A better system? Teaching healthcare virtually

A story from our sister site, Metaverse Health.

MyCaseSpace data image

Rather than assessing their students through a paper-based examination, or even by having real, live people come in to pretend to be patients, it is starting to become more common to hear of healthcare educators asking their students instead to use computer applications and tools featuring digitally-created patients.

There are a myriad decisions that need to be made surrounding patient care. Students need to be able to wield a large amount of technical data, be able to think well on the fly, and be able to make quick yet considered decisions as healthcare professionals. These digitally-created, or virtual, patients can assist in building these skills.

Though virtual patients look just like the avatars that represent actual people in virtual worlds, the virtual patients usually have either an artificial intelligence (AI) or a scripted backend behind them. As opposed to an AI, the scripted backend cannot make decisions itself – instead , it follows a decision tree that has already been set before the student engages with it.

Medicine

Source 1, Source 2

MyCaseSpace is a Web-based application which presents virtual patients to students at irregular intervals throughout the span of their course. Virtual patients may contact the student at any time of the day or night, through their computer, and request a clinical consult. The virtual patients use avatars to communicate visually with students; the speech of the virtual patients can be accessed in 13 different languages. These patients use a scripted backend for their interactions, the design of which was based on video-game decision trees.

The application can easily be updated and altered to include virtual family members of the virtual patient to make demands upon the students.

Critical thinking skills used to be tested by setting examination papers; some people believe that the current set of students, being more digitally aware, will respond better to a digital presentation. Others are of the opinion that modern students have an expectation that they will continue to receive paper exams, and may have trouble with digital resources.

Though it has not been proven that this method of assessment results in either better or poorer results for the students, the professors and tutors find the system to be most beneficial for them. The application collects, stores, and processes data generated by the students’ assessments, cutting down on time and tedium, and increasing accuracy, for the marking individual.

Nurses

Source

“Nurse Island” has been set up inside Second Life by the Glasgow Caledonian University. Apart from the virtual representation of the university, built so that prospective students can learn to find their way around campus, the Nursing Skills Laboratory has been recreated and populated with virtual patients. These patients can be controlled either by an AI or by a tutor, and use text to speech synthesis rather than recorded voices.

The conversations held between patients and students are recorded, so that students can be debriefed later by a tutor. This facility will open early next year.

Paramedics

Source 1, Source 2

This Second Life project represents a partnership between St George’s, University of London and Kingston University.

Paramedic students will work in teams of three or four, and will encounter emergency scenarios in Second Life in which they will need to treat a virtual patients or patients. They will need to perform such tasks as checking the patient’s pulse, dressing wounds and administering drugs. They may also need to be able to use equipment that would typically be found in an ambulance, such as oxygen masks and electrocardiograms (ECG). After assessing and treating the patient, they must load the patient into the ambulance and set a GPS device to take them to the hospital.

On reaching the hospital, students then handover a set of patient notes to their tutor via email.

Emily Conradi, e-Projects Manager, says: “Paramedic students spend a lot of time in work placements, which can be based anywhere in the country, so it can be hard for the students to meet face-to-face with each other and with their tutors.”

CPR and emergency first aid

Source

The Italian Resuscitation Council (IRC) headquarters in Second Life (to teleport there, click here) has been set up as a place that people can be trained and re-trained, whether they be instructors, medical professionals or laypeople.

The IRC training simulations for instructors and medical people would include simulations to improve and test teamwork, leadership and technical skills. The simulations would also impart knowledge concerning CPR and other emergency training procedures.

Some of the information directed at laypeople includes cardiac arrest prevention knowledge and basic life support information.

In conclusion

Effectiveness of learning is not the only reason to use a virtual world or virtual patients. If learning is not less effective than by using other methods, and there are other benefits to the virtual alternatives, they may still be well worthwhile.

