Game on
Video games are for kids only, right? Wrong! Sadat Edroosexplains how such games have evolved
from mere toys into potential learning aids
Level one—introduction
In the time
it’s taken most new doctors to make the journey from cradle to house
officer, things have changed dramatically. Computers, email, MP3
players; all seemed apparently to make life easier, happier, quicker and
more entertaining. Among all the diversions the electronic world offers,
none can be more pointless, costly, engaging, or compulsive than video
games.
LP WOODS
More than an infantile compulsion, video games are big
business. Fiscally the business as a whole has often been quoted on a par
with the Hollywood movie industry. The average age of a video game player
has changed, too. The first video games were largely made for children, but
the Nintendo generation of the 1980s has now grown into their 20s and 30s.
1
2
Technology has matured in leaps and bounds. The
graphics of early games were limited by technical constraints and bear
little similarity to the photo-realism of today. A prime example is Super
Mario, lead character of Nintendo’s consoles, whose appearance has
transformed over the years. 3
In his first appearance, he was given a hat to hide
the fact that the console couldn’t draw hair. Nowadays it would be
possible to draw every hair on his head.
With a combination of an older audience and the
ability to make more realistic games, many games are now made exclusively
for adult players, with titles such as Resident Evil
"tbbref">4 being awarded
“18” certificates based on their “interactive horror
movie” content. As the video game generation enter their mid-20s, the
long term effects of a youth spent in front of games consoles are only now
coming to light.
Level two—changing the way we see the world
Too much of anything can be bad for you. In the case
of computer games various reports indicate both physical and psychosocial
effects, ranging from hand-arm vibration syndrome to poor academic
performance. 5
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And as with any form of media, exposure to violent
situations is increasingly thought to lead to aggressive behaviour
patterns. From time to time a teen shooting spree is attributed to the
influence of excessive game play and the re-enactment of super violent
scenarios.
But it’s not all bad news. Games require a
degree of hand-eye coordination, and their use can be seen as a form of
training in visuospatial skills. Although persistence will help you reach
the next level, it may also have a wider impact on everyday life.
Researchers found that the type of perceptual learning a game player
unwittingly undergoes leads to improvements in a range of visual skills.
They found that video game players have an enhanced attentional resource,
with wider fields of view, a larger capacity to focus attention over time
and better ability to switch tasks. 7
Extrapolating this into the real world, imagine a
couple trying to get to work. The games player may see his bus in the
corner of his eye, run across the street without getting hit, and get to
the stop in time while finding the correct change in his pocket and putting
the cigarette out that he’d just lit. The games player’s
partner, who last night complained about how much time he spends with the
Playstation, never even sees the bus that knocks her over.
On the other hand it could just be that people who are
good at video games do well in these tests because they were born with
better visual skills. That might be why they like playing them. However,
the same researchers took a group of non-game players, and made them play
for an hour a day over 10 days. Some played an action game, with lots of
shooting and moving around, while others played a relaxing, sedate puzzle
game. The first group, who were simultaneously managing several tasks, did
much better in tests of visual ability than the second group. In other
words, you don’t have to be good at video games to learn skills from
them, although the type of skill you learn depends on what situation the
game puts you in.
Bonus level—being a medical student without the
exams
Computer games may be useful in disposing of an
irritating partner, but is there any excuse for playing them when you
should be studying? Funnily enough the answer may be yes. Medicine has been
the subject of a few games. Life and Death 8
(1992) cast the player as a lowly junior doctor,
managing patients who had been admitted to the surgical department. With
the benefit of a brief history, a patient is examined by running the mouse
over their abdomen and clicking to palpate. Any reaction guides your
further investigations and management, choosing between x rays,
ultrasounds, referral, or discharge. Make a mistake and the nurse points
you in the direction of the lecture theatre and a dressing down from the
professor. The manual is informative on surgical principles, and although
it might not be an all encompassing revision tool, the game is surprisingly
instructive.
Theme Hospital 9
(1997) turned the tables, sending the player to the
Dark Side of hospital management. The game allows you to build your
hospital, picking the different equipment and types of treatment on offer.
Fittingly, the aim is to have the happiest patients while making as much
money as possible.
