Good morning. Today I will be discussing the feasibility of using virtual worlds in chiropractic education based on a project completed at NWHSU this year.
This slide depicts just a few of the virtual worlds currently available. A virtual world is an interface that allows users to interact using text or chat in a computer-based 2D or 3D simulated environment populated by avatars.
Second Life is the virtual world most commonly used for educational purposes and it also supports a significant and growing health care education presence2.
Why virtual worlds? The 2007 HorizonReport predicted that virtual learning spaces would impact higher education and be adopted on a wide scale basis within the next two to three years… While this wide scale adoption has not yet occurred, the use of virtual worlds in education is growing considerably.
A number of health care professions currently have a virtual educational presence in Second Life including Pharmacy
Pharmacy case histories in a virtual world Using their Second Life avatars, UNC-Chapel Hill Pharmacy students visit a virtual representation of Greensboro’s Moses Cone Family Practice Center. There, they learn the location of the exam room and waiting room and the layout of the building. They view video clips demonstrating a successful and effective patient interview. Another pharmacy student, whose avatar has the role of patient, is given all the information they need to effectively play their role. The patient is invited into the exam room for a consultation with the pharmacy student who takes the case history. The interview is conducted with the voice chat feature of Second Life, allowing the students to talk to each other in real-time as if they were conducting a real interview at the Family Practice Center. At the conclusion of the interview, the “patient” leaves the Exam Room, and the pharmacy student proceeds to a quiz station where he or she takes a quiz to assess the effectiveness of the information obtained during the case history interview. Once the review is completed, the results are e-mailed to the pharmacy instructor to assure him or her that the student has completed the module successfully.
Many medical education institutions including the Indiana University School of Medicine
Nursing as shown in the postpartum simulation created by the University of Auckland
Postpartum simulation scenario The entire floor of the central building has been dedicated to the simulation, and includes a lecture area complete with whiteboard, a round-table discussion area for debriefing, and the medical simulation itself. The simulation comprises a single hospital room, but it is surrounded by a one-way curtain (see in, but not out) that prevents participants from seeing people in the observation seating area. The simulation requires student nurses to interview a patient in the bed (played by the instructor) and to make appropriate clinical decisions following the discovery of profuse bleeding (fig. 11).
Dentistry at Texas A&M and the University of Maryland
Using an online 3D virtual world called “Second Life,” Drs. Hutchins, Wathen and colleagues have begun to develop a grand rounds dental experience. They envision inviting clinicians in various specialties to present important, evidence-based issues as the subject matter of each grand round. Basic science faculty will participate to provide foundational support for the integration of the subject matter. The format to be used will include several short segments modeled after the Burton and Roth grand round format (New England Journal of Medicine 340:1516, 1999).
U of M http://www.youtube.com/watch?v=7tvdySF0J1s A US dental school is opening the doors of the first-ever 3D virtual dental education facility. students will be able to ‘experience' aspects of dentistry, ranging from lessons in dental hygiene practices to infection control and anatomy.
We started our investigation of this question with a focus group of students who suggested that perhaps SL could be used as an elective option for for fulfilling some of their clinical education observation hours with a site that just happens be a virtual one instead of in real life.
A focus group was formed to begin exploring this possibility9. Students were intrigued by the concept, but were concerned about time and technology constraints. They also expressed an unwillingness to substitute a virtual world experience for hands-on electives. As an alternative, the focus group participants suggested that certain Second Life interactions could be presented as options for fulfilling clinical education hours.
Based on this feedback we decided to use Second Life to simulate a clinical patient interviewing experience. A virtual world chiropractic clinic could expose patients to diverse patient populations not otherwise available in the typical patient interviewing curricula. Students could interact with geriatric patients, or patients with disabilities, and could interview real patients with real histories in real time. The use of avatars offers some degree of anonymity for the patient, perhaps making them more willing to share their health histories for educational purposes
I then created a virtual chiropratic clinic in SL.
I have had two courses in SL but do not consider myself an expert and I have no coding experience. So this process is definitely possible for the average educational institution.
Clinical Rotations are required, 'one-time' observations at various chiropractic sites around the metro area. This Voluntary Clinical Rotation
During the winter of 2010 5 students volunteered to conduct a virtual interview with a geriatric patient in Second Life. Moodle was used to disseminate information such the patient intake forms completed by the real patient. Instruction manuals were developed to guide students through the process of downloading the software, creating a customized avatar, and interacting with the virtual world. An avatar was created for a 72-year old real-life patient with multiple health care issues, and the patient was trained to use this avatar
Each student’s avatar met the patient’s avatar in the virtual clinic and conducted the interview using voice chat. Following completion of the interview, students completed a survey comprised of multiple choice and open-ended questions regarding the experience.
