Serious Game-Based Training for Withholding and Withdrawing Life-Sustaining Treatments in the ICU

Overview

Background: Withholding and withdrawing life-sustaining treatments (WWLST) are frequent in ICU and raise important ethical, legal, and communication issues. Despite their importance, specific training on WWLST remains limited. Study Objective: evaluating the impact of a serious game on medical students' knowledge and skills regarding WWLST in ICU Population: The study population consists of 164 medical students who are randomly assigned to two groups Study design: prospective, multicenter, randomized controlled, single-blind study. The study will compare two educational approaches: a 25-minute serious game (SG) and a 25-minute narrated PowerPoint lecture (PPL) Parameters: The primary objective is to assess the impact of the serious game on students' competencies, measured by an Objective Structured Clinical Examination (OSCE) on WWLST in ICU. Secondary outcomes include a multiple-choice 10 questions (MCQ), two Script Concordance Tests (SCTs) immediately after training and satisfaction scales Hypothesis: A serious game-based training program on a highly complex topic such as WWLST in ICU could enable medical students to develop better skills and experience greater satisfaction compared to a conventional teaching method.

The HUGS study ("Helpful Use of serious Game in life-Sustaining withdrawal") is a prospective, multicenter, randomized controlled, single-blind study evaluating the impact of a serious game on medical students' knowledge and skills regarding Withholding and withdrawing life-sustaining treatments (WWLST) in ICU WWLST are frequent in ICU and raise important ethical, legal, and communication issues. In France, these decisions are governed by the Claeys-Leonetti law, which emphasizes respect for patients' wishes, avoidance of unreasonable treatment, collegial decision-making, consultation with an external physician, and documentation. Despite their importance, specific training on WWLST remains limited. The study will compare two educational approaches: a 25-minute serious game (SG) and a 25-minute narrated PowerPoint lecture (PPL). The serious game was developed to strengthen knowledge of the decision-making process, ethical considerations, and communication with healthcare teams and patients' relatives. The primary objective is to assess the impact of the serious game on students' competencies, measured by an Objective Structured Clinical Examination (OSCE) on WWLST in ICU. Secondary outcomes include a multiple-choice 10 questions (MCQ) and two Script Concordance Tests (SCTs) immediately after training, satisfaction with the educational method, and self-assessment of competence following the OSCE. Participants will be medical students in years DFASM1-3 undertaking internships in anesthesia and intensive care departments of the PARABOL university medical group. Eligible participants must be aged 18 or older. Students who have previously completed the serious game or the control training will be excluded. A total of 164 students (82 per group) will be recruited across four centers: Bichat-Claude Bernard, Lariboisière, Saint-Louis, and Beaujon hospitals. The inclusion period will last 12 months. Using a previously published distribution of OSCE scores among medical students (standard deviation = 5 points), and assuming 90% power with a two-sided type I error of 5%, the required sample size was calculated to be 164 participants (82 per group).