The latest games console, the Nintendo DS, has changed
the way games are played. The small handheld machine is released in Europe
this March. Rather than the traditional control pad and buttons, DS has a
touch screen, like a personal digital assistant. Actions can be performed
by rubbing a pen across the screen. Equipment originally used to put phone
numbers into electronic diaries has now been used to move characters around
and shoot at things. 10
Imaginative game designers, influenced by Life and
Death, have transferred this input device into a surgery game, Tendo Dokuta
(2004). 11
As before, the screen shows a picture of an acute abdomen or
a surgical field. This time, instead of a mouse or control pad, the player
wields the console’s pen stylus like a scalpel. By running the pen
over the abdomen the player can look for signs of tenderness in the virtual
patient’s face, and with these clinical findings an operation can be
chosen. Cuts are then made using the stylus to carry out the procedure on
screen.
Later this year, an ER
video game inspired by the television series, is due to be
launched. In the game, the player joins the ER
team as a newly hired intern and handles a steady flow
of patients. Through it all will deal with ethical dilemmas and engage in
romances. With perseverance, the player will gain prestige among players
and supervisors and ascend the ranks of Chicago’s County General
Hospital.
Final level—medical school in a laptop
The medics of the future will see technology have a
bigger role in their lives than ways to spend spare time. Games may have
driven the ability to create and manipulate a graphical image, but other
developments have allowed the creation of medical simulators. “We see
that there are several things colliding in space at the right time, which
will allow a greater deployment of computer based simulation,”
explained Ross Horley, director of Medic Vision Limited, a company at the
forefront of these changes. 12
The technology to create these simulations is becoming
cheaper and therefore more accessible. Force feedback has allowed a level
of tactile imitation that is altogether more complex. And with demand for
methods of training that are proficiency based and can measure directly how
good a trainee is at a task, simulators seem to be the way forward.
New developments in the field of haptics have made
these simulators more realistic. Haptics aim to recreate the perception of
solid objects by means of force feedback. In its most primitive form, this
tactile feedback is used in computer game controllers and mobile phones,
making the handset buzz when something happens on screen or a text message
arrives. Haptics takes this idea to a much higher level of sophistication.
“Screen based, minimally invasive procedures are perfect for a
simulator; we just need to generate the feel through the instruments. With
haptics we can simulate the hardness of bone, the softness of tissue, the
elasticity of skin,” continued Horley.
“What you see on the screen is the other end. So
we can render a graphical data set to look realistic and apply a haptic
overlay. Through an interface device which will plug into your computer we
can feel the virtual model.” Though the models are realistic in
appearance and texture, they also act the way you’d expect them to
while being cut open. “We can simulate deformation characteristics of
under a millimetre—which is similar to your thumb and forefinger just
touching.”
These machines have obvious applications in the
medical industry, from surgical and anaesthetic training for postgraduates
to anatomy training for medical students. The culture of training is
changing, and this concept looks set to play a key role. “There will
be testing for proficiency, moving from knowledge-based to
proficiency-based education. Computer e-learning concepts [and] simulation
products will be commonplace.”
“We are at this point where there is a huge
shift. We are on the very first rung of a very steep, exponential
ladder,” he concludes. “It’s taken a while to get here,
but it is easy to see now that the road ahead is a good road. Three years
ago it was difficult. People thought we were crazy doing what we’re
doing.
Sadat Edroos, final year student, Warwick Medical School
Email: sadat@edroos.co.uk
studentBMJ 2005;13:89-132 March ISSN 0966-6494
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- Grossmann L. Busjacking for grownups. www.time.com/time/archive/preview/0,10987,384808,00.html (accessed 17 Jan 2005).
- The evolution of Mario. http://nfg.2y.net/games/mariosprites/ (accessed 9 Jan 2005).
- Resident evil. http://capcom.com/re4/ (accessed 9 Jan 2005).
- Cleary AG, McKendrick H, Sills JA. Hand-arm vibration syndrome may be associated with prolonged use of vibrating computer games. BMJ 2002;324:301.
- Gentile DA, Lynch PJ, Linder JR, Walsh DA. The effects of violent video game habits on adolescent hostility, aggressive behaviors, and school performance. J Adolesc 2004:27;5–22.
- Green CS, Bavelier D. Action video game modifies visual selective attention. Nature 2003;423:534-7.
- Life and death. www.the-underdogs.org/game.php?gameid=636 (accessed 9 Jan 2005).
9. Theme hospital. www.the-underdogs.org/game.php?id=2079 (accessed 9 January 2005).
- Nintendo DS. http://ds.nintendo.co.uk (accessed 30 Jan 2005).
- Tendo Dokuta. www.spike.co.jp/tendo-dokuta/ (accessed 17 Jan 2005).
- Medic vision. www.medicvision.com.au (accessed 10 Feb 2005).