Forester Research: building engagement in virtual worlds

In the past week, Forester Research have released a paper titled ‘Consumer Engagement In Virtual Worlds’. The report was commissioned by a consortium of virtual world companies including Metaplace, Inc., Doppelganger (vSide), Gaia Interactive, Inc. (Gaia Online), IMVU, Inc., Linden Lab (Second Life), Donnerwood Media (Meez), PHD, Sony Computer Entertainment America (Home), Sulake Corporation, Oy. (Habbo Hotel), MTV Networks Inc. (Virtual MTV), Vivaty and WeeWorld.

The 19-page report covers some familiar ground around brand awareness and engaging audiences in virtual worlds and actually provides some guidance along those lines, differentiated by the types of virtual worlds (gaming worlds, structured worlds and unstructured / open worlds). Reported negatives from those initial marketing forays into virtual worlds included low numbers of users and inappropriate brand associations. Positives included the global reach, internal enthusiasm for initiatives and tapping new creative options.

The three conclusions drawn by Forester are that

  • The period of experimentation and ad hoc virtual world marketing is over
  • Engagement, community, and tapping creativity should be the virtual world mantra
  • Planning and measurement are lacking

The findings of the report won’t be a surprise to the commissioning consortium but it does provide a useful overview of the ROI challenges for business in virtual worlds and some broad strategies on developing effective engagement strategies.

Forterra ups the ante in enterprise virtual worlds

Enterprise-focused developer Forterra this week ramped up its virtual world offering, emphasising the gains for business over traditional teleconferencing and videoconferencing solutions. Forterra’s OLIVE virtual world platform has reached version 2.2 and with the upgrade comes integration with IBM’s instant messaging / web conferencing application, Lotus Sametime.

The video below provides a striking example of the potential of virtual worlds for enterprise (the really interesting stuff starts around the one-minute mark):

Forterra’s pitch to business is based on cost-reduction:

Audio and Web conferencing are inexpensive, ubiquitous, and generally easy to use. However for meetings involving complex or longer topics the participants can be challenged to grasp the discussion context and maintain focus due to multi-tasking. Virtual meetings in OLIVE are proving to be less expensive yet more engaging and productive for users. Most enterprise-grade teleconferencing systems charge $0.10 to $0.25 per person per minute which can equate to thousands of dollars of expense per employee every year. OLIVE pricing is an order of magnitude less.

Other features in the new update include a reservation system for virtual meeting rooms, with full integration with email calendars via MS Exchange and Lotus Notes. PowerPoint and Windows Media files are able to be viewed in-world, as can any Windows desktop application. Another feature that stood out for me was avatar integration with services like LinkedIn, Facebook, Lotus Connections, or an enterprise-based HR system or Learning Management System. Participants in meetings can right-click on an avatar to get full profile information from the selected service.

We’ve covered another integrated enterprise solution, Immersive Workspaces, previously. These solutions are helping to tackle perceptions of virtual worlds as insecure environments with no obvious return on investment.

AVWW Doggie Bag

Anastasia

A big thanks to Feldpsar Epstein for attending the real-world AVWW event last weekend. What follows are some of the highlights from her perspective. We’d also love to hear your thoughts.

The Australian Virtual Worlds Workshop, Friday 28 November and Saturday 29 November 2008, held at Swinburne University, Hawthorn Campus, was a bit of a mixed bag. I present here some of my favourite take-away notions.

Presence in Virtual Worlds

The presence afforded by virtual worlds of many flavours can put conference and class participants on a more equal footing, where each individual has access to the event in the same way, i.e. through a common virtual world. Unlike video or phone events, where some people are present physically, and others are present through a technological medium, virtual worlds create a more compelling atmosphere, since each person has an equal presence.

Investing in understanding

It makes sense for educational institutions to make use of contractors and ‘experts’, especially where that knowledge or those skills are lacking amongst the faculty. However, it’s important also that the faculty invest some time and effort into expanding their own knowledge to the point that they understand what they are asking the contractors to do. There is little point in asking for the impossible and then feeling disappointed or cheated when it cannot be done.

Students are not just consumers of education

Students at all levels need to have input into their own education. It is important that students collaborate with and mentor not just each other, but also the faculty. This kind of education goes on in the real world all the time; failure to support it in virtual environments represents diminished opportunity for students.

