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    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>The Simplest iTextbook for Cardiovascular Anatomy: A CRAM Minigame</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Reva Freedman</string-name>
          <email>rfreedman@niu.edu</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Virginia Naples</string-name>
          <email>vlnaples@niu.edu</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Darin Brockmann</string-name>
          <email>darinbrockmann@gmail.com</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Ian Sullivan</string-name>
          <email>IanSullivanOTI@gmail.com</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Dean LaBarbera</string-name>
          <email>deanmichaellabarbera@hotmail.com</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Northern Illinois University</institution>
          ,
          <addr-line>DeKalb, IL</addr-line>
          ,
          <country country="US">USA</country>
        </aff>
      </contrib-group>
      <abstract>
        <p>This paper describes a cell phone minigame for teaching students the fundamentals of the relationship between the heart, the lungs, and the oxygenation of body tissues. It is one of the rst of a series of minigames intended to teach cardiovascular physiology to undergraduate and graduate biology students. The game covers the most basic things students need to learn about the anatomy of the heart in a way that we believe will be more engaging and more e ective than the use of conventional textbooks.</p>
      </abstract>
      <kwd-group>
        <kwd>intelligent textbooks • anatomy education • gami cation</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>Introduction</title>
      <p>Human anatomy is a required course for both undergraduate and graduate
students in health related disciplines, including everyone from medical technologists
to premed and biology majors. Many students experience it as a di cult
\gatekeeper" course that they need to pass to complete their program.1</p>
      <p>Students face three main challenges in learning anatomy. First, the subject
requires mastering a large amount of detail in order to understand each organ
system. Second, many of the functional activities taking place in the body occur
simultaneously. Finally, students need to build a hierarchy of ideas to cope with
the increasing level of complexity.</p>
      <p>
        Standard textbooks for these courses, e.g., Tortora and Nielsen [
        <xref ref-type="bibr" rid="ref5">5</xref>
        ] for
lowerlevel courses or Moore et al. [
        <xref ref-type="bibr" rid="ref4">4</xref>
        ] for upper-level courses, do not help students
overcome these challenges. Even publisher-produced computer-based supplementary
materials, such as those found on thePoint or WileyPLUS, while interactive and
multimodal, provide little additional insight because they do not help students
draw connections. Proper sca olding has the potential to help students learn
anatomy faster and more successfully.
      </p>
      <p>As part of the Cardiovascular and Respiratory Anatomy (CRAM) project, we
are building a prototype of an intelligent textbook based on a set of minigames
1 Copyright ' 2021 for this paper by its authors. Use permitted under Creative</p>
      <p>Commons License Attribution 4.0 International (CC BY 4.0).
and designed for mobile platforms. The purpose of the project is to provide a new
model for the teaching of anatomy that ameliorates the problems listed above. It
is intended to cover the content at the level that students need, promote active
learning, yet contain text that is much shorter and simpler than conventional
textbooks.</p>
      <p>The total text written for the game shown here and the next one in the series,
which adds the chambers of the heart to the diagram shown below, consists
of about two pages of text. Based on a survey of six textbooks, conventional
textbooks spend 4{8 pages on this topic. The sentences in our text are similar in
length and complexity to the slides an instructor might use, but the minigame
encourages active learning rather than memorization.
2</p>
    </sec>
    <sec id="sec-2">
      <title>Background</title>
      <p>Gami cation has the potential to increase not only time-on-task but quality of
engagement. Mobile platforms are popular with students and make it easy to
provide multimodal content and tactile input.</p>
      <p>Minigames are smaller or simpler games incorporated within a larger
framework. By chunking and sequencing the material, the use of minigames reduces
the level of complexity for the student without reducing the amount of content
to be taught. It also simpli es game authoring by limiting the amount and
complexity of material in each game, much as object oriented programming does in
large system design.</p>
      <p>
        The system uses a logic-based approach with underlying hierarchical causal
concept maps [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ] that make explicit the causal, hierarchical and simultaneous
relationships between biological processes. In addition, concept maps also provide
an outline for the material to be covered, a bene t for authors and students.
