Action Research project using Problem Based Learning for Nursing in Second Life Clinical Simulation

1. Problem based Learning
in a 3D Virtual World
Evelyn McElhinney
aka Kali Pizzaro
School of Health and Life sciences
TELP Webinar

2. • Brief overview of 3D VW and the affordances of 3D Virtual
Worlds
•Discuss why simulation in a 3D virtual world eg. Second Life (SL)
•Describe how I used and created Problem Based Learning scenarios
in SL
•Examples of student interaction in VWs and decision making
•Some results from Action Research Project

3. Poll
How many of you have used a 3D virtual world?
How many have use a 3D virtual world for teaching?

4. What is a 3D virtual World?
•3D multi user environment (MUVE)
•Users create a digital representation of self (avatar)
•Immersive – user should feel immersed and a sense
of presence and social presence in the environment
•Content creation
•Sharable user generated digital contents
•Viewer required or web interface
(de Frietas 2008)

5. Gartner Hype Cycle 2011
http://www.gartner.com/newsroom/id/1763814

6. http://www.kzero.co.uk/insight-research/

7. Avatars
“Digital representation driven by humans”
(Blascovich and Bailenson 2011, p11)
“A virtual human can not only look and behave like us,
but once we form a psychological connection with the virtual human,
it can become us.”
(Ahn, et al. 2012)

8. Affordances of 3D Virtual Worlds
• Self-representation (via the avatar)
• Spatial cognition, immersion & social presence
• Increased socialisation
• Increased engagement
• Increase active learning
• Educational (clinical) simulation
• Collaboration – local or international
• Guest lectures
• Field trips
Savin-Baden (2010),
Minocha and Roberts (2008)

9. Pedagogy
• Experiential
• Situated
• Social Constructivism
Many more

10. Educational activities in 3D Virtual Worlds
• Virtual quests
• Collaborative simulations
• Collaborative construction
• Virtual Laboratory
• Virtual Field trip
• Role Play
• Game – based learning
• Lectures
Duncan et al (2012)

11. Why?
• Part time – Blended
‘protected time for practise in clinical area’
• Unable to access physical world CSL – needed authentic
looking immersive synchronous environment
•Competing demands – work, family etc
•Delphi – hindering factors – confidence in diagnostic history
taking and listening to heart sounds, documentation (McElhinney
2010)
•Difficulty engaging with asynchronousVLE

12. What? - Simulation using Problem
Based Learning scenarios
• Patient/patient bot or distant volunteer - real life health
history
• Heart sounds – simulator worn on avatar chest and
controlled by lecturer
• Continue – documentation, investigations –given roles –
short term management – with literature to back up
• Present as a Multi Disciplinary meeting to international
audience in SL

13. How?
Live to SL

14. Student Presentation to International Audience

15. Methods - Data Collection
• Pre survey – self assessed computer ability
•Student diaries – completed after all sessions
in the VW
•Lecturer diary – usability, etc = changes
•Post VW self assessment of group work

16. Analysis - 5 Stage Model of Teaching and Learning in
Second Life
Salmon et al. (2010)

17. Adaptation of Salmon et al. Model
Access and
motivation
Development - Online Socialisation
transfer to Social Presence
physical world
Knowledge Co-
Construction Information
and reflection – Exchange
new knowledge

18. Access and Motivation
• In lab induction
• Created their avatar
• Taught basics required for the scenario

19. Online Socialisation (social presence)
• Students customised their avatars as soon as possible
• Commented on each others clothes – unhappy if they had the same look
• “The experience itself is very immersive. Think this is a combination of
the software environment (CSL lab) and the avatars” Feels like we are
sitting in the same room going over the material. Feel just as nervous
taking a history in second life if I was sitting in a class room with the
facilitator and my peers. Didn’t anticipate this” (Student 7, Male)
• “I feel no difference in authenticity, when I am taking a history in SL, it is
easy for me to immerse myself in the experience” (Student 6, Female)
• “Logged on to see if I could move around and get to home before
scenario. Went straight to home base and managed to move around with
no problems. Changed my clothes with ease. Felt a bit lonely without the
group (Student 8, Female)