VastPark – vast possibilities, simplicity in action

Vast Park is a virtual worlds platform being developed in Australia. The standards are open (as in Open Source), as is the code, to a large extent, except for pieces such as the renderer; these closed-source pieces have been introduced to cut down on the amount of work needed to be put into technologies that already exist and need not be duplicated. The Immersive Media Markup Language (IMML) was conceived with this notion in mind – “A deaf person must be able to communicate with a blind person.” This means, in essence, that rich, complex environments can be described simply, and that there is a vast range of accessibility options available.

“VastPark” is the name of the technology behind the virtual worlds that other people will create.

Hedonic Consumption Behaviours

Hedonic behaviours account for approximately 51% of intentions to use virtual worlds, making enjoyment the most significant predictor of usage.

AVWW 2008 commences

The Australasian Virtual Worlds Workshop is underway today and continues tomorrow (all day Friday and Saturday 28th / 29th November Australian time). The base for events is Swinburne University’s Koala Island.

It’s still not too late to get involved and it’s even free to join the Second Life component of AVWW (click here for landmark)

We’ll be covering both the RL and SL event over the coming two days – the event organisers have arranged a comprehensive program so do take some time to participate if you can. We’re proud to be a media partner for this event.

Check it out in-world

Avatar: representation, communication, experience

The many faces of Feldspar

“Virtual Worlds Research: Consumer Behavior in Virtual Worlds” 
Vol. 1. No. 2  ISSN: 1941-8477  November 2008
Symbolic and Experiential Consumption of Body in Virtual Worlds: from (Dis)Embodiment to Symembodiment

Source

This experiment focused on the corporeal body (real, physical or atomic embodiment), and the virtual body (digital, non-corporeal embodiment), also called an avatar in some digital environments. Each embodiment can be for social and self-presentation as a part of communication, and as a project, for creating experiences by altering one’s appearance and living new lifestyles associated with that appearance.

Prior to this research being undertaken, there were two primary competing views regarding virtual embodiment:

  1. Disembodiment – the user is able to break away from their corporeal embodiment, into a virtual embodiment.
  2. Embodiment is essential, even in virtual worlds, to whatever degree it can be achieved.

This research team has concluded that the embodiment/disembodiment debate is non-resolvable and futile. Instead, they introduce the concept of symembodiment: that is, that an avatar is a symbolic embodiment but not a physical embodiment. There is always a partial degree of embodiment.

The body in modern, Western, society has more meaning placed on it than perhaps at any time in the past, because it is easier to modify the body, successfully and safely, than it has ever been. Body image – creating and maintaining a “perfect” look – is paramount. On the flip side, disease and disability are much harder to cope with in this modern age - because there are so many treatments available for common ailments now, anyone with a visible issue is seen not have care about their body image, or the social and moral implications of their perceived “choice”. Thus, while for some people the body can be seen as a “project”, to be worked on and altered, other people tend to view their bodies as hindrances – they have greater constraints on how much their bodies can be altered, and on the type of experiences they can have through their bodies.

The researchers contend that an avatar, as a body that is as much a representation of self as the corporeal body, can be an end that the user playfully engages in for its own sake – modifying the avatar becomes an experience in and of itself.

Their research questions included the following:

  1. How do consumers attach meanings to the digital self images they create?
  2. How are these images constructed and reconstructed?
  3. How and what do consumers experience through their virtual bodies?

Avatar: the body in the virtual world

The mind and previous bodily concepts of the user greatly influence the types of virtual bodies they inhabit. With virtual bodies, it is common to have at least two, if not many more, symbolic bodies.

Second Life

Second Life tends to support the use of multiple selves. Once the skill of avatar alteration is learnt, it becomes a very quick and simple process to change between virtual bodies. Second Life also supports using avatar alteration as a form of play or experience – avatars are very malleable, and have fewer constraints to alteration than our physical bodies.

