This document provides an introduction to integrating game-based and virtual learning environments into simulation curricula. It begins with presenter disclosures and learning objectives. Key topics include terminology related to virtual worlds, avatars, and pedagogical approaches like experiential learning. Contemporary expectations of digital natives are also discussed. The document demonstrates a virtual environment called CliniSpace and provides examples of how virtual simulation can complement other forms of simulation. It concludes with references.

1. INTRODUCTION TO GAME-BASED AND
VIRTUAL ENVIRONMENTS:
COMPLIMENTARY AND SYNERGISTIC
INTEGRATION INTO YOUR SIMULATION
CURRICULUM
Presenters/Authors: Eric B. Bauman, Parvati
Dev, Katie White, Wm. LeRoy Heinrichs, Gerald
Stapleton, Cindy Foronda
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 Palyground, 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
 Katie White, MD
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 develop an understanding of
contemporary pedagogy and terminology related to
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game-based learning and virtual learning
environments.
2. Learners will understand how game-based learning and
digital environments engage contemporary learners
and attend to the challenges associated modern clinical
education.
3. Learners will identify strategies and opportunities to
integrate game-based learning and digital
environments into their simulation curriculum.

7. Overview of Main Topics
 Introduction to game-based and virtual
7
environments
 Introduction to contemporary pedagogy and
terminology
 Immersive play in virtual environments

8. Terminology
 Game-Based Learning:
8
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
9 environment, 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 know 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. Pedagogy
 Experiential Learning (Kolb)
 Novice to Expert – Thinking-in-Action (Benner)
 The quality of the clinicians 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 towards 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

13. Pedagogy
 Situated Cognition
 Socially Situated Cognition (Gee)
 Learning and eventually practice takes place in an inherently social context. The
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how, 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

14. Engagement Expectations
 Digital Native vs. Digital Immigrant
14 Digital immigrant: Refers to those of us have adopted
digital technology as adults or later in life. Not all digital
immigrants were born prior to the wide spread adoption
of digital media and devices. The concept of the digital
immigrant may not always map to a generational context
and can relate to people just encountering innovative
digital technology (Presnsky, 201).
Digital native: Generally referring to those people who
have always been part of the net (as in Internet) or digital
generation. Digital natives are fluent in the language of
the digital environment. They possess an innate sense of
media literacy (Prensky, 2001).

15. Engagement Expectations
 Juxtaposition among and between
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Teachers and Students
 Today’s students/learners have a degree of technical and digital
literacy that generally far exceed that of their instructors
 They have a host of expectations in how information
dissemination, presentation, and transfer will take place
 Those institutions that fail to address these expectations will fail to
attract and retain the best and brightest students

16. Introduction to CliniSpace
16

17. Introduction to OpenSim
17

18. Lets Play – Immersive Experiences
18

19. Leveraging Virtual Simulation
 Mass triage or disaster simulation
19  Pre-post simulation for continuity
 Electronic Health Record / documentation
 Communication
 Capstone
 Clinical Visit
 Clinical Visits
 High-stakes testing
 Intra and interdisciplinary collaboration
 National and international education

20. Leveraging Virtual Simulation
 Enhance web-based instruction
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 Hybrid- in conjunction with mannequin-based
simulation
 Entrance testing
 Enhance lecture
 Assignments
 Simulation for clinical experiences difficult to
arrange (i.e. high risk pediatrics)
.

21. Virtual Environments to Compliment other
forms of Simulation
21
.

22. Virtual Environments to Compliment other
forms of Simulation
22
©Bauman 2012 Rights Reserved

23. References
 Benner, P., Tanner, C., & Chesla, C. (2009). Expertise in nursing: Caring, clinical judgment, and ethics. New York: Springer
Publishing Company.
 Bauman, E. B. (2012). Game-based Teaching and Simulation in Nursing & Healthcare. New York, NY: Springer Publishing
Company.
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 Gaba, D. M. (2004). The future vision of simulation in health care. Quality and Safety in Health Care, 13(Suppl. 1), i2-10.
 Games, I. and Bauman, E. (2011) Virtual worlds: An environment for cultural sensitivity education in the health sciences.
International Journal of Web Based Communities 7(2), 189-205, doi: 10.1504/IJWBC.2011.039510
 Gee, J.P. (2003). What videogames have to teach us about learning and literacy. New York, NY: Palgrave-McMillan.
 Gould, J., & Bauman, E. (2012). Virtual reality in medical education. In Tsuda, S., Scott, D.J. & Jones, D.B. (Eds) Textbook of
simulation, surgical skills and team training. Woodbury, CT: Cine-Med.
 Hayes, E. (2005). Women, video gaming and learning: Beyond stereotypes. TechTrends, 49(5), 23-28.
 Heinrichs, W.L., Bauman, E. Dev, P. (2012). SBAR ‘flattens the hierarchy’ among caregivers. Studies in Health Technology
and Informatics 2012(173), 172-185, doi: 10.3233/978-1-61499-022-2-175.
 Kolb, D. (1984). Experiential learning: Experience as the source of learning and develop- ment. Upper Saddle River, NJ:
Prentice Hall.
 Lenhart, A, Jones, S., & Mcgill, A.J. (2008). Adults and video games. Pew Internet and American Life Project, Washing D.C.
 Prensky, M. (2001). Digital natives, digital immigrants part 1. On the Horizon, 9(5), 2-6.
 Prensky, M. (2010). Teaching digital natives: Partnering for real learning. Corwin Press.
 Schön, D. A. (1983). The reflective practitioner: How professionals think in action. New York: Basic Books.
 Squire, K.D. (2006). From Content to Context: Videogames as Designed Experience. Educational Researcher, 35(8), 19-29.
 Squire, K. D. (2007). Open-ended video games: A model for developing learning for the interactive age. In K. Salen
(Ed.), The Ecology of Games, The John D. and Catherine T. MacArthur Foundation series on digital media and learning (pp.
167-198). Cambridge: MIT Press.

24. Questions & Answers
©Bauman 2013 Rights Reserved
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