Assignment 5

Assignment 5 involves a gamified online collaborative activity.

Gamifying the occupational therapy fieldwork toolkit

Design in short: Gamification would encourage students to collaborate on a crowd-sourced psychosocial toolkit of reference materials, tips and information designed by occupational therapy students before, during, and after fieldwork – first for themselves and then for the next cohort of students who follow after them.

Design rationale and original activities

Occupational therapy and other health science students receive education that comes in two parts: a didactic, information-focused section that can last from one to two years, followed by a second part that involves hands-on clinical practice working with patients, with a mentor and teacher typically called a “preceptor”.

In the field of occupational therapy, or OT, this second period is called “fieldwork”, and learning to work with the variety of occupational therapy clients, including those who are homeless, or mentally ill, can be a huge shock to students who have recently been preoccupied with didactic memorizing of concrete muscle groups and functions in the body, and similar learning.

While students practice writing SOAP (subjective, objective, assessment, and plan) notes prior to fieldwork, OT students often do not have the same breadth of reference publications that other health professions can refer to as they care for clients or patients. For instance, student nurses can buy the RNotes flipbook and keep it in a pocket throughout their career; the same publisher, FA Davis, puts out a number of books for OTs but no quick reference for fieldwork. Yet like nurses and doctors, OT students are just as likely to face a client or patient who needs psychosocial help, such as someone dealing with a substance abuse or schizoaffective disorder, and benefit from some kind of reference to help them “reflect in action” and quickly provide an intervention and other client assistance.

I previously worked with two occupational therapy professors who were looking for similar solutions to the fieldwork challenge, and we strategized different ways of building a “toolkit” that their students could fill out or even self-design and take with them as they moved into fieldwork.

With one professor at UT-Medical Branch, a specialist who had a neurological training background (unusual in OT), I introduced the RIME (Reporter-Interpretor-Manager-Educator) assessment method designed by Louis Pangaro (2006), that historically has been used to assess medical residents as they move from data collection (Reporter) to the most sophisticated level of learning while providing care (Educator). This neurological OT, now based at an OT master’s program in Austin, turned the RIME into a self-assessment for students to use at the beginning and later in a semester, and had students track and collect what they were learning in one of the required classes before fieldwork, in Microsoft OneNote, with students expected to use their completed OneNote notebook during fieldwork.

Using a passworded wiki on a learning management system, we also worked out a system of digital SOAP notes and references that a small group of this professor’s students could work on together, to help each other assess and care for clients. These students worked as part of a fieldwork team at the St. Vincent’s Clinic for unfunded patients, in Galveston County.

Working with one of her colleagues, who taught the same cohort about mental health, mental illness, psychological frameworks, and the kind of interventions a OT can use – we decided to test Blackboard Portfolios, which is a very spartan framework that enables individuals to make a HTML container with embedded links and media, and download their work.

The OT mental health professor designed a Blackboard Portfolio template for students to individually fill in reference knowledge they were gaining (see above slide from Collins, Wieland, and del Pino Kloques, 2017, for topics; “FORs” refers to “Frames of Reference,” theoretical bases for treatment, similar to the frameworks or models used in educational psychology). After students filled in this reference knowledge, it then could be downloaded as a HTML-based document to their smartphones. She found, however, that many of the students grumbled about “busy work” and did not truly understand how taking notes and collecting information for their later fieldwork would be meaningful.

These students would benefit from a crowdsourced toolkit, a kind of knowledge base that could be designed during the didactic phases of learning, then downloaded during the transition, with students potentially adding new resources as they tapped them during their fieldwork phase. Over a twelve week course, students could be encouraged to move from a “red light” to a “green light,” collecting and sharing in a knowledge base that would either be downloadable (using the previous Portfolio method of having students submit their own materials, or using a new tool, Nuclino, suggested below) or accessible using an app (a Slack group channel that could be available post-semester’s end if total micro-messages stay under 10,000).

Game ElementsStrategies

Justification / Rationale for Strategies
Level 1 (RED): Reporter
Field Notes
Five points are collected each time a student enters a new piece of written, authoritatively sourced information to a psychosocial diagnosis topic in the fieldwork toolkit: Depression, Anxiety, PTSD, Schizoaffective Disorders, Bipolar Disorders, Other Cluster B Personality Disorders, Cluster C Personality Disorders, Substance Abuse Disorders, and Eating Disorders.
Students would receive three and a half points for linking a written blog post about the topic. Three points would be calculated if the student shares an auxiliary item such as a video, podcast or other secondary source that cannot be used quickly in the clinical setting (just as clinical students are often reprimanded for bringing and drinking coffee in a client or patient room, students should not expect to have the ability to watch a video in a clinical setting, even on their smartphone).
Eight bonus points are collected each time a student is the first to post information in a topic.

Points have a positive impact on students’ sense of competence in a gamified course. (Sailer, Hense, Mayr, & Mandl, 2017).

Using levelling to help students see how they progress, along the path first designed in the RIME framework, may also be considered a form of gamification.
Level 2 (YELLOW): InterpreterGenesis12 (cc BY SA, 2006)
In addition to continued points (5 points as standard, lower points for videos, podcasts, and higher points for being the first to post) for posting new information on frames of reference (Psychodynamic, MOHO, PEO, the Recovery Model, and Allen’s Cognitive Disability), students can collect an internal Digital “Interpretation” badge after collecting 50 points, and responding to at least five submissions of data, resources, or other materials with differential diagnosis information; for instance, if a student has reported information about PTSD in veterans for use in a Veterans Administration fieldwork assignment or a nursing home assignment, another student can provide differential diagnosis to help identify how traumatic brain injury, rather than PTSD, may be the cause of certain actions or needs. Each differential diagnosis addition comprising two or more sentences is worth 10 points.

