Purpose: Serious Games (SGs) are gaining attention since they can improve the learning quality in a digital era. SGs can be used as a learner-centered educational approach in which users control their learning through interactivity. This research aims to evaluate the usability of a virtual learning environment (VLE) for clinical decision-making.

Methods: A VLE was developed at the University of Southern California, featuring a series of scenarios related to chronic pain. One case focusing on headache diagnosis and management, titled “Peggy has a headache,” was used as the prototype for a stand-alone educational experience. To validate the usability of the case, a qualitative, remote, moderated testing session was performed with three medical students, which allowed for testing the interface with the case, with the purpose of uncovering problems, discovering opportunities, and learn about users. This study qualified as IRB exempt UP-20-01285.

The methodology includes three elements: a facilitator, the tasks and the participant. The facilitator observes the participant’s behavior and listens for feedback. The instruction provided was to interact with the virtual case, and to speak aloud while navigating the system. The participants were three medical students with general knowledge in medical terms. The sessions were recorded, and three categories were analyzed: usability (system usefulness), aesthetic (interface quality), and learning potential (information quality).

Results:
The usability test showed that the users were able to access the system with the provided link and were able to start the case with no additional information; however, the amount of information was overwhelming. The content was considered comprehensive and useful as an academic resource. The system usefulness was analyzed by the smoothness of the interaction. Participants enjoyed the overall experience. They felt it was intuitive and easy to follow. Small suggestions included creating a "next" button at the bottom of each section and a larger indication as to which sections had been completed. The use of highlighting the text as reading or using the cursor to indicate advance was of notice. The interface quality considered the aesthetic. Participants liked the look of the site. Small mistakes were noticed, such as spelling errors, different fonts on the same page, and grammatical errors. The information quality was considered as a measure for the learning potential of the system. Participants felt that it was a unique and useful learning tool. Suggestions included a section for writing notes because of the amount of information. Participants expressed feeling overwhelmed because of the quantity of information and the duration of the exercise.

Conclusions:
The use of a serious game is a useful strategy to provide new content in an innovate way. The design of the case should be kept simple and avoid excessive information. Suggested solutions included providing a back button and a progress bar or progress indicator of some kind, and to clarify the scoring system.

Keywords: Virtual case, learning objects, educational resources.