Methodology

  1. The researchers entered Second Life as users.
  2. They fully participated in Second Life culture and conducted participant observations.
  3. They found participants by using their own personal networks.
  4. They conducted both online, in-world interviews and offline, atomic-world interviews.

Questions asked during interviews focused on the participants’ feelings and motives about their lives in Second Life, how they went about creating and recreating their avatars (virtual bodies), and what sort of experiences the participants had with their avatars.

Findings

The researchers felt that users were highly involved in Second Life due to the ability to alter and experience the alteration of the avatar, and due to the freedom afforded in such alterations compared to the corporeal form. They also noted that users create multiple avatars, or at least multiple, vastly differing looks for a single avatar, each of which is derived from a facet of the user’s own concept of self. I wonder to what extent each individual takes on a separate role to go with each representation – do they take on different morals and ethics? Perhaps, less drastically, it is more similar to our representations of ourselves that we use at work and at home – different dress, different speech /language.

In Second Life, a ‘null’ representation – one designed not to  draw attention, is just as apt to be interpreted by other users as are more interesting or daring representations. Any representation says something about you to other people.

Some people found there to be excitement associated with the experience of having different bodily features to those in the atomic world. I note that there can also be a sense of normalcy associated with the difference, particularly for those people whose atomic body does not fit their mental concept of self, or for those whose atomic body varies greatly from some desired, unreachable, state.

Discussion

Your representation of yourself in virtual worlds, your avatar, has a great impact on how you communicate with and convey meaning to others. However, the avatar is more than this. In symembodiment, the users playfully construct and engage with their avatars – the user experiences the avatar, and has experiences through it.

“The modern impulse of seeking an ideal life is waning, while the desire to experience multiple alternate lives that allow
extraction of different meanings from life waxes.”

Conclusion

The researchers believe that the virtual body, rather than just being on display for communication purposes, becomes an experience in and of itself.

Out of consumer error – insert more consumers

Source: Journal Of Virtual Worlds Research Vol. 1. No. 2. ISSN: 1941-8477  November 2008

“Consumer Behaviour in Virtual Worlds”

The “New” Virtual Consumer: Exploring the Experiences of New Users

By Lyle R. Wetsch, Memorial University of Newfoundland, Faculty of Business Administration, St. John’s, Newfoundland, Canada.

In essence, Lyle Wetsch’s idea is that there are insufficient numbers of people already participating in virtual worlds, so businesses need to attract new users into these worlds, to “effectively recruit real world consumers into the virtual world and retain them through positive interactions.” Whether or not this should be the goal, or whether the goal should be to study the existing populations of virtual worlds and make the advertising and other offerings more attractive to them, is somewhat of a moot point. What is more important here is that there are new users entering these digital environments, and that we need to understand their grievances and positive experiences, in order to know how best to tailor consumer experiences for them.

40 undergraduate business students and 10 MBA graduate students spent 12 weeks in Second Life becoming acclimatised to that environment, all having entered as first-time users. Through blog entries, online discussion groups and interviews of these students, information about new user experiences was gleaned. Wetsch feels that this information is able to “guide suggestions for improving the experience of new virtual consumers in order to create long-term consumer relationships with an organization’s virtual presence.”

Second Life is one of the prime candidates being considered as a potential advertising base for real world consumers. It is one of few virtual worlds with the capabilities required for business endeavours – user-created content and user-to-user transactions.

In summary: section by section

Research Problem: We need to reduce churn – this is where users register, but fail to continue to use the product – by coming to understand the new user experience better.

Theoretical Framework: Research done on text-based chat environments. This seems inadequate – users interact with other users, but are more likely to interact with their environment, unless a business has provided a staff member to interact with at their build.

Methodology: “Student comments and discussions provided insight into the mind of the new entrant to the virtual world in real-time as they experienced it, commenting on their blogs at the time the incidents occurred to enhance the
accurate recall of events.”

