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Table 1 A comparison of component facets for games and simulation

From: A conceptual framework of game-informed principles for health professions education

Facet Realized in games… Realized in simulation…
Competition Almost always present in some form or other, structured through win/lose states, rankings, scores, progression through levels Depends on the scenario but generally limited use of competition other than seeking to improve performance over time or in the context of simulation for assessment purposes
Conflict Either isomorphic such as in war games, anisomorphic (in terms of a player’s symbolic relationships with their game opponents), or absent altogether in opponent-free games such as puzzles Only present if it is isomorphic with practice: conflict in communication, management, teamwork, etc. Conflict may be realized in the medical problem or challenge or in the relationships between participants
Chance/luck Wide range from isomorphic to anisomorphic —typically in the form of random elements (dice or cards) to player responses (chess, go) Depends on scenario—may be realized in randomized patient data, randomized pathways through algorithms, or interactions with other participants
Experience Wide range from isomorphic to anisomorphic—linked to game media Always present in some form or other in physical simulation, limited in onscreen simulation
Performance Wide range from isomorphic to anisomorphic—usually linked to the game medium employed Typically in the form of clinical skills in physical simulation, extremely limited in onscreen simulation
Simulation Wide range from isomorphic to anisomorphic Direct representations of clinical settings, patients, presentations, tasks, challenges
Make-believe Wide range of uses from isomorphic (conformance with mythic or fantasy idiom) to anisomorphic (innovative) Fictional or fictionalized narratives and roles. Fourth-wall techniques such as debriefing in role and providing feedback out of role
Tactics and strategies Wide range from isomorphic to anisomorphic Depends on scenario—should be isomorphic with real-world practice
Media Physical, virtual, or augmented Physical, virtual, or augmented
Symbols and actions Tendency to greater abstraction (anisomorphism) Depends on scenario—should be isomorphic with real-world practice
Complexity Game-specific, represented in the game’s boundaries Depends on scenario and its intended outcomes—should be isomorphic with real-world practice
Difficulty Depends on game levels and/or opponents Should relate to intended outcomes and transfer to professional practice