Discussion
Our study shows that the serious game ‘Underwater’ enhances ultrasound learning. The intervention group completed the exam faster and with less probe lifting during the ultrasound exam. Although the expert score did not differ between the two groups, the accelerometer showed less probe movements in the intervention group. Analysis of the whole group showed an inverse relationship between expert scores and probe movements. The game parameters (for example total playing time, attempts per coin, and contact moments) show increasing skills of the participants as demonstrated by the difference between the first and last level they have played. This indicates the learning effect of the game in probe handling. Finally, the participants positively value the use of this serious game to learn ultrasound and they feel it will help them in acquiring ultrasound skills. They also state that it is a fun alternative way to learn new skills and should therefore be used in ultrasound curricula. These results show that serious games, our research the game “Underwater” are useful for the enhancement of mastering medical technical skills.We did not find any differences between the two groups in ultrasound performance regarding the expert scores. This may be explained by the fact that subtle improvements are difficult to identify when looking at all parameters at the same time, or due to the limitations of the video recording with a mobile device. Another explanation might be that subtle movements did not greatly improve the final ultrasound image, and hence there was no change in expert scores. It is also possible that the gaming time was too short to improve the spatial orientation and hand-eye-coordination skills. In our experience, it generally takes several hours or even longer to learn and improve probe movement skills, suggesting 30 min of playing time might not have been enough. Finally, the short ultrasound introduction for both groups might have been insufficient for performing a real ultrasound exam, limiting the possibility for the game to make a large difference. In future research, different applications and scanning protocols may be used with longer gaming time in advance.To master ultrasound probe movements, several stages of learning may be identified as suggested by Fitts and Posner in 1967 [Serious games are being developed and used to teach medical technical skills, but most games have not demonstrated improved skills in real practice, in contrast to the game ‘Underwater’ used in our study [There are several ultrasound simulators available which may also serve as an alternative way of learning ultrasound. One important disadvantage is the high costs of such a device, and most simulators use real medical simulation and not a game lacking the fun part of gaming.