End-user Development of Virtual Simulations for Task Training: A Literature Review

Extensive training in a safe environment is key when practicing medical procedures. At Ostfold University College in Norway we are investigating the design and use of games and clinical virtual simulations, shedding light on how these can become more suitable as digital training tools for the medical practitioners at Ostfold Hospital Trust. Previous studies have revealed multiple benefits when using virtual simulations as medical task trainers, as well as various issues regarding design, development and use of these digital tools. One of the issues point to the complexity of virtual simulations and their development cost. In a previous study, we discovered that simulations often lack variation within each training exercise and that the cost of expanding the simulation to better support a varied gameplay with multiple scenarios is high. To understand how these tools can be more beneficial to medical practitioners we have turned to the field end-user development (EUD), which focus on methods, tools and techniques that enable users to make adjustments within different software, modifying them to the user's needs. By combining knowledge from both research fields when designing virtual training tools, medical instructors can be empowered by using a digital toolkit where they can build various adjustable virtual training exercises. In this paper, we will present findings from a literature review focusing on EUD and how this field can improve and give insights into the design and use of serious games and clinical virtual simulations for task training. In addition to literature on EUD and serious games, we have looked at state of the art tools developed for users to create virtual simulations for both entertainment, education and task training. In this review we have identified 1) promising end-user tools for creating virtual simulations for task training, and 2) issues and implications regarding the design and use of such tools. From discussing these findings, the article will recommend the next step to take in developing usable and effective tools for end user development of clinical virtual simulations for task training.