3
      </p>
    </sec>
    <sec id="sec-3">
      <title>Playing the Game</title>
      <p>The gure to the left contains a sketch of
the rst minigame for teaching
cardiovascular anatomy. The top section contains typical
gami cation features: number of points the
student has earned, time remaining, number
of lives remaining and a di culty bar. The
di culty level is currently set to green, which
gives the student the most time to play the
game.</p>
      <p>The main part of the screen shows the
simplest possible schematic of the cardiovascular
system, showing just three objects: the lungs,
the heart and the body. It also shows four
connecting vessels, two between the heart and the
lungs and two between the heart and the body.</p>
      <p>The Simplest iTextbook for Cardiovascular Anatomy
At the bottom of the screen is a ag allowing the student to see the vessel names
if interested.</p>
      <p>The student's job is to state two features about each of these vessels, namely
which direction the blood is owing and whether the blood in that vessel is
oxygenated (red) or deoxygenated (blue). In order to accomplish this, each vessel
is decorated with two widgets, one for direction and one for color.</p>
      <p>The student chooses one of the vessels and sets its color and direction. After
the student sets one of these items, the remaining one is highlighted and other
widgets on the screen are locked out so that the student has to nish each vessel
before moving to the next. Students can choose the order of vessels that makes
the most sense for them. Highlighting is used because it is more e ective to
guide the student non-verbally through the task where possible. We don't want
to drown the student in words about the task; we want to save the words for the
textbook content.</p>
      <p>If the student gets either the color or direction wrong, the game pops up a
contextualized sentence from the textbook. The second author, who has taught
di erent types and levels of anatomy throughout her career, wrote all of the
sentences and chose the ones to be used in this game. The sentences for the four
vessels, clockwise from the upper left, are as follows:
1. Pulmonary arteries (upper left): Deoxygenated blood returns from the heart
to be oxygenated in the lungs.
2. Pulmonary veins (upper right): Pulmonary veins carry blood, oxygenated in
the lungs, back to the heart.
3. Systemic arteries: (lower right) Systemic arteries carry oxygenated blood
from the heart to the body.
4. Systemic veins (lower left): Systemic veins carry deoxygenated blood from
the body back to the heart.</p>
      <p>The systemic vessels are named in line with a concept we expect the student
to have learned earlier, namely that arteries usually carry oxygenated blood and
veins carry deoxygenated blood. The pulmonary vessels are the exception to this
rule, causing the student to have to work harder to understand the upper loop
in the diagram.</p>
      <p>The simplest version of the game defaults to being played without the names
of the vessels. The goal is to get the student to learn the idea behind the double
loop system before trying to memorize the terminology. Similarly, although most
anatomical diagrams show the relationship of the vessels to the chambers of the
heart, we are leaving that to the next game in the series.
4</p>
    </sec>
    <sec id="sec-4">
      <title>Minigame Ecology</title>
      <p>Once students have mastered this game, they can move to another minigame.
That minigame might cover a new topic, cover the same topic using a di erent
type of question, or level up to a more complex game on the same topic.</p>
      <p>Freedman et al.</p>
      <p>With regard to the game shown here, the next level contains a view of the
heart at a deeper level of the hierarchy. It teaches students a more traditional
view of the heart, showing the four chambers and ensuring that they can connect
each of the vessels to the correct chamber.</p>
      <p>Just as some games have interstitial ads, we are considering showing an
interstitial piece of content from the online textbook before the next game appears.</p>
      <p>
        The game is implemented in C# using the Unity game engine [
        <xref ref-type="bibr" rid="ref6">6</xref>
        ]. We are
looking forward to testing this game and its successor with students in anatomy
and physiology classes. In addition to learning whether the games are successful
and enjoyable, we are interested in testing di erent game mechanics.
5
      </p>
    </sec>
    <sec id="sec-5">
      <title>Conclusion</title>
      <p>
        Ken Koedinger's observation that \the student is not like me" [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ] remains
relevant today. Learners of human gross anatomy face many challenges. The CRAM
project attempts to address these challenges. We have developed a new ITS
platform which aims to improve student learning and reduce cognitive load through
the use of minigames. We have implemented two prototype games, one to teach
the student about atrial brillation and the one described here.
      </p>
      <p>Implementing individual minigames has several advantages. In addition to
being easier to conceptualize and implement, this approach is consistent with
contemporary trends in game design. Some of the additional cost of designing
multiple games for related topics can be amortized by reusing art, widgets and
other design elements.</p>
      <p>
        The use of minigames cannot x the fact that anatomy is a voluminous and
complex topic, but it does help organize it consistent with ways that instructors
organize material such as slides, class demos and lab assignments, moving from
simpler to more complex and from recognition to recall items. Although there
are other games for teaching aspects of anatomy (see, e.g., [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]), we do not know
of any that depend on a logic-based approach to the underlying content.
      </p>
    </sec>
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