Assignment Spotlight: The Last Straw

Several years ago, I learned about a board game called The Last Straw. It was developed by 2 doctors in Canada. It's a game that is designed to teach about the social determinants of health (SDOH) and also help students build empathy and critical thinking skills. I quickly realized its potential to be used as an educational tool and decided that I wanted to play this game with students to see how they responded to it and if they felt it was a good way to learn about SDOH. In today's blog post, I will share with what how the gameplay went and how this game can be adapted for an online class.

The Last Straw was developed by Kate Reeve and Kate Rossiter in 2007 as a result of a class project in which they were tasked with developing an innovative game to teach about the social determinants of health for a graduate -level health promotion class (I love this class already!). The 2 Kates worked together to develop a board game that has since gone on to receive awards and recognition as an effective and engaging teaching tool. As you already know, I LOVE all things revolved around games and engagement to enhance learning so I was sold the moment I heard about it.

Unfortunately, it took me several years of planning before I was actually able to implement the game with students but I finally got the chance in Spring 2024. I was able to implement the course in 4 sections of a health policy course and even got IRB approval to invite students to answer some survey questions and provide feedback on the game (look out for those published findings soon!). The students' response to the game was overwhelming positive! However, what I really wanted was to find a way to play a similar game with online students so here is what I came up with. Below, you will see some aspects of The Last Straw board-game along side some suggestions for an online adaptation. Rather than make one online game, I like the idea of taking different aspects of The Last Straw and creating smaller online class activities that are inspired by the game. Here are some of my ideas:

1. Students take on a character profile: In The Last Straw players get to create their own character profile and demographics. This is a simple thing to do. You can have students select from a list of pre-made characters or allow them to create their own. This adds an element of personalization and engagement for students. Students can then retain this profile throught the class and respond to weekly discussion posts from the perspective of that character.

2. Move through life stages: In The Last Straw players move through different life stages such as childhood, adolescence, adulthood and old age and different events happen to them based on this life stage as well as different socioeconomic factors. This can be adapted as a stand-alone online activity where students can make choices and see the consequences of those choices as they navigate through their character's life. For example, you might create a Choose Your Own Adventure-type slide deck where students are presented with a scenario (ie: Adam is a 6 year old African-American boy with asthma). Then they can select from buttons at the bottom of the screen that indicate different socioeconomic statuses. Students can then see different scenarios for kids with asthma based on various factors affected by socioeconomic status. 

3. Gain and lose chips based on profile: In The Last Straw players gain and lose what is called "vitality chips" based on different aspects such as their gender, race, socioeconomic status, etc. A fun online adaptation of this might be creating an online slide-deck based game where students see a progress bar depending on answering certain questions about SDOH factors correctly. This will determine if students understand the concepts of SDOH. 

4. Players die when out of chips:  In The Last Straw the game ends when players make it to the end of the game board (win condition) or run out of chips along the way (lose condition). An online adaptation might end when you get to the end of the semester. You might pose a different scenario to students each week (or a variety of scenarios) and compare who makes it to different stages of life.

I am excited to work on some online versions of these ideas and feature them as the template and featured sample assignment in the November Innovative Online Nurse Educator Academy resources!

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