Findings:

  • Technical Requirements: Many students were disappointed with the lack of capability to run Second Life that their computers demonstrated. Both the students and the researchers compared Second Life graphics and overall quality of response to other “gaming” environments, not taking into account that those other environments, using game-like graphics, can store much of their data locally, rather than having to make continual updates, as happens with Second Life.
  • Graphics: Those students able to access the digital environment easily were for the most part impressed with the graphical quality of Second Life.
  • Avatar control: Interestingly, this group of students seems to have had quite a lot of difficulty with avatar control, particularly those with prior gaming experience, who found the different controls to be disorienting. Time and practice seemed to fix the problem.
  • Griefers: “Griefing was experienced by less than 10% of the students.” However, those affected by it seemed most upset and put out by it.
  • Variety of experiences: Many of the students expressed great disappointment with the Search function, especially when comparing it with Google’s performance.
  • Lack of people/interactions: The students had quite a lot of trouble finding other users to interact with. Even when they were able to find groups of users conversing, often the other people would not talk to them. This brought about feelings of isolation and loneliness.
  • Building is not enough: A lack of effort is recognised by users, and will have a decidedly negative impact on them as consumers.

Conclusions and Implications

“The key is the INTERACTION. Without the interaction, there are better channels to present the information.”

  • Expectation Management: Users are more likely to be forgiving if you let them know what they are getting and why they are getting it – if you have a good, rational explanation for, for example, the technical requirements for your product being so steep, people tend to be more forgiving.
  • Ease of use: Improve the new user experience by making the environment easier to interact with. Provide useful tools and expectation management.
  • Interaction: Make it interactive. If there are no users to interact with, consumers need some other sort of interaction to keep them engaged.

Journal of Virtual Worlds Research – second issue

The latest issue of the Journal of Virtual Worlds Research has been released and this time consumer behaviour is the focus.

There’s eight research papers, of which five are peer-reviewed, plus there’s six ‘think pieces’ on related topics.

The full contents:

Peer Reviewed Research Papers

Consuming Code: Use-Value, Exchange-Value, and the Role of Virtual Goods in Second Life (Jennifer Martin)
Virtual World Affordances: Enhancing Brand Value (So Ra Park, Fiona Fui-Hoon Nah, David DeWester, Brenda Eschenbrenner, Sunran Jeon)
On the Relationship between My Avatar and Myself (Paul R Messinger, Xin Ge, Eleni Stroulia, Kelly Lyons, Kristen Smirnov, Michael Bone)
The Social Construction of Virtual Reality and the Stigmatized Identity of the Newbie (Robert E. Boostrom, Jr.)
The “New” Virtual Consumer: Exploring the Experiences of New Users (Lyle R Wetsch)

Research Papers

Ugly Duckling by Day, Super Model by Night: The Influence of Body Image on the Use of Virtual Worlds (Enrique Becerra, Mary Ann Stutts)
Symbolic and Experiential Consumption of Body in Virtual Worlds: from (Dis)Embodiment to Symembodiment (Handan Vicdan, Ebru Ulusoy)
Demographics of Virtual Worlds (Jeremiah Spence)

“Think pieces”

Surveillance, Consumers, and Virtual Worlds (Douglas R Dechow)
Second Life and Hyperreality (Michel Maffesoli)
Having But Not Holding: Consumerism & Commodification in Second Life (Lori Landay)
Metaverse: A New Dimension? (Yohan Launay, Nicolas Mas)
Virtual Worlds Research: Global X Local Agendas (Gilson Schwartz)
Real Virtual Worlds SOS (State of Standards) Q3-2008 (Yesha Sivan)

There’s some serious reading time in it all and if virtual goods, branding, avatar identification, new user experience or demographics are of interest, this is one must-read issue from a journal hitting the ground well and truly running. Well researched quantitative and qualitative studies will be key as virtual worlds expand in scope and popularity – this Journal deserves kudos as one of the pioneers of empirical observation of virtual worlds.

The rise and rise of the Game Widow

(From our sister site, Metaverse Health)

This article in the Canadian publication, the London Free Press, describes in detail a couple of case studies of gaming addicts. The case studies themselves paint a fairly standard picture of someone with a compulsion for intensive gaming, though some effort has been made to provide balanced coverage of the issue.

