Building a video game in higher ed

By: Jacqueline Dunbar-Jacob and Joe Horne

For the past two years, the School of Nursing worked closely with the Teaching Center to conceptualize, construct, test, and implement a video game for nursing students. The game is called PsychOut!, is played on the iPad, and is designed to teach players about using therapeutic communication techniques to assess the mental health of patients as well as building trust and rapport. Ten unique case-based scenarios are available in the game, dealing with topics such as depression, intimate partner abuse, suicide, HIV, alcoholism, and PTSD (post-traumatic stress disorder). During the process of creating this game, both the Teaching Center and the School of Nursing learned many lessons – and only a small portion of those lessons are included here. These ten questions may illuminate some important lessons we learned that could benefit others who are considering this path. All game projects have several unique considerations that are shaped by departments, schools, technologies, institutional commitment and much more. Before embarking on such a big project, make sure you are ready to take it on.

  1. What can the students do in the game that they cannot do in real life? It’s important that your video game give the students some kind of learning experience that they cannot get in the classroom. We discovered early on that students did not get enough practice interacting with patients, so we built the game around as many patient interactions as possible. We also tried to keep the game as close to reality as possible. This meant using real people as patients and nurses instead of avatars. While the development process was time consuming, it paid off in that we now have a game that is largely situated in real life but provides a safe place for nursing students to practice with their patients – where no one gets hurt.
  2. How will the video game be incorporated into your existing curriculum? It’s important to look at your curriculum holistically when building a game. This helps when choosing the optimal place and time for students to have their gaming experience. Will it be important for the students to play the game early in the semester or towards the end? Should the game performance serve as a portion of their grade, and how will their performance in the game be tracked? How important will it be for the faculty to deliver content before playing the game, and what should that content be?
  3. Do you need a game or a simulation? One could argue that PsychOut! is more simulation than game. While definitions of game and simulation vary, generally speaking, a game is supposed to be fun while a simulation is supposed to be realistic. In the context of PsychOut!, it’s hard to say that topics such as suicide, alcoholism, and depression could (or should) be turned into a “fun” game. In other words, ask yourself if the best learning tool for your situation is really a simulation instead of a game. You’ll save yourself a lot of time coming up with clever (or possibly meaningless) point systems to make it game-like, when in fact, your students will be just as happy, and learn just as much, through a simulation.
  4. What are the long-term goals of the game, and how will you assess whether the game is successful or not? We’ve spent the last several months testing the functionality of the game and also whether or not students enjoy it. In addition, we’re looking at how playing the game may or may not influence learning outcomes. Looking back, we should have been thinking about our test plans at the beginning of the conceptualization process. This information would have driven specific content in the scenarios and might have influenced what was included (and not included) in the game.
  5. Will players interact with faculty and students as part of the game? Our game was designed to be played by a single person on a single device; however, we learned by accident that social interaction with their peers around the game might serve as a critical layer of engagement. Early in the development process we had a large group of nursing students play the game to collect initial feedback. Because we didn’t have enough iPads, groups of 3 played the game together on one device. We noticed right away that the students discussed the cases, interactions, and answers within their group, discussing what would be the best path forward with the patient. These conversations seemed to enrich their learning, and it also kept the students engaged with the game. In retrospect, we would strongly consider making a more socially-driven game if possible. Because we didn’t formally test this theory, we can’t say for sure, though other classroom-based studies have suggested this.
  6. How do your students tend to play games, or access educational content? Our game was designed for the iOS platform, and given the rich media of the game, it requires a larger screen than an iPhone offers. As a result, we built the game around iPad specs. While some students have an iPad, many have only a laptop or a smartphone. In retrospect, we should have surveyed students to find out which devices were most prominent amongst the nursing student population. While almost all the students own an Apple device, it isn’t always an iPad so we had to provide those devices to many students when we tested the game. In addition, a non-native app (playable within any web browser) may have also met our needs.
  7. What outside talent do you need to make your video game? We received bids from three companies to do the coding for our game. Most companies did not want to bid on the work because our budget was too small, and they weren’t sure how to partner with us to do the work (we created all the media). The partnership worked out reasonably well; however, there are some contract stipulations that we would word differently if we did this again. In addition, corporate entities tend to move faster than academic entities. Our partner frequently waited on us to complete something so they could do their work. Make sure you properly allocate time and resources so your development partners are in synch with you.
  8. How will faculty be compensated for their work on the game? While you might have tremendous enthusiasm for your game project, your subject matter experts (SMEs) may have very little excitement about the project. Additionally, because a citation in a game carries less weight than a publication in a respected journal, you may find yourself struggling to keep faculty engaged in the work. We strongly recommend allocating a portion of your budget to buy out some faculty time. When you do this, make sure you set clear expectations for what the faculty will be doing. Some will enjoy doing the work as it’s rather different from writing a traditional research article, but others may struggle.
  9. What is your long-term strategy for keeping the game alive (sustainability)? No matter what platform you use for your game, you must have a plan (and budget) for updating the game when a new OS is released, as well as a budget for updating content. While these details might seem small at first, OS releases come out frequently for every platform, and these OS changes often mean that your game must be updated. In addition, faculty may want to adjust content in the game. Who will do this work? How will you manage requests? Who will test the changes once they are made? It’s a complicated process and you should make sure you have the resources to oversee all this work.
  10. Do you have time to patent, copyright and offer it commercially? Regardless of whether or not your intention is to create the next best-selling video game or to just have something that you run in a class that you teach once a year, you’ll need to make time to go through the patent and copyright process. It’s time consuming but necessary. If your plan is to release it widely to the world, make sure you know how to price, promote, and protect it (not to mention support it). Depending on how widely it’s used, you may have just created a full-time job.

This article barely scratches the surface on what we learned during the past two years. If you’d like to learn more about the work, our lessons, or play the game, please contact us at

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