“Hello, you must be Flo!” is the first European Virtual Gaming Simulation (VGS). The intended audience is baccalaureate nursing students, however, many of the learning objectives are also relevant to other healthcare disciplines:  

• Provide person- and family centered health care in the home environment using an interprofessional model.   
• Address functional impairment of the older adult.   
• Support self-management of the older client with diabetes mellitus type 2.  
• Apply the basic principles of prevention and management of complications of diabetes mellitus type 2.   
• Select appropriate therapeutic communication skills in alignment with the client’s health literacy.   

This first generation European VGS is designed for online distant learning. With this approach, “Hello, you must be Flo!” can be assigned to learners to be played individually at home, from prebriefing to debriefing.  One of the most important principles of teaching or learning with virtual gaming is that a sound pedagogical process must be followed to maximize learning. This process includes prebriefing, enactment, debriefing and ongoing evaluation of learner knowledge gains and satisfaction. 

Prebriefing 

Prebriefing is an information or orientation session given by the facilitator to prepare learners for the virtual gaming simulations experience prior to enactment. Prebriefing contributes to a safe learning environment so that learners feel comfortable making decisions, initiating actions, and sharing their experiences. When learners will be playing the virtual gaming simulation individually, the prebriefing should occur as soon as the virtual simulation has been assigned.  

The online prebriefing of “Hello, you must be Flo!” provides teachers and learners with information about learning outcomes, online environment and technology requirements. The ground rules of simulation are explained; fiction contract, confidentiality and safety. The case report is the last step to prepare the enactment or simulation scenario. 

In “Hello, you must be Flo!” the learner or user assumes the role of Flo Becaspin, a caregiver of a primary health care team. The patient is Mrs. Nelly Flament, a 72-year-old client with type 2 diabetes on self-management. Mrs. Flament has missed two previous appointments (‘no show’) at the health care centre. Now, Flo is reaching out to her during an announced home visit. 

“Hello, you must be Flo!” promotes the application of knowledge and skills related to self-management support of an older adult with type 2 diabetes aligned with the client’s health literacy during a home visit.  
The user needs a foundational knowledge of diabetes, gerontology, health literacy and primary care.  As a presimulation preparation, it is advised to review the content of textbooks or class notes related to these items. It is important that every learner understands these contents before applying it in this virtual gaming simulation.  

To contribute to a safe learning environment, we advise facilitators to be clear to their learners if this simulation experience will be graded are not. If marks are given for participation, explain how they will be awarded and whether a rating rubric will be used (Verkuyl et al., 2022). 

Detailed information for the prebriefing is included in our VGS “Hello, you must be Flo!”.

Enactment 

Enactment is the term used for playing the scenario of the virtual gaming simulation. The scenario of “Hello, you must be Flo!” begins with a movie clip in which the learner, in the role of Flo Becaspin, approaches Mrs. Flament’s house and rings the doorbell. Mr. Flament invites Flo to come in. 

How the home visit proceeds, depends on the decisions made. “Hello, you must be Flo!” consists of a total of 19 decision points. At each decision point, the participant chooses the best action to take.   

• If the best choice is made, the game continues. The following video provides information about why this is considered the best choice for this home visit and builds up to the next decision point.   
• If the wrong or not the best answer has been chosen, written feedback and/or a short video clip will invite to rethink about the chosen answer. You can choose another option to progress in the enactment.

With the focus on remote learning, learners can play this game individually. A major advantage of this approach is that the learners have control over the experience. They determine when and where to play the game; they can take as much time as they want to complete the game and they can choose to replay the experience as often as they want. Learners usually find this psychologically safe, as they can make choices without the influence of others and mistakes are made privately. Learners also obtain a true picture of their knowledge and skills related to the simulation content because they are making decisions independent of peer influence decisions (Verkuyl et al., 2022). 

Debriefing 

Debriefing is considered an essential part in all types of simulation. During the debriefing, learners respond to the client scenario, think critically about their performance, and identify gaps in knowledge so that they can plan for future learning to apply concepts as professionals in real-life clinical situations. 

For this first generation Envision VGS, with a focus on self-directed remote/distance learning, a structured self-briefing tool was developed and integrated into the VGS with H5P content types. An advantage of the self-briefing is that learners can reflect on their decisions without the influence of peers. Self-debriefing may also be considered when other debriefing options are not practical.  
To encourage students to think critically, the open debriefing questions were supplemented with guided debriefing questions, designed according to the learning objectives to be achieved. 
An important limitation of the self-briefing is that learners do not have the opportunity to hear what decisions their peers have made and what their facilitators think about those decisions (Verkuyl et al., 2022). Therefore, a specific question was integrated into the self-briefing tool, allowing the facilitators to reflect on the need to organize a group discussion after the self-briefing. 

Evaluation

Educators routinely evaluate their teaching and learning activities and virtual gaming simulation should be no exception. 

• Evaluation questions may include: 
  • Did the learners learn? 
  • What actions or activities contributed to learning? 
  • Was my facilitation technique or strategy effective? What could I do better? 

An important principle of evaluation is not to try to answer all questions in one evaluation. It is a good idea to clarify the scope of the evaluation in the initial planning stage.  A helpful way to get started is to develop a list of questions that the teaching team most wants answered and which can be answered. 

An example of the evaluation of “Hello, you must be Flo!” as used at the Artevelde University of Applied Sciences is enclosed in the user guide. 

Reference (2023):  
Verkuyl, M., Goldsworthy, S., & Atack, L. (2022, February 28). Using Virtual Gaming Simulation: An Educator’s Guide. OER Pressbooks. Retrieved September 19, 2022, from https://ecampusontario.pressbooks.pub/vgsguide/