A Virtual Clinic for Medical Student Training in Second Life Using Chat-Enabled Patient Simulations Mary T Johnson, Ph.D. SL: Magistra Clary Indiana University School of Medicine Statewide Director for Problem Solving Competency Associate Professor of Microbiology and Immunology Terre Haute, IN 47809 [email_address]

Abstract Indiana University Medical School Virtual Clinic Developed in Second Life (SL) as a virtual setting for learning medical microbiology and infectious disease medicine. Located on Eduisland 5 Provides training in diagnosis, laboratory medicine and problem solving within the SL multi-user virtual environment Students encounter simulated patients within the Virtual Clinic and work in teams to apply the skills of a practicing physician as they organize information about infectious disease cases IUSM is the only medical school in Indiana & has 9 campus sites Students are encouraged to bond within Learning Communities focused on areas of shared clinical interest. This is especially meaningful in a distributed environment, where students might feel isolated without such interactions.

Indiana University Medical School Virtual Clinic

Developed in Second Life (SL) as a virtual setting for learning medical microbiology and infectious disease medicine.

Located on Eduisland 5

Provides training in diagnosis, laboratory medicine and problem solving within the SL multi-user virtual environment

Students encounter simulated patients within the Virtual Clinic and work in teams to apply the skills of a practicing physician as they organize information about infectious disease cases

IUSM is the only medical school in Indiana & has 9 campus sites

Students are encouraged to bond within Learning Communities focused on areas of shared clinical interest.

This is especially meaningful in a distributed environment, where students might feel isolated without such interactions.

Collaborative, clinic-like environment for first and second year medical students.

Patient Avatar in Virtual Clinic Waiting Room Three Learning Areas : Rural Medicine, International Medicine, and Poverty Medicine

The Patient Examination

Chatbot Background Simulated virtual patients were created based on chatbot technology; allows lifelike interactions between virtual patients & students, who can practice interviewing skills. The chatbot patient answers when posed with a specific set of questions that are relevant to the patient case. As the chatbot patient answers questions, students construct a patient history.

Simulated virtual patients were created based on chatbot technology; allows lifelike interactions between virtual patients & students, who can practice interviewing skills.

The chatbot patient answers when posed with a specific set of questions that are relevant to the patient case.

As the chatbot patient answers questions, students construct a patient history.

Students at early stages of training are provided with a set of appropriate questions. After completing a minimum number of cases, students independently elicit patient information. Students can request specific background information about expected diseases. Basic science underpinnings for relevant diseases are provided as mini-lectures.

Suitable heart, lung and bowel sounds are available as streaming audio retrieved using a virtual stethoscope during the physical exam section of the patient encounter. Laboratory results (hematology, chemistry, microbiology) and imaging studies (X-ray, CT, MRI, angiogram) are incorporated as retrievable objects and are also displayed on notecards that can be collected in the students’ inventory. Laboratory & Imaging Image courtesy of the CDC Public Health Image Library

Suitable heart, lung and bowel sounds are available as streaming audio retrieved using a virtual stethoscope during the physical exam section of the patient encounter.

Laboratory results (hematology, chemistry, microbiology) and imaging studies (X-ray, CT, MRI, angiogram) are incorporated as retrievable objects and are also displayed on notecards that can be collected in the students’ inventory.

Discussion Cased-based clinical problems are well-established as a method for teaching medical learners. However, paper-based cases are traditionally used for this purpose and they are sometimes not as interactive a format for student learning as intended by the case developers. Computer simulations are powerful learning tools because they promote active, hands-on, problem-solving by learners (NRC, 1999), but they are best used for individual training. An online shared environment like SL is especially practical for cooperative learning using medical simulations (Piturro, 2008). Although only in its beginning stages, there is great potential for the Medical School Virtual Clinic to evolve into a dynamic and meaningful platform for the exchange of ideas. Lessons learned apply to medical training at multiple levels, from high school vocational education to university pre-med programs through to medical school & post-graduate settings for learning.

Cased-based clinical problems are well-established as a method for teaching medical learners.

However, paper-based cases are traditionally used for this purpose and they are sometimes not as interactive a format for student learning as intended by the case developers.

Computer simulations are powerful learning tools because they promote active, hands-on, problem-solving by learners (NRC, 1999), but they are best used for individual training.

An online shared environment like SL is especially practical for cooperative learning using medical simulations (Piturro, 2008).

