This document discusses hybrid simulation, which combines multi-method simulation for educational interventions and research protocols. It begins by introducing terminology used in game-based learning and virtual environments. Next, it discusses pedagogical approaches that support learning in virtual spaces, including experiential learning, situated cognition, and designing authentic environments. Finally, it provides an introduction to CliniSpace and OpenSim, which are virtual environments that can be used for hybrid simulation.

1. HYBRID SIMULATION: COMBINING
MULTI-METHOD SIMULATION FOR
EDUCATIONAL INTERVENTIONS AND
RESEARCH PROTOCOLS
Presenters/Authors: Eric B. Bauman, Parvati
Dev, Katie White, Wm. LeRoy Heinrichs, Gerald
Stapleton, Cindy Foronda, and Phil Bertulfo
IMSH 2013 | Orlando, Florida

2. Disclosure(s)
 Eric B. Bauman, PhD, RN, Paramedic
1
 Associate Director – Center for Simulation
Excellence, DeVry, Inc. Healthcare Group
 Division Chief, EMS – Blooming Grove Fire Dept.
 Managing Member – Clinical Playground, LLC
 Springer Publishing – Author
 Adjunct Faculty – CAE Healthcare
 Relevant Stock – CAE, Zynga, GE

3. Disclosure(s)
 Cindy Foronda, PhD, RN
1 Assistant Professor
 University of Miami – School of Nursing & Health Studies
 A portion of this project was supported by funds from the
Division of Nursing (DN), Bureau of Health Professions
(BHPr), Health Resources and Services Administration
(HRSA), Department of Health and Human Services
(DHHS) under grant number D11HP19238, Nurse
Education Practice and Retention, award amount of
$721,912. The information or content and conclusions are
those of the authors and should not be construed as the
official position or policy of, nor should any official
endorsement be inferred by, the DN, BHPr, HRSA, DHHS,
or the US Government.

4. Disclosure(s)
 Gerald Stapleton, MS
1 Director of Distance Education
 University of Illinois
 School of Medicine, Department of Medical Education
 Director – Distance Education
 Katie White, MD
Clinical Assistant Professor – Internal Medicine
 University of Iowa
 Carver College of Medicine
 University of Iowa Healthcare

5. Disclosure(s)
 Parvati Dev, PhD
1
 President and CEO – Innovation in Learning, Inc.
 CliniSpaceTM
 Wm. LeRoy Heinrichs, MD, PhD
 Co-Founder and Executive Medical Director
 CliniSpaceTM
 Phil Bertulfo
 Associate Director – Distance Education
 University of Illinois, School of Medicine, Department of
Medical Education

6. Learning Objectives
1. Learners will be introduced to terminology found in the game-
based learning movement
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2. Learners will be introduced to pedagogy that supports learning
occurring in game-based and virtual environments
3. Learners will be introduced to and immersed into virtual learning
environment
4. Learners will be guided through storyboarding educational
experiences occurring in virtual environments
5. Learners will experience a hybrid simulation - combining multi-
method simulation

7. Overview of Main Topics
 Game-Based and Virtual Environment
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Terminology
 Game-Based and Virtual Environment
Pedagogy
 Immersion into Virtual Environments
 Storyboarding the Educational Experience
 Multi-Method Simulation

8. Terminology
 Game-Based Learning:
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Learning that provides a system of rewards for
accomplishing specific tasks and objectives. Many
game-based learning environments also provide a
narrative to engage learners.
 Digital Game-based platforms use virtual
environments to stage the game.
 Not all virtual reality environments are game-based

9. Terminology
 Virtual World:
an environment that hosts a synchronous digital environment,
9 persistent network of people, represented as avatars,
facilitated by networked computers (Bell, 2008).
 Game-Based Environment:
An environment that provides a narrative and system of
rewards for accomplishing specific tasks and objectives.
 Game-based platforms use virtual environments to stage
the game.
 Not all virtual reality environments are game-based
(Bauman, 2010, p.186).

10. Terminology
 Avatar or Player Character:
The term avatar is originally from Greek mythology. The gods would
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take the shape of mortals in the form of human avatars to walk the
earth. In video games and virtual environments, an avatar
transcends two planes of existence: the real world and the in-world
or virtual world. The avatar or player-character is the embodiment of
the person playing the game. Players live in and interact with the
virtual or game-based environment through their avatars. (Bauman
2010 p.183).
 Non-Player Character:
In-world agents of and from the game or virtual environment. NPCs
are a function of programming and do not exist outside of the game
or virtual environment. NPCs are in-world characters that the
players’ (learners’) avatars interact with. This term originated from
paper-based role- playing games like Dungeons and Dragons. It is a
narrower definition than bot; however, there is often a blurring
between the definitions of bot and NPC (Bauman, 2010 p. 186)

11. Terminology
 VOIP (Voice Over Internet Protocol)
Voice Over Internet Protocol. VOIP is most commonly known for
applications like Skype or Magic Jack, where it is used in place of a
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traditional telephone line. VOIP is also used in a number of other
applications including web-based game or virtual world environments.
 Text-Based Communication Platform (i.e. in Second Life, Unity, Others)
Text-Based Communication Platforms allow for written communication
to occur via the internet and other communication tools. Short Message
Service (SMS) is the most widely used data application used in the
world (3.6B users). While most commonly used in the mobile phone
industry, texting is an often found and used tool in web-based virtual
worlds and game environments

12. Hybrid Simulation
Virtual Sim Real World Sim Virtual Sim
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Successful Hybrid Simulation uses multiple modalities of simulation in a
complimentary way to meet facilitate a learning experience or facet research
Real World Sim Virtual Sim Real World Sim

13. Pedagogy
 Experiential Learning (Kolb)
 Novice to Expert – Thinking-in-Action (Benner)
 The quality of the clinician’s decision making is influenced and
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improves over time based on previous experience within the
profession
 Thinking-on-Action& Thinking-in-Action (Schön)
 Novices first learn to think on action, reflecting on their past
decision-making process or experience.
 Later as students move toward proficiency and expertise they
are able to think-in-action because they have a stable of
experiences to draw on. The practitioner engages in a form of
internal talk-back as an experience unfolds.

14. Pedagogy
 Situated Cognition
 Socially Situated Cognition (Gee)
 Learning and eventually practice takes place in an inherently social context. The how,
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why, perception of the learning space and eventual clinical space matters in terms of
outcome
 Designed Experience (Squire)
 Learning and evaluation take place as a function of performance
 Created Space/Environment (Bauman)
 An environment that has been specifically engineered to replicate an actual existing
environment, producing sufficient authenticity and environmental fidelity to allow for the
suspension of disbelief
 Ecology of Culturally Competent Design (Games and Bauman)
 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

15. Introduction to CliniSpace
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http://youtu.be/9ki8FATgJzU

16. Introduction to OpenSim
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