| (1) Presentation of the rules and the game’s structure |
| 1) Emergence of metacognitive experiences related to success and failure. |
“At first, I had a little difficulty.” (Hello Kitty) |
| “Nervousness, despair.” (Lalalopsi) |
| 2) Checking for access to metacognitive knowledge regarding the task. |
“I remembered the DHE* class, that’s all that came to my mind.” (Barbie) |
| “I remembered the patient has a patient we got in the last term.” (Furby) |
| “This would be a Directed Study.” (Opereta) |
| “That I was on House [TV show].” (Merida) |
| “I tried to grasp [the task] as much as possible, but I kind of need to systematize it.” (Polly) |
| (2) Reading the clinical case |
| 1) Requirement to integrate metacognitive experience with metacognitive knowledge. |
“I was desperate, I was trying to understand what had happened, but it actually seemed to be a bit of desperation of not knowing exactly [what happened] and immediately what was going on.” (Ariel) |
| 2) Emergence of the broader perception of the task’s level of difficulty level. |
“Oh man, what do I do now? I go to the infirmary and the patient is like this. How will I act to solve the problem?” (Ken) |
| 3) Accessing memory content to search for available knowledge, applying metacognitive knowledge. |
“It seemed to me not what the nursing diagnosis was, but the diseases that could be.” (Rosinha) |
| “Several different diagnoses went through my head because [for] every symptom I talked about, I imagined something different.” (Bella) |
| (3) Insertion of challenges into the game |
| 1) Increasing the task complexity brings out the metacognitive experience of feeling difficulty, allowing one to assess processing fluency. |
“Association (steps to resolution).” (Nina) |
| “The difficulty is that we don’t have the normal results in our heads yet; the evaluation of the results is that the patient’s disease is not well known. I managed to get around it by analyzing the results, thinking since the patient’s admittance until their release... After I made the notes, I tried to remember, I tried to get feedback of everything we learned so far and also with a little of the experience we have had so far in practice.” (Alice) |
| 2) Expanded use of metacognitive control and monitoring skills. |
“The greatest difficulty was because we were in doubt between the two. In fact, before, we were thinking about which diagnosis that it wasn’t because of the mental confusion, of the urea, and it wasn’t, it was sodium.” (Judi) |
| 3) Planning regulation to direct attention to relevant information and diagnose the electrolyte disturbance. |
“With what we were good at, I think we were bad at one and good at the other. So, I will associate one and the other, signs and symptoms and lab tests.” (Marie) |
| 4) Correction in the flow of actions to achieve goals by the metacognitive skill of conflict regulation. |
“One balanced the other (signs and symptoms).” (Bella) |
| (4) Decision-making |
| 1) Metacognitive experiences are developed for monitoring and controlling thinking. |
“It was when you gave me a hint with the joker [card], that I had an easier time, then I thought more and went deeper, then it hit me [that it was] potassium and sodium, but I answered potassium because I didn’t know which was intra and which was extra.” (Tinker Bell) |
| 2) The student evaluates the effort required to achieve the proposed goals. |
| 3) Self-evaluation as successful or unsuccessful in the task and search for ways to correct any perceived problems. |
| 4) Dynamically integrates metacognitive knowledge, skills, and experiences. |
“Basically, the correlation between the different problems, what they related to regarding cause and effect, what causes that problem, and what are the effects of their repercussions and so trying to form a chain to see what that patient’s grievance is, its complexity, and how to act, how to solve it.” (Dexter) |
| (5) Final performance evaluation |
| 1) Once the game is over, the student retrospectively evaluates their steps using metacognitive skills integrated with metacognitive knowledge. |
“I think the game worked with a very complete level of case study... it manages to create a scenario and all that storyline as if you were there. And even that can be bad because it can bring fear, insecurity, and uncertainty to those who don’t have that, but on the other hand, you bring the need for the person to actually think, to impose themselves; it’s not because the clinic is saying it’s that and it’s interesting because you can experience a little of what it is, here in a safe environment, a controlled environment, [...] a game, in quotes, because it’s not a game, we know it’s a scientific work but a game in quotes that is pleasurable, entertains, and teaches, I think this is the future of education.” (Dexter) |
| 2) The student performs a self-assessment by appreciating their metacognitive experience. |
“Ah, look, I manage, I already managed after much studying alone at home, reading this thing of the electrolytes of the spaces, but I still haven’t managed to do the proper comes to be; I wouldn’t say reasoning, I don’t like the word memory, to memorize things, I like to understand, I still haven’t managed to understand. OK, I know what’s in the liquid in the electrolyte here and there, but I still haven’t managed to study a lot and enough to understand the disorders and what causes them; I have to sit down more and study.” (Opereta) |
