The document explores the inadequacies of traditional learning theories in adapting to modern educational needs, especially in the context of virtual and game-based learning environments. It outlines how contemporary students, influenced by digital culture, require innovative pedagogical approaches that emphasize experiential learning, cultural competence, and identity development through engagement in simulated environments. The author advocates for embracing new theoretical frameworks that prioritize interactivity, contextual learning, and narrative-driven experiences to better prepare students for professional practice.

1. Examining Contemporary Theory for
Virtual and Game-Based Learning
Eric Bauman, PhD, RN, Paramedic
© Copyright by Eric B. Bauman 2010
All Rights Reserved

2. Author Information and COI Statement
Eric Bauman, PhD, RN
Faculty Associate
University of Wisconsin School of Medicine &
Public Health
Department of Anesthesiology
COI: Consultant -Vernon M emorial Healthcare and TM FD
Investments: Pfizer, SHSAX

3. What’s Wrong with Traditional Theory
Nothing & Everything
• Traditional theory provides historical prospective and
in some cases a starting point for contemporary
theories.
• Traditional learning theories predate modern
technology including virtual and game-based
immersive environments.
• The learner can no longer be seen as an empty
vessel waiting around for a fill-up of expertise
• Traditional learning theories often does not
adequately address behavioral aspects of
professional practice such as Culture & Diversity

4. Students are Students, Right?
What worked for me is good enough for today’s students
• Most of today’s students grew up in the age of the Internet - they
embrace digital culture. They are likely to have a high degree of media
literacy and adaptability
• Students are well positioned to take advantage of virtual and game-
based learning environments and opportunities
• Digital media is no longer seen as a facet of culture limited to
entertainment and communication.
• The modern learner is accustomed to multi-media environments and is
comfortable using these environments for academic, personal, and
professional gain. Students today don’t expect good engaging
technology - they DEMAND IT!
• Institutions that do not embrace a sense of media literacy find it
increasingly difficult to compete for today’s best and brightest students

5. Historical Perspective
Experiential Learning Theories
• Schön (1983): Reflection-on-Action.
Reflection through internal dialog or
talk-back
– Contextually Emergent
• Benner (1984): Thinking-in-Action.
Reflection of previous experience
effects current practice
– Contextually Emergent
• Kolb (1984): Experiential Processes
as Cyclical and reflective

6. Contemporary Theories
• Created Environment1
• Designed Experience2
• Socially Situated Cognition3
• Ecology of Culturally Competent Design4
(Bauman 20071;Games & Bauman4; Squire, 20062 Gee, 1991,19933

7. Created Environment
• An environment that has been specifically
engineered to accurately replicate an actual
existing space, producing sufficient authenticity
and fidelity to allow for the suspension of
disbelief. Simulated environments, whether fixed
in the case of mannikin-based simulation
laboratories resembling elaborate theatrical sets,
or existing in virtual reality, are created
environments. Bauman, 2007

8. Designed Experiences
• A Designed Experience is engineered to
include structured activities targeted to
facilitate interactions that drive anticipated
experiences. These activities are created to
embody participant experience as
performance. Many theme parks are based
in part on the theory of designed experience.
Squire 2006

9. Socially Situated Cognition
• Refers to learning theory that is
situated within a material, social, and
cultural world. Learning that is situated
takes place in contextually specific and
authentic environment with a host of
values and expectations.
Gee,1991,1993

10. Ecology of Culturally
Competent Design
• Addresses the rigors and challenges of
accurately situating culture within
virtual environments using a four-
element model that emphasizes the
importance of activities, contexts,
narratives, and characters.
Bauman, In Press; Games and Bauman, In Press

11. Activity
• Interactivity is one of the most important defining characteristics of
successful learning in games and virtual worlds.
• Participation in virtual worlds is only meaningful when players are
actively engaged in their environment rather than passively observing it
• The game and its environment define identity and develop affinity
groups
• In the health sciences, virtual spaces include familiar settings where
learners can practice many of the activities germane to the professions
they hope to join
(Gee, 2003; Taekman, Segall, Hobbs and Wright 2007)

12. Context
• Virtual simulated spaces can be designed in ways that
authentically capture environmental fidelity
– Replicate in virtual form aspects of the real world that
students occupy in actual practice
• Safer environments where students could afford to learn from
mistakes with no risk to patients
– virtual worlds provide opportunities for learning and
professional development without the consequences
associated with actual therapeutic misadventure
• Virtual simulation overcomes some of the barriers associated
with fixed or physically created environments
– Money, Location, Space allocation
Games and Bauman, In Press; Squire 2006; Bauman, 2007

13. Narrative
• Narratives provide peoples’ memories with a collection of
patterns that help them recognize and make sense of the world
• Narratives assist players in the negotiation of their identities,
particularly projective identities. Projective identities place
learners in the shoes of the virtual identities they are playing
• Narratives also provide spaces for reflection on the
consequences of student action or inaction. Learners can be
encouraged to see the consequences of their decisions from
multiple perspectives and deliberate practice
(Bruner, 1991; Gee, 1991, 2003)

14. Character
• The fluidity and malleability of virtual environments applies not
only to the look and feel of virtual teaching spaces, but also
learners identities
• The ability to try on multiple identities may be of great value for
the construction of learning experiences involving culture and
diversity
• Players shape and design their avatars (characters), which
become their in-world identities
• Identity expectation related to one’s future professional affinity
group is an important tenet of learning
(Gee, 2003; Squire, 2006)

15. So why should we
turn to these new
fangled theories?
Cracked.com & capt_weasle
Why turn to theories
that stem from the
modern videogame
movement and the
entertainment
industry?
Cracked.com & darrenjames140

