Serious Games

Tagung vom 16. & 17. Januar 2020, Collegium Helveticum

Serious Games for Ethics Training in Medicine

Summary in German; Report in English


Das ‚Institute of Biomedical Ethics and History of Medicine‘ der UZH hat ein ‚Serious Moral Game‘ entwickelt, um die Sensitivität der Medizinstudierenden in ethischen Fragestellungen zu erhöhen. Ob dies gelingt, ist noch nicht geklärt; weitere Studien folgen. Nach einer ausführlichen Einführung zum Spiel ‚uMed‘ durften wir es selber spielen.

Celia HodentGame UX (user experience) consultant, war aber das Highlight der Tagung. Ihr Vortrag und die ‚Masterclass‘ waren dem Thema Spieldesign-Psychologie und kognitive Verzerrungen gewidmet.

Der untenstehende Bericht (auf Englisch), besteht aus den Beiträgen von Celia Hodent und beinhaltet Spannendes zu unserem Hirn, unserem Denken, ‚Dark Patterns‘ und was ein Lernspiel im Vergleich zu anderen Spielen zusätzlich benötigt.

The Brain

First the basics! Our human brain is wonderful but:

  • Perception is subjective
  • Attention is scarce
  • Memory is fallible

Because of this, we can be fooled very easily. (The internet is full of videos where this is shown over and over again. Or think of optical illusions!)

Try this: Test Your Awareness: Basketball

This is also fun: Test Your Awareness: Whodunnit

It is very important for designers to be aware of our brain limitations. For example, they cannot overuse our attention span. They cannot assume that we will see something while we are focussed on something else. And so on.

In UX Design two main topics are important: Usability and Engage-ability.


Regarding usability, of the seven topics Celia Hodent identified two are the most important ones:

  • Signs & Feedback
  • Clarity
  • Form Follows Function
  • Consistency
  • Minimum Workload
  • Error Prevention / Recovery
  • Flexibility

Slide Usability

The motto of game design on usability is: Where is the challenge? Make everything else as simple as possible!

Make everything else as simple as possible! Really! If the challenge of the game is not spatial or memory training, help the players with additional cues (to find out where they are), provide mini-maps and more.

Game accessibility guidelines

Because ’slow thinking‘ requires energy, we use ‚fast thinking‘, whenever possible!

Thinking, Fast and Slow – Wikipedia
Thinking, Fast and Slow is a best-selling book published in 2011 by Nobel Memorial Prize in Economic Sciences laureate Daniel Kahneman.It was the 2012 winner of the National Academies Communication Award for best creative work that helps the public u…


Definitions translated from Bertram Köhler’s commentary:

  • [Fast thinking] works automatically and quickly, largely effortlessly, and without deliberate control.
  • [Slow thinking] is attention-controlled and carries out strenuous and complicated mental operations in orderly steps, which are controlled consciously.


To reach engagement on parts of the player, watch out for the following three areas:

  • Motivation
  • Emotion
  • Game flow

Motivation is of primary importance and can be achieved through making the players feel competent, giving them autonomy, and creating a sense of progression. The content, goal or focus of the game should be relatable and have meaning.

Dark Patterns & Nudges

Sometimes players don’t do what the designers want them to do. In many games (and in many other contexts) dark patterns are used to trick or force the players in doing or buying something they don‘t necessarily want.

UX is against dark patterns because they are good for commercial reasons but not for the user.

Dark patterns make use of the scarcity of our attention and our many cognitive biases.

Examples of dark patterns:

  • Guilt-tripping
  • Loss aversion
  • FOMO (Fear of missing out)
  • Pay to win / Pay to remove friction
  • Social obligation
  • Lootboxes tied to monetization

As an example, Snapchat ruthlessly punishes disengagement through social obligations. It‘s scary.

Nudges are much better than dark patterns. Nudges also make us do things we may not do without a nudge but for our own good. Examples are seatbelts and smoking bans. They are (just) milder versions of dark patterns and very paternalistic! So, nudges should only be used based on consent of the community and population. See „Examples of engineering of the environment“ below for more examples and fun nudges.

Dark Patterns

Dark Patterns are tricks used in websites and apps that make you buy or sign up for things that you didn’t mean to. The purpose of this site is to spread awareness and to shame companies that use them.


Implicit Biases & Inclusion

Because of slow and fast thinking, because of our limited energy, because of our cognitive biases, we have blindspots. And: We are blind to our blindness. This is a very difficult position to be in. This is also the reason why we don’t think about diversity if it is not around us.

Group dynamics, specifically group pressure, —remember the Ash experiment— and cognitive dissonance relate to many biases. Bandwagon effectgroupthink, and herd behavior are biases related to group dynamics. „Three cognitive biases are components of dissonance theory. The bias that one does not have any biases, the bias that one is ‚better, kinder, smarter, more moral and nicer than average‘ and confirmation bias.“

Cognitive dissonance (Wikipedia)

It’s very uncomfortable for us to accept that we are biased (because we’re human). So, don’t point fingers; people don’t want to feel discomfort. It will backfire if you do!

In a study (not mentioned) an added reflection task made the results worse (no change in comparison to positive change). Reflection may be a problematic task especially if done in groups, and it is —if we’re honest— mostly uncomfortable for us.

If you want to change behavior,…

  • Education
  • Enforcement
  • Engineering (of the environment; more fun, easier, etc.)

Examples of Engineering of the Environment

Engineering is the most efficient and the fastest!

Memory is fallible. Attention is scarce. Perception is subjective and is influenced by so many things (anchoring, language choice, group pressure,…). We have to accept that we are biased and find out what to do to change the system.

Cognitive Bial Codex Graph

List of cognitive biases (Wikipedia)

Cool infographic by Visual Capitalist: 50 Cognitive Biases

Educational Game

For an educational game, you need one more ingredient (than for a ’normal‘ game)! On top of usability and engage-ability, you need to have at least some kind of transfer of the learning content. It is a pity that most educational games may train skills but don’t offer transfer tasks.

Take-away message: Usable, motivational and transferable.

AI and Bias

Some people think that we should use AI (Artificial Intelligence) in many contexts, like law or education. They think, because AI is a machine, that it will not be biased. Let’s see about that!

Let’s translate the phrase ‚He is a doctor‘ and ‚She is a doctor‘ with Google Translate into Turkish:

O bir doktor

The Turkish language doesn’t have gender pronouns, and that is why both sentences are the same. In English, this sentence should be translated as „This/that person is a doctor“ to be more or less accurate. Now, some time ago, translating the Turkish sentence back into English with Google Translate you would get ‚He is a doctor‘ and if you did the same with ’nurse‘, you would get ‚She is a nurse.‘ That is a flagrant bias.

The point here is that AI uses human data. Human data is biased, and AI may well have the power to perpetuate and reinforce biases. Fortunately, some people are sensitive to the topic and correct biases. Nowadays, Google Translate will show you both translations. (Google hasn’t learned French yet. The sentence „C’est son pull“ translates into „It’s his sweater“ although it could just as well mean „It’s her sweater“.)

Take away message: Change the environment, design it!

Gender neutrality in genderless languages (Wikipedia)

A Game That Really Fights Bias

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