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Training & Education in Virtual Environments: The experience at St George’s Luke Woodham, Sheetal Kavia, Terry Poulton –  St George’s University of London
Virtual Patients
PREVIEW Problem-based learning in Virtual Interactive Educational Worlds -  http:// www.elu.sgul.ac.uk /preview Virtual Patients in Virtual Worlds Virtual worlds platform has many potential benefits Environment adds context to scenarios, increasing level of immersion Open-ended decision making Patient management decisions can be explored in a realistic, responsive, but safe way Collaborative experience, both remotely and locally
PIVOTE Common problems for both Virtual Patients and tools in Virtual Worlds Expensive and time-consuming to produce Require specialised skills to develop and implement PIVOTE (PREVIEW Immersive Virtual Training Environment) tackles problem in two ways Uses data standards (ANSI/MEDBIQ VP.10.1-2010) Takes the case logic and data out of the virtual world
Other Considerations Hardware requirements Although system requirements are higher than for other tools, Second Life can run satisfactorily on standard school PCs at SGUL Regular software updates required Regular mandatory software updates are required for SL, which is a problem for systems which can only be updated at institutionally-approved intervals SGUL avoided this issue by making use of a VMWare-based thin-client solution for accessing SL client Student (and Tutor) training The significant majority of students (and if used, tutors) will need training and practice time in order to become proficient enough that the interface does not distract from the learning Additional sessions were run by SGUL in order to provide this opportunity
 
Student reflections
Paramedic Student perceptions (n=20) SA A N D SD I can access Second Life scenarios at my own convenience 7 13 0 0 0 Second Life scenarios will enable me to analyse my own clinical performance 2 10 4 2 2 Second Life scenarios will help me to manage patients with similar conditions 4 12 4 0 0
Comments “ Communicating with others helped assess the situation… gave better understanding”  “ It’s much better to be able to actually perform treatments rather than just talk about it.”  “ the open nature lends itself very strongly to creating a rich and valuable decision-making exercise.”
Spring and Summer Schools Small groups, all in one room School leaving age One group, one avatar Different approach to collaboration
The G4 Project Curriculum transformation Replacing all paper-based cases in the medical curriculum with interactive VPs Web-based and Second Life VPs
Medical Scenario Delivered to 160 students rather than groups of 2-5 Patient followed through multiple locations History taking requires more involved “chat”  Different equipment and tests Objects all in the scene, no inventory required
 
Usability Changes Increased coverage of visual mannequin Limbs covered by two regions to allow for bent arm/leg position Small, tricky to click regions merged into one
Option buttons removed Text labels replaced by icons Visual indicators of current status
Media Resources Videos Web Images
Student Feedback Comments
Usability Feedback n = 244 14.0% 30.2% 51.1% 4.7% The scenario as a whole  10.3%  22.3% 54.1% 13.3% Moving between the GP surgery / renal unit  7.1%  22.7% 58.0% 12.2% Viewing media e.g. images  7.9%  27.5% 54.6% 10.0% Using the HUD 5.5%  24.1%  52.7%  17.7% Conducting a physical assessment  5.0% 12.9% 61.8% 20.3% Using the medical equipment 15.1% 41.8% 38.5% 4.6% History taking  Very difficult Fairly difficult Fairly easy Very easy to use
Future Work July 2010 - funded to create a Psychiatry scenario to teach students how to carry out a psychosis patient’s first home assessment Exploring a collaboration with European partners to create a Mental Health Nursing scenario.
Resources St George’s, University of London Virtual Worlds  www.elu.sgul.ac.uk/virtualworlds / G4  www.elu.sgul.ac.uk/g4 / PIVOTE Information  www.pivote.info In-world information centre  http://slurl.com/secondlife/St%20Georges%20University/121/36/21 [email_address]
Acknowledgements Some of the Second Life images and objects have been created by St George’s, University of London and Daden Ltd. St George’s, University of London would like to acknowledge Imperial College London for the Second Life ambulance object St George’s, University of London would like to acknowledge Daden Ltd for the PIVOTE web user interface  Images of web resources (Skills videos, X-ray, and Key topics) have been created by St George’s, University of London