16. Because we are interested in
teaching our students to
become something other than
good technicians!

17. What we are really
interested in…
Cracked.com
• Identity and Consequence
• Acculturation and Indoctrination of a
professional into practice
• Cultural Competence
• Learning as Behavioral Change
Popkewitz, 2007

18. Identity and Consequence
• Virtual communities encourage participants to “try
on” different identities and reflect on the
consequences of their decisions while “wearing”
these identities.
• Identity is fluid and malleable - How can we use this
fluidity to enhance learning experiences?
• As instructors should we or do we need to impose
restrictions on in-world identity
(Gee, 2003; Turkle, 1995)

19. Acculturation - Indoctrination
• Part of the educational experience focuses on learning how to
become part of a cohort
• Beyond the required professional knowledge base, novice
clinicians must come to understand the conduct and
expectations of the rank and profession they hope to join
How to: Look - Act - React
Gee, 2003; Popkewitz, 2007

20. Cultural Competence
• Published literature readily discusses the importance of integrating
cultural competence into health sciences curricula
• There is little literature to indicate that simulation and standardized
patient education has readily integrated culture and diversity into
health sciences curricula.
• Both obvious and subtle cues related to culture, gender, and race can
often have profound social-cultural implications and biological
consequences related to diagnosis and treatment
• Cues derived during observational and behavioral encounters may
drive important decisions related to diagnosis and patient care.
(Culhane-Pera, Reif, Egli, Baker, and Kassekert, 1997; Tervalon and Murray Garcia, 1998;
Smedley, Stith, and Nelson, 2003; Steele and Aronson, 1995)

21. Learning as Behavioral Change
• Through in-world interaction and during post experience
debriefing instructors can facilitate behavioral responses from
students that represent either cultural competence or cultural
cliché and stereotypes
• Educators bear the responsibility for providing environments
that provide a safe medium to facilitate the transfer of
knowledge and facilitate behavioral change
• Web-based and virtual worlds can provide a translational
platform for behavioral change related to culture and diversity
Thiagarajan, 1992; Games and Bauman 2009

22. Transition from the virtual world to the real world
• Avatars and virtual worlds can be designed to evoke students
preconceived notions of culture and identity
– In terms of cohort social norms and cues
– In terms of professional expectations and cues
• Virtual or web- based communities that authentically replicate
real-world clinical experiences can provide translational
educational and research experiences for both students and
educators
• Virtual or web-based experiences may provide consistent
exposure to diverse cultural content across curricula that are
NOT available in actual clinical or traditional mannikin-based
simulation environments

23. References
Bauman, E. (2007). High fidelity simulation in healthcare. Ph.D. dissertation, The University of Wisconsin-
Madison, United States. Dissertations & Thesis @ CIC Institutions database. (Publication no. AAT
3294196)
Bauman, E, (In Press). Virtual reality and game-based clinical education. In Gaberson, K.B., & Oermann, M.H.
(Eds) Clinical teaching strategies in nursing education (3rd ed).New York, Springer Publishing Company.
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA:
Addison-Wesley.
Bruner, J. (1991). The narrative construction of reality. Critical Inquiry 18 (Autumn), 1-20.
Culhane-Pera, K.A., Reif, C., Egli, E., Baker, N.J., and Kassekert (1997). A curriculum for multicultural education
in family medicine. Family Medicine, 29(10), 719-723.
Games, I. and Bauman, E. (In Press). Virtual worlds: An environment for cultural sensitivity education in the
health sciences. International Journal of Web Based Communities.
Gee, J. P. (1991). Memory and myth: A perspective on narrative. In A. McCabe & C. Peterson (Eds.), Developing
narrative structure (pp. 1 - 26). Mahwah, NJ: Erlbaum.
Gee, J.P. (2003) What Videogames Have to Teach Us Ab out Learning and Literacy. New York, NY: Palgrave-
McMillan.
Popkewitz, T. (2007). Cosmopolitianism and the age of school reform: science, education and making a society
by making the child. Routledge.
Smedley, B. D, Stith, A. Y, and Nelson, A. R. (Eds.). (2003) Unequal treatment: Confronting racial and ethnic
disparities in health care. Washington, D.C.: National Academies Press.
Steele, C.M. & Aronson, J. (1995) Stereotype Threat and the Intellectual Test Performance of African Americans.
Journal of Personality and Social Psychology. 69(5), 797-811.
Squire, K. (2006). From content to context: Videogames as designed experience. Educational Researcher.
35(8), 19-29.
Taekman J.M., Segall N., Hobbs G., and Wright, M.C. (2007). 3DiTeams: Healthcare team training in a virtual
environment. Anesthesiology. 2007: 107: A2145.
Tervalon, M. and Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in
defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and
Underserved, 9(2), 117-125.
Turkle, S. (1995) Life on the screen. Identity in the age of the Internet. New York: Touchstone.

24. Special Thanks
• Eric Graves: American Research Institute
• Gerald Stapleton: University of Illinois at Chicago
College of Medicine
• Jerry Heneghan: Virtual Heroes
• Melanie Lazarus: ARCHIMAGE
• Jeff Taekman: Duke University - Human Simulation
and Patient Safety Center
• Bob Waddington: SimQuest
• Allan Barclay: University of Wisconsin - Madison,
Ebling Library

25. Contact Information
Eric Bauman, PhD, RN
B6/319 CSC
Department of Anesthesiology
600 Highland Avenue
Madison, WI 53792-3272
Email: ebauman@wisc.edu
Office: 608-263-5911
Linkedin: http://www.linkedin.com/in/ericbbauman