The goal of this study is to access the effect of facilitation on amount of psychological Flow generated in medical students playing a medical serious game. Students will be randomly assigned to play a serious game designed to revise diabetes management knowledge with and without a facilitator and the amount of Flow experienced compared. They will then be invited to partake in a focus group discussion to elicit insights into the mechanism of action governing facilitator-induced Flow

The prevalence of diabetes and their complications is set to increase in line with Singapore's aging population, and the increasing complexities of medicine have left healthcare professionals beyond endocrinology reduced time or interest to seek out clinical sources of rehearsal. Despite having been taught diabetes management, knowledge not practiced fades over time, and delays or errors wrought by uncertainties may result in preventable loss of life or limb. Additionally, while many digital products exist to assist diabetes patients and caregivers, few cater to busy healthcare professionals and fewer account for differing levels of competency amongst them.

To address these needs, the study proposes the development and feasibility testing of a simulation-based diabetes management digital game incorporating a feature allowing for a human facilitator to moderate and personalise the rehearsal activity with consideration for a learner's strength and weaknesses.

The proposed mixed methods study thus presents the following aims:

Feasibility examination of the developed game intervention as an appropriate rehearsal tool for medical students

Comparing the degree of Flow (a state of total cognitive immersion in an activity) experienced by students who play the intervention with and without a facilitator

Generation of preliminary training data to guide either the development of more refined interventions wherein formal training data may be collected, or the direct training of a machine intelligence to assume the place of the human facilitator Map, where possible, the structure of the mechanism of action governing the interaction of facilitation and Flow in rehearsal-based digital serious games The study aims to accomplish these aims by first conducting a two-arm superiority randomised control trial (RCT) comparing the Flow Short Scale (7-point Likert scale survey measuring Flow) scores and in-game game analytics, such as number of correct decisions and reaction times, between students assigned to the facilitated and non-facilitated conditions.

Following this, students assigned to both conditions will be either be invited to partake in a focus group discussion, or given an open-ended questionnaire structured to solicit their attitudes, perceptions, and opinions of the game that may reveal insights into the mechanism of action governing facilitator-induced Flow.

Inclusion Criteria:

• Subjects enrolled in M1 through to M5 of the MBBS program under LKCMedicine.

Exclusion Criteria:

• Students who have previously partaken in play testing of the intervention
• Students not enrolled in the Bachelor of Medicine and Bachelor of Surgery (MBBS) program under LKCMedicine