Table 1 A comparison of component facets for games and 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