Gameplay

Starting a game

• After logging in, click on ‘Start a game’. You will then be prompted to enter a game code that you should have received from a teacher.

• Following this, you can choose a name for your character in the game - this is optional, so you may also leave this field blank.

Dashboard

• Upon clicking on ‘Start’ you will be taken to the Departmental Dashboard. This provides an overview of all the virtual patients who are currently in the A&E department. You can swap between this view and a ‘Bird’s Eye View’ of the A&E department by using the menu on the left-hand side of the screen. There is also a list of ‘Discharged Patients’ that you may want to return to later once you have actually discharged virtual patients from the A&E department - you will then also find Feedback on your performance in this section.

• At the top of the screen, there are some additional options, e.g. an ‘End Game’ button and a display of the number of turns you have used (see below). Finally, notifications that come up during the game will be visualised as numbers close to the bell icon.

• For each of the patients in the list, you can see their names, sex and age, presenting symptom and how they arrived at the A&E department (either walked in or brought by ambulance).

• At the start of a game, none of them will have a diagnosis, and you will be able to assign a diagnosis to them later. At this stage, patients cannot be discharged as they need a diagnosis and a completed discharge form first (this information is also given when you move the mouse over the greyed out ‘Discharge’ option).

• Depending on your priorities as derived from the initial information on patients, you can now choose which patient you want to attend to first by clicking on ‘Review’. You will then be asked to assign the patient to either a Majors or a Resus Room by using the drop down menu and clicking on “Move”. This will take you to the Patient Overview.

Patient Overview

• The Patient Overview is the principal interaction space with a virtual patient.

• The basic information from the Dashboard is visible on the right, underneath a AI-generated face of the patient. The colour of the skin my give you a hint towards the underlying condition.

• Please note the little grey pencil icon on the far right - you will need this a lot as clicking on it will allow you to add patient notes that will be saved in the Documentation (see below).

• At the bottom, there are two blue buttons allowing you to either make a diagnosis or move the patient (using drop-down menus that will appear upon clicking on one of the buttons.) Some of the options to move a patient will only become available once you have established a diagnosis and completed the discharge form.

• The Patient Overview also features the Observations Chart. Click on “Take Obs” to get a first reading of blood pressure, heart rate, respiratory rate and oxygen saturation of your patient. Blood pressure and heart rate will also be displayed in the graph.

• The x axis displays the Turns at which observations were taken. In this game, Turns represent time as well as a sort of currency. Thus, each action “costs” a number of Turns (e.g., taking observations ‘takes’ 1 Turn while any part of the physical examination takes 2 Turns). Using more Turns means spending more time - this is important as laboratory and investigation results will take a certain amount of Turns to be revealed.

• You will need to find the right balance of taking enough Turns to get those results back and not wasting too many Turns on things you may not need - the number of Turns per game is limited which is meant to help you set the right priorities.

Chat

• The Chat option in the menu on the left hand side allows you to take a history from the patient.

• Just enter your question and press Enter (or hit ‘Submit’). In order not to forget the information you obtained from the chat, please make sure to click on the grey pencil icon underneath the patient photo and enter everything you thought was important as a patient note. Once you close the chat, the entire conversation will disappear.

Examine

• The next option on the left-hand side menu is the Examine function. Clicking on this will open another vertical menu containing all parts of the physical examination.

• Choose one at a time and click on the blue ‘Examine’ button at the centre of the screen. All parts of the body you have already examined will move to the top of the vertical menu, and findings will remain visible as long as you keep on examining your patient.

• Again, please make sure to take notes of all the important findings by clicking on the grey pencil as - just like the chat - the findings will disappear once you click on any other option on the left-hand side.

Tests

• The fourth option on the left-hand side menu is called Tests. This encompasses a Blood Test Ordering form, access to Blood Test Results as well as to Investigations. These options will be shown as you move the mouse over the Tests icon.

• If you would like to order Blood Tests, click on the appropriate icon, choose the values you want to know and finally click on ‘Order’ (top right). This will automatically take you to the Blood Test Results page. Blood Gases will be displayed immediately.

• However, you will need to spend a number of Turns before all other results become available. Values that are above or below the norm will be highlighted in red.

• If you want to order Investigations, click on the appropriate icon and choose an investigation from the drop-down-menu. You can also type in a few letters in order to facilitate the search for the investigation you are looking for. You may also set the priority for each investigation you would like to order. You will not be able to order investigations without justifying them. Please explain why and how an investigation will help in that specific clinical scenario before clicking on ‘Submit Order’. Results will be shown as ‘Pending’, and - eventually, i.e. after spending a number of Turns - as ‘Available’. Each report comes with an additional pencil icon that can be used to enter comments on that particular investigation result.

• Any Blood or Investigation orders will automatically be copied across to the Documentation (see below) but results (and comments on these) will not be copied. Thus, you will need to take care to check for those results and enter all relevant information in the Documentation by clicking on the grey pencil underneath the photo and adding a patient note.

Treatment

• Treatments encompass drugs and other forms of treatment, and by moving the mouse over the Treatment option, you will be shown two additional buttons to choose from.

• Drugs can be found in the drop-down menu, and typing a few letters of the drug you would like to administer considerably speeds up this process. Once you have found the drug, simply click ‘Add drug’, and you will be able to see any effects that drug may have on vital signs if you take new observations in the Overview.

• Treatments other than medication can be ordered the same way as Investigations - again, you will need to provide a justification before being able to Submit your order.

Specialty Consultations

• Specialty Consultations can be ordered by clicking on the respective item in the vertical menu on the left-hand side. After selecting the desired specialty from the drop-down menu, additional information on the patient and a reason for referral need to be entered into the respective boxes.

• Once the request has been submitted, the consultation will appear in the section ‘Pending Consultations’ and once results have been returned, it will be moved to ‘Available Consultations’.

Documentation

• Hovering over the Documentation icon opens up two more options: View Notes and Discharge Form.

• The patient notes are automatically populated with in-game actions so you can see what you did at what turn. However, findings and their interpretation will not be copied across to these notes so you will need to enter all relevant information by clicking on the grey pencil underneath the patient photo.

• The Discharge Form needs to be completed before a virtual patient can be discharged or moved to another ward/department. It comes in two types - please choose by clicking on ‘Admission’ or ‘Discharge’. If you are planning to discharge a patient, simply complete the three sections of the form (‘Presentation’ / ‘Actions Taken’ / ‘Follow-up’) and hit ‘Submit’.

• Once a diagnosis has been made and the right form has been completed, a patient can be moved by clicking on the button ‘Move’ on the right-hand side at the bottom of the screen. Alternatively, you can return to the Dashboard (see button in the upper left corner of the screen) and discharge patients from there.

Guidelines

• Finally, if you need to look up the management of a specific clinical problem, you can find a selection of Guidelines by clicking on the last icon of the vertical menu on the left-hand side.