20. Information Exchange
• Combination via SL, via BB, via email
“I passed on the information by dropping the notecard into the
trolley, but I also passed it to the others by dropping it into an
instant message that meant we all knew what was happening
and could move on” (Avatar 3, Female)
“There were a few communication difficulties at first, two of the
group members had accidently muted the module facilitator
and were unable to see her dialogue in local chat. I assisted
them in fixing the problem, and we were back on track in 15
minutes” (Avatar 7, Male)

21. Knowledge co – construction,
reflection – new knowledge
“The different clinical experience in the group really helped when reviewing our test
results. Really impressed with how collaborative the process is. Managed to reach
consensus quicker than I anticipated. Second life has been invaluable – chat logs
were especially useful for me. Allowed me to examine my own and other people’s
decision making and thought processes. Met up with the group to decide on our
recommendations for the scenario. Really liking the collaborative nature of the
software” (Student 7, Male)
“All in all it was a good learning experience, both the actual scenario and to brush
up on computing skills.. Find it a good way of learning, as we can learn from each
other” (Student 8 , Female)

22. Knowledge construction through discussion
Lecturer: “So what are your thoughts at the
moment?”
Student 1: “We have to decide if the tumour is operable
or not and if she is fit for anaesthesia?”
Student 7: That means I am up, eh?
Student 4: Yeah, now we need to decide how we can
stage properly and we can ask for surgical review, then
decide on anaesthetic review and talk to the patient”
Student 7: I think it is safe to say she will get surgery
Lecturer: Think back to her health history
Student 1: Oh wait we need to address her warfarin
therapy

23. Development transfer to physical world
Self assessment of their group work
• Improved diagnostic history taking and
documentation
• Increased confidence in history taking and
interpreting investigations
• Increased understanding of need for good teamwork
• Improvement of communication in the clinical area
• Increased transferable computer skills

24. My reflections
• Think about what you want to do and if 3D virtual worlds will offer
something different to other platforms
• Socialisation is easier with a visual avatar compared to text chat
environments leading to quicker engagement
• Subject experts must gain an understanding of VWs to enable creation
of PBL and teaching and learning activities to be developed in - world
and facilitate troubleshooting
• Link up with others who have done similar things to that you want to
do for scripts, buildings, ideas
• VW can offer an immersive environment that encourages a multiple of
skills and increases engagement
• Link up with your friendly neighbourhood tech!

25. Challenges
• There is a learning curve (but good induction can ease this)
• Computer issues and broadband use of mobile devices
• Understand you are dealing with a 3rd party tool so need to
be prepared for maintenance or downtime
• Support from within your organisation
• Cost – SL can be cica $2000 for a decent piece of land
(island), however GCU have 2 islands willing to ‘rent’ to
others
• Alternatives grids – create your own VW or have your
organisation run a VW server (cheaper)
• Time to create and need a builder

26. Take Home
•Virtual worlds can offer a flexible alternative to physical
world simulation
•Allow for experiential and social constructivist learning in a
safe environment
•Increase engagement with activities compared to
asynchronous text virtual environment
• Pre-course in-lab or in-world practice is essential to enable
easier transition for learning in VWs
•Exchange of Chat logs can enable reflection, feedback and
feed forward

27. PROCEED UNTIL APPREHENDED

28. References
Ahn, S, J., Fox, J., and Bailenson, J. N. (2012) Avatars, in Bainbridge, W. S. (Ed) Leadership
in Science and Technology: A reference Handbook: Sage Publications
De Freitas, S (2008) Serious Virtual Worlds: A scoping study, JISC E-Learning Programme
Duncan, I., Miller, A., Jing, S (2012) A Taxonomy of virtual worlds usage in Education.
British Journal of Educational Technology Vol 43, No 6 p949-964
McElhinney E, (2010) Factors which influence nurse practitioners ability to carry out
physical examination skills in the clinical area after a degree level module – an electronic
Delphi study, Journal of Clinical Nursing, Vol 19, issue 21-22 pp 3177 - 3187
Salmon, Gilly , Nie, Ming and Edirisingha, Palitha (2010) Developing a five-stage model of
learning in Second Life, Educational Research, 52: 2, 169 — 182
Savin-Baden M, (2010) A Practical Guide to Using Second Life in Higher Education, Open
University Press