of 4.4 ⫾ 0.05 (vs. 4.1 ⫾
0.09 for the Who Wants to be a Physician Game).
Thus these scores document that changing to multiple choice questions improved the game.
Individual Responses
One of our goals was to increase participation and
interaction. In regard to the individual questions
within the categories (Table 1), students responded
to statement 5, “How would you characterize your
involvement in the game?” with a score of 3.8 ⫾ 0.08.
This score is significantly higher than the score received for the same statement (2.9 ⫾ 0.12) for the
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FIG. 2.
A Likert scale was used to determine the effectiveness of the game as an educational tool. All students
were encouraged to complete the Likert scale after playing the game. Twenty-seven statements were
employed to evaluate five general areas: 1) goals and objectives, 2) participation, 3) content, 4) components and organization, and 5) summary and recommendations. Students were asked to evaluate the
extent to which they agreed with the statements on a scale from 1 to 5 (1, strongly disagree; 2, tend to
disagree; 3, neither disagree or agree; 4, tend to agree; 5, strongly agree). This figure presents the
responses for the 5 general categories, expressed as means ⴞ SE. The overall responses of the students
to the game were very positive. Among these scores, the students rated Goals and Objectives highest,
with a mean score of 4.58 ⴞ 0.03. The lowest scoring category was Participation, with a mean score of
4.21 ⴞ 0.04.
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Other questions within the categories (Table 1) received
scores similar to the scores reported in the Who Wants
to Be a Physician? game (3). For example, students
reported that basic information was integrated to understand broader concepts and mechanisms (statement 13,
4.4 ⫾ 0.06) and that the thematic organization helped to
develop higher levels of thinking (statement 17, 4.4 ⫾
0.05). Students also reported that they had an opportunity to assess their understanding through questions and
answers provided (statement 23, 4.5 ⫾ 0.05). Students
also reported that the materials fulfilled the goals and
objectives as stated in the introduction (statement 4,
4.5 ⫾ 0.05).
T E A C H
to work together to answer questions, make calculations, and discuss answers.
Of the 179 surveys returned, 49% (vs. 55% for the
Who Wants to Be a Physician? game) provided written
comments and/or suggestions. Overall, students’
comments were very enthusiastic and encouraging,
including statements such as, “great learning tool, I
enjoyed it,” and “great way to test our knowledge and
level of understanding.” Other students enjoyed the
game because it was “fun and educational too.” Another student thought that the game was “an interesting way to review a large amount of information and
access knowledge.” Finally, a student commented,
“wonderful way of getting students to participate and
want to learn the material.” Most of the suggestions
concerned the pace of the game. These students recommended that a time limit be set for answering the
questions. They felt that this would allow the game to
move faster and in turn allow more material to be
covered and more students to participate in the game.
Teamwork (tribes), collaborative learning, and peer
instruction were important components to the success of this learning experience. It was important that
students felt a sense of responsibility for the success
of their tribes and that the success of each individual
depended, in part, on the participation of the student
audience. Student audience participation kept everyone interested, since the student audience was responsible for determining the correct answer and
correcting misconceptions. Students reported that
there was a sufficient amount of collaboration and
that the collaboration facilitated understanding of pulmonary physiology. Peer instruction challenges students to learn material from a different perspective by
interacting with one another and working together
cooperatively to accomplish shared learning goals.
These activities promote the development of crucial
collaborative social skills. That is, it requires all individuals involved to listen actively, not interrupt, encourage others, be open minded, tactfully defend
one’s views, compromise, give constructive feedback, and show respect for others. This is an important component, because employment opportunities
in the future will require employees to work cooperatively to solve problems and develop solutions.
DISCUSSION
The Survivor game was developed to address limitations associated with our previous educational game,
Who Wants to Be a Physician? (3). Results from the
survey documents that the improvements increased
the effectiveness of the game.
The Survivor game was utilized as a review of pulmonary physiology concepts presented to a class of firstyear medical students. The review was administered
at the end of a 12-hour series in pulmonary physiology. The very high attendance and participation in
the game, approximately 72% of the class enrollment,
suggest a strong interest in this educational tool. During the game, students were afforded the opportunity
As reported for the Who Wants to Be a Physician?
game (3), the students reported that they found the
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Review sessions typically involve an overview of course
materials followed by a period of questions and answers.
These sessions are useful for providing insight into topics that may be covered during the exam. However,
often times, these review sessions are uninformative and
uninteresting, simply a brief lecture on material previously covered. In contrast, the Survivor game was developed to provide a collaborative, interactive, and fun
way to review material. During Survivor, students are
active participants in the learning process and are afforded the opportunity to work together to gather evidence, evaluate it, and learn from it. These studentactive techniques send the message that students can
actively discover, analyze, and use knowledge on their
own. With this participatory empowerment, students
understand that they assume individual accountability
and personal responsibility for their learning.
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Address for reprint requests and other correspondence: S. E.
DiCarlo, Dept. of Physiology, Wayne State Univ. School of Medicine, 540 E. Canfield Ave., Detroit, MI 48201 (E-mail sdicarlo@
med.wayne.edu).
educational tool extremely useful, well presented,
thorough in its content, and valuable in the mechanisms it reinforced from their previous course in pulmonary physiology. What they appeared to value
most was the novel, fun, and innovative method of
reviewing course material. Furthermore, the students
seemed to enjoy the interaction and collaboration that
this educational game encouraged.
Received 2 May 2001; accepted in final form 1 November 2001
REFERENCES
1. Chandler MP and DiCarlo SE. An educational tool for understanding the cardiopulmonary changes associated with aging. Am J Physiol Adv Physiol Educ 267: S17–S36, 1994.
2. DiCarlo SE and Collins HL. Colored letters: a tool to increase
class participation in a large classroom. Adv Physiol Educ 25:
143, 2001.
3. Moy JR, Rodenbaugh DW, Collins HL, and DiCarlo SE.
Who wants to be a physician? An educational tool for reviewing pulmonary physiology. Adv Physiol Educ 24: 30 –
37, 2000.
4. Rao SP and DiCarlo SE. Peer instruction improves performance on quizzes. Adv Physiol Educ 24: 51–55, 2000.
5. West KM. The case against teaching. J Med Educ 41: 766 –771,
1966.
We wish to thank Mr. Michael F. Copado, audio-visual technician,
for his expert technical assistance in setting up the classroom for
the game format.
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Our goal in creating this educational game was to
address the limitations associated with the Who
Wants to Be a Physician? game (3) and provide a fun,
interactive, and innovative method by which students
could learn and review basic pulmonary physiology
concepts. On the basis of the positive feedback, we
believe that the goals and objectives were accomplished. Moreover, we hope that this will serve as a
model for future class review sessions.