Using Twine Open-Source Software to Create Serious and Entertaining Digital Games - Enhancing Doctor and Patient Management of Diabetes

Background: Diabetes management is a complex learning process for patients and an area of low confidence amongst junior doctors. Serious digital games allow healthcare professionals to simulate clinical interactions in a safe environment. Many facets of diabetes management, such as carbohydrate counting, also lend themselves to gamification. Our work utilises Twine open-source software to create digital games that facilitate patient and healthcare professional education in diabetes management. Method: Three serious digital games with virtual patients were developed using Twine open-source software, Wacom Intuous Pro, Autodesk SketchBook, Camtasia Studio, and simulated patient videos. Chalk-talk explanations of key concepts are integrated into these cases. A prototype was piloted by a small cohort of medical students and junior doctors and evaluated using the Kirkpatrick model. A detective-themed game was also developed using the aforementioned technology to enable diabetic patients to engage in aspects of management in a safe environment. Results: Pilots with senior medical students and junior doctors have demonstrated high levels of engagement, as well as significant improvements in confidence and knowledge (p