Badges are not only recommended by Sailer et al., (2017) as another means of motivating students in a gamified course, and developing self-efficacy, but also have been used in nursing education as means of encouraging memorization of difficult topics, as described by White and Shellenbarger (2018) and Wingo, et al. (2019).
Level 3 (GREEN): Manager
Five points are collected each time a student enters a new piece of written, authoritatively sourced information about OT interventions that can be used immediately out of the fieldwork toolkit: Mindfulness, Cognitive Behavioral Practice, Therapeutic Use of Self, other Therapeutic Activities, and Teaching Life Skills (e.g. Assertiveness, Coping, Stress Reduction, etc.)
Students would receive three and a half points for linking a written blog post about the topic. Three points would be calculated if the student shares an auxiliary item such as a video, podcast or other secondary source.
Eight bonus points are collected each time a student is the first to post information in a topic.
Students who collect at least fifty points would receive a digitized avatar of their image and a digital download that they can continue to use, and receive an internal digital badge for Intervention Skills.

Avatars – Sailer et al. (2017) note that avatars can help create or improve a sense of relatedness among students in a gamified course. This is particularly meaningful in occupational therapy, a people-oriented practice.
Level 4(BLUE): Educator
This section of the toolkit could either be used in any fieldwork that takes place during didactic classes, or during the full fieldwork segment of learning, generally a full six month period in the occupational therapy master’s degree program. Five points are collected each time a student enters anonymized information about documentation in their fieldwork, or about the different activities they created for clients they worked with during fieldwork.
Students who collect at least fifty points would receive an open digital badge for OT fieldwork education,which would be visible outside of the university platform, and could be downloaded and used on LinkedIn or other platforms.
Students would also be encouraged to agree to share their existing information a year later with the next cohort when they move to fieldwork; if there is time, this would enable a discussion with the newer cohort as to why the resources used by one cohort or another differ – is it because of something they learned this year? A specific learning experience in the classroom? A specific person worked with or issue encountered during fieldwork?

Badges can also be utilized as an alternative microcredential, as noted by Gibson, Ostashewski, Flintoff, Grant and Knight (2015); an open badge created using Badgr on the adapted OpenBadge model created by Mozilla can also indicate specific skills that this professor or a specific program want to share with the wider world; for instance, successful fieldwork at the St. Vincent Hospital for underserved or underfunded patients could be noted with a single openbadge that could be used by other clinical learners or practitioners in the UTMB system.

The existing platforms that are available for this professor to continue development of the “toolkit” through group collaboration include SharePoint, a Microsoft system available at UTMB not yet opened to all personnel, let alone students at the time I entered doctoral study in 2018; Blackboard’s limited, but built-in class wiki system that is already gradable, and Google Docs or a Dropbox. These are usable without any cost or setup, with SharePoint being the most robust and requiring training for students to use; Blackboard being the clunkiest; Google Docs being the easiest and students being most familiar with it.

Preferred tools would either be a communication system like Slack, which would enable students to collect information in different channels as they gained experience, for instance adding to an individual @Depression, @Eating Disorder, or @Lifestory channel, or a knowledge base development system such as Nuclino, which would enable as many as 50 distinct pages to be edited with a free group account, which would roughly match the information needed for the toolkit, and be accessible through an iOS or Android mobile app.

Game points would be independently assessed by the professor once a week and updated in the learning management gradebook. It is unlikely that the school would agree to port Blackboard data to a leaderboard, but this would also be a positive means of motivating students, and Blackboard offers this as an option for schools willing to pay extra (Murdock, 2017). Digital badges would be created in Badgr, due to their open source nature (IMS Global Learning Consortium, n.d.) and ability to be either ported into Blackboard (the current UTMB system), or Canvas, where Badgr is now the native solution (Badgr, n.d.) Canvas is currently used by UT Austin and many other UT systems; previously in discussion as a preferred system before I exited and entered this doctorate program. However, the digital open badges could be available for use off-site even if UTMB does not permit any gamification on its current LMS platform, which would be likely.


Badgr. (n.d.) Home page. Retrieved from

Blackboard. (n.d.) Badges. Retrieved from

Collins, D., Wieland, P., del Pino Kloques. (2017) Dual purpose portfolios in Blackboard. [PowerPoint slides]. Retrieved from

Gibson, D., Ostashewski, N., Flintoff, K., Grant, S., & Knight, E. (2015) Digital badges in education. Education and Information Technologies, 20(2): 403-410.

IMS Global Learning Consortium. (n.d.). Advancing digital credential and competency-based learning.

Pangaro, L.N. (2006). A shared professional framework for anatomy and clinical clerkships. Clinical Anatomy, 19(5), 419-428.

Murdock, J. (2017, January 4). Blackboard Gamegogy leaderboard. In Valencia College Learning Technology Services [Web blog] Retrieved from

Sailer, M., Hense, J. U., Mayr, S. K., Mandl, H. (2017). How gamification motivates: An experimental study of the effects of specific game design elements on psychological need satisfaction. Computers in Human Behavior, 69, 371-380.

White, M., & Shellenbarger, T. (2018). Gamification of nursing education with digital badges. Nurse Educator, 43(2), 78-82.

Wingo, N. P., Roche, C. C., Baker, N., Dunn, D., Jennings, M., Pair, L., … & Willig, J. H. (2019). “Playing for Bragging Rights”: A qualitative study of students’ perceptions of gamification. Journal of Nursing Education, 58(2), 79-85.

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