The premise of the article is the establishment of a support service for gaming addicts in London, Ontario – apparently the first such group in Canada. What caught my eye was that the wife of one of the addicts described in the article, Wendy Kays, has written a book called Game Widow. (we’ll hopefully be reviewing the book soon).

The term ‘game widow’ has been around for years and it’s increasingly resonating with the broader public. It further emphasises the need for more research in the area as well as a vigilance toward not typecasting all gamers as addicts. Terms like ‘game widow’ also accentuate the gender divide in some gaming genres. There are surely ‘game widowers’ out there but they’re likely to be in a distinct minority.

One final comment to the author of the article – online roleplaying did not begin with Everquest in 1999.

Distance education close-up

Coat of arms of Finland

Learning together apart: Distance education in a virtual world – Kim Holmburg and Isto Huvila

Holmburg and Huvila’s study, as related in the article link above, focuses on distributed learning opportunities for distance education students, ‘distributed learning’ meaning that multiple tools are used.

Background information

Some of the tools compared in the study were traditional face-to-face classroom teaching -  asynchronous systems such as blogs, wikis and discussion forums. Synchronous systems include chat rooms, video conferences, and lectures and classroom teaching in digital environments like Second Life.

Overall, students in the past have reported that the use of distributed learning has caused them to be more engaged with the class material. This seems unsurprising – the more learning modalities they are exposed to, the more learning styles a student has access to. Synchronous systems in particular were useful for encouraging interaction between students.

Lectures run in Second Life were found to be distinctly advantageous for distance education students. Students report preferring face-to-face classes, however they also found Second Life to be a more ‘fun’ learning experience compared to the other modalities they were exposed to. Additionally, lecturers found that students were more likely to participate in lectures run in Second Life than in face-to-face classes.

Using Second Life creates an interreality for the users – users are immersed in a digital environment, but are also making use of the real world. They are neither in one reality or the other completely. Digital environment experiences, being used the way they are at present, are best interleaved with real world experiences – students getting solely one set of experiences or the other will be missing out.

The major reason for students to prefer face-to-face education over distance education is because of perceived technical problems with remote connections, rather than a difference in perceived quality of overall educational experiences.

Some researchers have found that digital environments that the students engage well with, will positively impact on students’ emotions. Others fear that digitally mediated distance education will lead to emotional distance.

Holmburg and Huvila’s Study

This study had 30 participants – 28 female, 2 male. Of those, 6 had technical difficulties responding to the survey. Moodle, Second Life and one day of face-to-face teaching were used during the course. A classroom was built in Second Life, in which the lectures were held; the classroom closely resembled real-world classrooms to increase familiarity and emotional engagement. The course was arranged by the Centre for Open University Education at Åbo Akademi University.

Respondents were born between 1952 and 1984.

Each student was given instructions about how to use Second Life, and was expected to get to grips with it before commencing lectures.

Respondents felt that the Second Life client was not too difficult to use. Face-to-face education still rated as ‘better’, though Second Life rated as ‘better’ than web-based educational methods. Second Life was rated as the most fun method. Sixty percent of respondents felt that Second Life lectures could replace face-to-face lectures.

The assumption was made at the outset of the study that using Second Life – manoeuvring an avatar – might be challenging for students who were non-gamers. This turned out to be incorrect.

Second Life itself provides many opportunities for different modes of learning, however there are still benefits to be gained from face-to-face communication, when that is easy to organise, since this adds yet more modes.

Second Life provides significant benefits where distance education is involved. If travel time is short and travelling easy, face-to-face teaching is to be preferred. Nonetheless, Second Life increases the fun in learning, an outcome which in and of itself increases engagement and participation amongst students.

In conclusion

The authors of the study state that fun “is always a desired outcome.” This does not always seem to be the case: for many years, anything ‘fun’ has been questionable in educational circles. Hopefully, studies like this in which the fun of an activity is shown to have a positive impact on learning outcomes will go to show that education can be fun and worthwhile at the same time.

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