Moodle Patient intake forms, instructions, Second Life User Manual
Upon review of data collected from the student surveys, several common themes emerge
The students found that the real-time chat dialogue was valuable- “…I could hear his voice and he responded to questions in a way that was not just a script”,
Technology was an issue both in terms of the time required to become proficient as well as difficulty in getting the technology to run reliably. A powerful computer with an up-to-date video card and a fast broadband internet connection are required for optimal performance. IT department are not trained in this software and haven’t budged for support. Sound can be particularly problematic on many levels from using integrating microphones to issues with university firewalls. Time to learn!
In a typical educational setting the problems with using Second Life for teaching and learning are related primarily to technical issues. The software is free, but must be downloaded. Institutional IT departments may resist installing and providing support for this program. Sound can be particularly problematic, and may be blocked by firewalls. When voice chat is used on campus, a sound-proof space must be available., and university firewalls are frequently an issue. In addition, participants require a significant amount of time to learn how to navigate and interact in-world. During the current project we experienced issues with all of the above.
Students also had difficulty viewing the avatar as a “real” patient, expressing that the lack of body language obscured an important part of the clinical interview. They found that “not being able to see the person, inspecting them, watching for visual cues” was challenging. Overall, these students felt that they would rather interact with a patient in the real world.
There are a number of other issues that make Second Life challenging to use in the chiropractic educational setting including the very nature of chiropractic itself. As a profession, we pride ourselves on our low-tech, high-touch approach to patient care. Second Life offers the opposite to this type of encounter, which may make it difficult for the chiropractic student to consider a patient encounter in Second Life as anything but insincere. These students had difficulty suspending disbelief enough to truly see the patient behind the avatar, and were frustrated by the inability to communicate through body language.
Another challenge is the very nature of chiropractic itself. As a profession, we pride ourselves on our low-tech, high-touch approach to patient care. Second Life offers the opposite to this type of encounter, making it difficult for the chiropractic student to see this type of patient encounter as anything but insincere.
So, back to the original question. Is it feasible to implement and use Second Life at a chiropractic institution. Yes- at least at our institution and on a small scale basis.
However, does this necessarily mean that chiropractic educators SHOULD begin using virtual world technology?
Is it simply enough to say that if other health care professions are teaching in virtual worlds, we should follow suit?
Are we going to find that as enrollment of Millennials increases, demands for cutting edge experiences such as these will also increase? If so, will we be ready?
It is my opinion that we really need to continue to explore the possibilities inherent in virtual education. Technology is improving every day. The project I have described is just one possibility in a multitude of educational options available in SL. Based on our student surveys perhaps patient interviewing with upper level students isn’t the best way to proceed intitially. Perhaps we should explore other options.We need to think creatively about how we could use these virtual workspaces to enhance the chiropractic educational experience. if not patient interviewing then perhaps a virtual x-ray positioning lab, student dialogues with disability groups10, integrated clinical experiences offering our students interaction with others from across the world. The possibilities are limitless.
Virtual worlds for chiropractic education feasible or foolish
Glori Hinck, RD, MS, DC
Northwestern Health Sciences University
Bloomington, MN USA
Lynne Hvidsten, DC, MBA
Mary Berg, MA
2D or 3D
Text and/or chat
used for educational
“… virtual learning spaces will impact higher education
and be adopted on a wide scale basis within the next two
to three years….
Virtual patient interviews
A review of the literature and the
Web finds no reference to
utilizing Second Life as part of
elective option for
5 students (T8)
Avatar created for 72
Students created own
Met in virtual
“…I could hear his voice and he responded to
questions in a way that was not just a script”
Gained insight regarding the challenges in taking
a history from a geriatric patient, “They tend to
jump around…they also have a lot of other
problems besides the primary complaint they are
seeing you for.”
Primary Problem: Technical issues
Software is free but must be downloaded
**Significant time investment by participants to
learn how to navigate and interact within world
“Not being able to see the person, inspecting
them, watching for visual cues”
Would rather interact with a patient in the real
These students had difficulty suspending disbelief
enough to truly see the patient behind the avatar,
and were frustrated by the inability to communicate
through body language
Second Life (http://secondlife.com/
Most popular virtual world platform for education
Computer/web- based simulated multi-media
3-D social network
Users interact via avatars
Voice chat/text chat/instant messaging
Integrate with Moodle via SLOODLE
Boulos, M.N., Hetherington, L., &Wheeler, S. 2007. Second Life: an overview of the
potential of 3-D virtual worlds in medical & health education. Health Information and
Libraries Journal. 24. 233-245.