Although only in its beginning stages, there is great potential for the Medical School Virtual Clinic to evolve into a dynamic and meaningful platform for the exchange of ideas.

Lessons learned apply to medical training at multiple levels, from high school vocational education to university pre-med programs through to medical school & post-graduate settings for learning.

Within SL, a safe environment is provided where the language, actions, informal culture, and norms of medical practice can fuse into a routine process through repetition and group interaction (Piturro, 2008; Yu and Young, 2008). This type of learning atmosphere has been heralded in the educational literature and popular media for its potential to “enrich existing curricula and supplement traditional classroom learning” (Lok et al, 2006). It also brings to bear on the learning process the power of social networking theory with its emphasis on a user-controlled environment (Ondrejka, 2004). Networking with peers, experts, and with additional information sources makes learning more interesting and more immediate. The relevant and applied context allows students to be more active and creative in their engagement with the learning process (Scardamelia, 2002).

Within SL, a safe environment is provided where the language, actions, informal culture, and norms of medical practice can fuse into a routine process through repetition and group interaction (Piturro, 2008; Yu and Young, 2008).

This type of learning atmosphere has been heralded in the educational literature and popular media for its potential to “enrich existing curricula and supplement traditional classroom learning” (Lok et al, 2006).

It also brings to bear on the learning process the power of social networking theory with its emphasis on a user-controlled environment (Ondrejka, 2004).

Networking with peers, experts, and with additional information sources makes learning more interesting and more immediate.

The relevant and applied context allows students to be more active and creative in their engagement with the learning process (Scardamelia, 2002).

References Lok, B, Ferdig, RE, Raij, A, Johnsen, K, Dickerson, R, Coutts, J, Stevens, A, & Lind, DS (2006) “Applying Virtual Reality in Medical Communication Education: Current Findings & Potential Teaching & Learning Benefits of Immersive Virtual Patients”. Virtual Reality 10(3-4): 185-195. Ondrejka, C. (2004) “A Piece of Place: Modeling the Digital on the Real in Second Life” Social Science Research Network, Accessed on 5-20-08 and available at SSRN: http://ssrn.com/abstract=555883 National Research Council (1999) How people learn: Brain, mind, experience, and school. Washington, DC: National Academy Press. Piturro, M. (2008) “Virtual Medical Simulation”. MD Net Guide New Media. Accessed on 5/22/08 www.mdnglive.com/articles/ Scardamelia, M. (2002). “Collective cognitive responsibility for the advancement of knowledge”. In B. Smith (Ed.) Liberal Education in a Knowledge Society. Chicago, Open Court Yu, C.-P. and Young, M.-L. (2008) “The Virtual Group Identification Process: A Virtual Educational Community Case” Cyberpsychology & Behavior, 11(1):87-90

Lok, B, Ferdig, RE, Raij, A, Johnsen, K, Dickerson, R, Coutts, J, Stevens, A, & Lind, DS (2006) “Applying Virtual Reality in Medical Communication Education: Current Findings & Potential Teaching & Learning Benefits of Immersive Virtual Patients”. Virtual Reality 10(3-4): 185-195.

Ondrejka, C. (2004) “A Piece of Place: Modeling the Digital on the Real in Second Life” Social Science Research Network, Accessed on 5-20-08 and available at SSRN: http://ssrn.com/abstract=555883

National Research Council (1999) How people learn: Brain, mind, experience, and school. Washington, DC: National Academy Press.

Piturro, M. (2008) “Virtual Medical Simulation”. MD Net Guide New Media. Accessed on 5/22/08 www.mdnglive.com/articles/

Scardamelia, M. (2002). “Collective cognitive responsibility for the advancement of knowledge”. In B. Smith (Ed.) Liberal Education in a Knowledge Society. Chicago, Open Court

Yu, C.-P. and Young, M.-L. (2008) “The Virtual Group Identification Process: A Virtual Educational Community Case” Cyberpsychology & Behavior, 11(1):87-90

THIS PROJECT IS PART OF A MULTI-INSITUTIONAL COLLABORATION USING AIM-L LANGUAGE AND THE SECOND LIFE ENVIRONMENT Mary T Johnson (SL: Magistra Clary) Indiana University School of Medicine Douglas Danforth (SL: DrDoug Pennell) Ohio State University College of Medicine Bob Heller (SL: Duyu Voom) Athabasca University Centre for Psychology Mike Procter (SL: Snik Philbin) Athabasca University