Optimizing Transgender Care gameplay. Note: not final content.
Optimizing Transgender Care Video Game
February, 2024
Optimizing Transgender Care (TGD Care) is an educational experience we’re building at Stanford Medicine. TGD Care teaches clinicians and residents how to care for gender-diverse patients through a storytelling-centered game. In the game, learners work to improve the gender-affirming care of Rose Way Clinic, meeting and working with characters such as Viola Phoenix, a transfeminine filmmaker, Roc Garcia, a transmasculine athlete, and Olivia, a nonbinary student, over several years. The learners’ decisions about how they care for and speak to their patients profoundly affect their lives. As time passes, the learner upgrades the clinic with décor and teaches students and colleagues gender-affirming best practices. This practice-based learning experience will equip learners to become leaders in gender-affirming care in their local communities.
Our team is deep in production for this project. As our creative director and game designer, I lead this project from a design, art, and production perspective. I am deeply invested in its success. Here, I’d like to show you some of the work we’ve done so far.
Above: Character illustrations by Katherine Cao
A Visual Novel? How Japanese Dating Simulators Led to Our Design Constraints & Technology Choices
As an educational technology team, one of our core missions is to research and discover innovative technology for medical education. Given that we are Stanford Medicine’s in-house EdTech studio, the skills and interests of our team of 16 staff play a role in the types of technology we explore. I can tell you that everyone on our production team has expressed interest in making a video game. With OTGC, we’re making one!
OTGC is a video game in the “visual novel” genre. Visual novels have been around for a very long time, with the most notable examples typically being Japanese dating simulators. Adapting the Japanese dating simulator experience to medical education may sound like an odd choice, but our team conducted extensive technology research and found that the visual novel genre and the technology available to us presented a serious opportunity to innovate.
The user experience overlaps between dating simulation visual novel and interactive patient visit medical education is relatively high. In both cases, the user’s experience is that of someone 1. meeting lots of characters who all have memorable traits and backstories, 2. deciding how to interact with those characters, 3. living with the consequences of high-stakes decision-making, and 4. being rewarded for their play performance. In both cases, the stories branch and they may be non-linear, meaning that the user can explore the story in whichever order they want. Finally, the success of the experience hinges on compelling writing; visuals, clever gameplay ideas, and other aspects of the game are ultimately secondary to characters, story, and decision-making.
Above: we research 20+ games, technologies, and educational experiences to decide what our design and technology approach should be.
With all of this overlap considered, our research led us to RenPy, a Python-based visual novel game engine. RenPy is free to use, with a robust developer community, a decade of open-source support, and stable releases on all major platforms, from the web to macOS, iOS, Android, and Windows.
With all of this overlap considered, our research led us to RenPy, a Python-based visual novel game engine. RenPy is free to use, with a robust developer community, a decade of open-source support, and stable releases on all major platforms, from the web to macOS, iOS, Android, and Windows.
Embracing this tool and the visual novel format created some very useful design constraints for us. As a 2D, image-based engine, our visual presentation couldn’t be overly complicated so that we could invest energy in the user experience and writing.
User Journey as Game Design Document
One of the roles I’m taking on with this project is that of our game designer. I’m running our user experience design (UX), game design, graphic design, and user interface (UI) efforts. For me, user experience design is the central driver of all of our work. In this case, we are treating our user journey map as our game design document. It incorporates our learning, technology, budget, and team constraints and implies the direction for everything else, from UX, to music, to character design, to UI, and so on. Below you can see the journey map for the main gameplay loop of TGD Care.
Planning out this gameplay loop was a big eureka moment for this project, because we realized that this loop structure would allow us to quickly scale up the amount of content in the game without multiplying the amount of development work required. This single gameplay loop is repurposed 18 times in our game with different patient visits.
Our user experience map is growing to include product considerations. We are experimenting with using this document as our game design document.
We’re using Figma to prototype and design the game's user experience and user interface (UI). One of our student workers worked with us to wireframe of the core gameplay experience. Now, I'm working with our UI designer to finalize the look and feel before handing off game assets to our development team.
Here is a snapshot of our student worker's UX prototype, built in Figma.
Below, you can see some of final designs for the game. Here's a little bit about the screens below, from top left to bottom right.
Patient Visit Dialog: This is the main screen learners will see during TGD Care. Here, they will speak to patients and their caregivers, if there is one, and make choices about how to reply to them. Learners will be able to see the player's trust and stress as the conversation progresses.
Visit Debrief: After each patient visit, the learner debriefs with their mentor about what went right and what went wrong during the visit. To control the length of this debrief, we've limited the review to a recap of the patient's trust and stress, and five key decisions the learner either did or failed to do during the visit.
Patient EMR: The learner can view the patient's health information, recaps of previous visits, and more, at any time during the visit.
Badge Decoration: As the learner progresses through the experience, they're awarded with decorative pins to place on their ID badges. This mirrors a behavior we see in our LGBT clinics at Stanford Medicine.
Collaborative Interactive Story Writing
I am leading the interactive writing aspect of the project. I did tool research to find the best possible collaborative, interactive, branching storytelling tool and came across Gem. Gem, created by Backlight, is a very flexible writing tool designed for game writing. It is a spin-off of Celtx, the screenplay writing tool we’re using to draft our linear stories. Our team of 12 writers is building final scripts in Gem that will then be inserted in RenPy via Gem’s API.
Gem has an intuitive branching interface that includes a traditional screenplay writing interface as well.
Building Team Leadership
TGD Care is one of our largest projects to date, with about three dozen people directly contributing to it. As our creative director and the senior manager of the production team, I am responsible for building and delegating project leadership for the project’s production. This project has created many opportunities for our team members to lead while also retaining roles as individual contributors. Our technical lead, for example, will also design environmental art and build our version control infrastructure. Meanwhile, our character designer will art direct all the work our freelancer artists do. Below you can see a little snapshot of the diversity of work that is involved in producing this project.
Team planning included identifying freelancer roles and delegating team responsibilities.
That said, this project doesn’t necessarily call for the video production skills that some of our team specializes in. Because of this, we are providing them with the professional development experience of casting and recording our voice-over artists. There is a lot of crossover in skillset here: working with actors, audio engineering, etc. In my opinion, understanding the capacity of the team to grow and learn new skills is vital when running an in-house production studio. It is likely that the work will change over time, and we need to recognize that our team’s skillset will have to change over time as well.
For now, that’s all I have to share! It’s quite an exciting project, with a huge potential for impact. I hope you enjoyed reading about our work. If you’re interested in learning more about the project, please reach out!
