Introduction: Given the complexity of teaching clinical reasoning to (future) healthcare professionals, the utilization of serious games has become popular for supporting clinical reasoning education. This scoping review outlines games designed to support teaching clinical reasoning in health professions education, with a specific emphasis on their alignment with the 8-step clinical reasoning cycle and the reflective practice framework, fundamental for effective learning. Methods: A scoping review using systematic searches across seven databases (PubMed, CINAHL, ERIC, PsycINFO, Scopus, Web of Science, and Embase) was conducted. Game characteristics, technical requirements, and incorporation of clinical reasoning cycle steps were analyzed. Additional game information was obtained from the authors. Results: Nineteen unique games emerged, primarily simulation and escape room genres. Most games incorporated the following clinical reasoning steps: patient consideration (step 1), cue collection (step 2), intervention (step 6), and outcome evaluation (step 7). Processing information (step 3) and understanding the patient’s problem (step 4) were less prevalent, while goal setting (step 5) and reflection (step 8) were least integrated. Conclusion: All serious games reviewed show potential for improving clinical reasoning skills, but thoughtful alignment with learning objectives and contextual factors is vital. While this study aids health professions educators in understanding how games may support teaching of clinical reasoning, further research is needed to optimize their effective use in education. Notably, most games lack explicit incorporation of all clinical reasoning cycle steps, especially reflection, limiting its role in reflective practice. Hence, we recommend prioritizing a systematic clinical reasoning model with explicit reflective steps when using serious games for teaching clinical reasoning.
In their developmental model, Stodden et al. (2008) propose age-dependent relations between motor competence, physical activity,perceived motor competence, physical fitness, and weight status thatcan lead to a spiral of (dis)engagement. The goal of this study was toexplore these relations in a large sample of Dutch primary schoolchildren. To our knowledge, this is the first study including all fiveaspects of the model and a large sample of children between four andthirteen years old. Cross-sectional data was collected in 2068 children(ages 4–13), divided over 9 age groups. During physical educationclasses, they completed the 4-Skills Test, a physical activity question-naire, versions of the Self-Perception Profile for Children, Eurofit testand anthropometry measurements. Correlation coefficients per agegroup were calculated (full information maximum likelihood) andtransformed using a Fisher’s r to z transformation, after which thetest-statistic z was calculated. The results show that all five factors arerelated to each other and that a tipping point exists at which relationsemerge or strengthen. Physical fitness is related to motor competenceand physical activity and these relationships strengthen with age. Arelationship between BMI and the other four factors emerges in middlechildhood. Although the model described that physical activity stimu-lates motor competence in early childhood, our data showed that at ayoung age, both motor competence and perceived motor competencehad no relation with physical activity, while they were weakly related toeach other. In middle childhood, both motor competence and perceivedmotor competence were related to physical activity. Our findingsdemonstrate that children in late childhood who have higher perceivedmotor competence are also more physically active, have higher physicalfitness, higher motor competence and lower BMI. Our results indicatethat targeting motor competence at a young age might be a feasible wayto ensure continued participation in physical activities throughoutchildhood and adolescence. Funding source: Netherlands Organization for Scientific Research.
Fully aware of the unusual timing of submitting a commentary 30 years later, we want to reflect on the June edition of the British Journal of Clinical Pharmacology (BJCP) (1993), which featured four research articles on education in clinical pharmacology and therapeutics (CPT) written by our former professor, Theo de Vries, and an editorial highlighting the imperative to improve CPT education, specifically by paying more attention to rational drug prescribing for common diseases.1–5 This plea was illustrated by five cartoons (Figure 1) and formed the basis for the World Health Organization's (WHO) Guide to Good Prescribing and its 6-step. The first four cartoons portrayed the suboptimal state of CPT education as a metaphorical ‘Clinical Pharmacology Continent’ (CPC) and a ‘General Practitioners Island’ (GPI), with a large gap between them. While clinical pharmacologists investigated new drug therapies, general practitioners frequently found themselves unprepared when making rational treatment decisions.1 The final cartoon introduced a solution: problembased learning education, depicted as a bridge connecting the continent and the island. Over the past 30 years, considerable progress has been achieved in bridging the gap. Therefore, we intend to illustrate this transformation with a similar cartoon (Figure 2).