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Training and Education in a Virtual World

  • 1. Training & Education in Virtual Environments: The experience at St George’s Luke Woodham, Sheetal Kavia, Terry Poulton – St George’s University of London
  • 3. PREVIEW Problem-based learning in Virtual Interactive Educational Worlds - http:// www.elu.sgul.ac.uk /preview Virtual Patients in Virtual Worlds Virtual worlds platform has many potential benefits Environment adds context to scenarios, increasing level of immersion Open-ended decision making Patient management decisions can be explored in a realistic, responsive, but safe way Collaborative experience, both remotely and locally
  • 4. PIVOTE Common problems for both Virtual Patients and tools in Virtual Worlds Expensive and time-consuming to produce Require specialised skills to develop and implement PIVOTE (PREVIEW Immersive Virtual Training Environment) tackles problem in two ways Uses data standards (ANSI/MEDBIQ VP.10.1-2010) Takes the case logic and data out of the virtual world
  • 5. Other Considerations Hardware requirements Although system requirements are higher than for other tools, Second Life can run satisfactorily on standard school PCs at SGUL Regular software updates required Regular mandatory software updates are required for SL, which is a problem for systems which can only be updated at institutionally-approved intervals SGUL avoided this issue by making use of a VMWare-based thin-client solution for accessing SL client Student (and Tutor) training The significant majority of students (and if used, tutors) will need training and practice time in order to become proficient enough that the interface does not distract from the learning Additional sessions were run by SGUL in order to provide this opportunity
  • 6.  
  • 8. Paramedic Student perceptions (n=20) SA A N D SD I can access Second Life scenarios at my own convenience 7 13 0 0 0 Second Life scenarios will enable me to analyse my own clinical performance 2 10 4 2 2 Second Life scenarios will help me to manage patients with similar conditions 4 12 4 0 0
  • 9. Comments “ Communicating with others helped assess the situation… gave better understanding” “ It’s much better to be able to actually perform treatments rather than just talk about it.”  “ the open nature lends itself very strongly to creating a rich and valuable decision-making exercise.”
  • 10. Spring and Summer Schools Small groups, all in one room School leaving age One group, one avatar Different approach to collaboration
  • 11. The G4 Project Curriculum transformation Replacing all paper-based cases in the medical curriculum with interactive VPs Web-based and Second Life VPs
  • 12. Medical Scenario Delivered to 160 students rather than groups of 2-5 Patient followed through multiple locations History taking requires more involved “chat” Different equipment and tests Objects all in the scene, no inventory required
  • 13.  
  • 14. Usability Changes Increased coverage of visual mannequin Limbs covered by two regions to allow for bent arm/leg position Small, tricky to click regions merged into one
  • 15. Option buttons removed Text labels replaced by icons Visual indicators of current status
  • 18. Usability Feedback n = 244 14.0% 30.2% 51.1% 4.7% The scenario as a whole 10.3% 22.3% 54.1% 13.3% Moving between the GP surgery / renal unit 7.1% 22.7% 58.0% 12.2% Viewing media e.g. images 7.9% 27.5% 54.6% 10.0% Using the HUD 5.5% 24.1% 52.7% 17.7% Conducting a physical assessment 5.0% 12.9% 61.8% 20.3% Using the medical equipment 15.1% 41.8% 38.5% 4.6% History taking Very difficult Fairly difficult Fairly easy Very easy to use
  • 19. Future Work July 2010 - funded to create a Psychiatry scenario to teach students how to carry out a psychosis patient’s first home assessment Exploring a collaboration with European partners to create a Mental Health Nursing scenario.
  • 20. Resources St George’s, University of London Virtual Worlds www.elu.sgul.ac.uk/virtualworlds / G4 www.elu.sgul.ac.uk/g4 / PIVOTE Information www.pivote.info In-world information centre http://slurl.com/secondlife/St%20Georges%20University/121/36/21 [email_address]
  • 21. Acknowledgements Some of the Second Life images and objects have been created by St George’s, University of London and Daden Ltd. St George’s, University of London would like to acknowledge Imperial College London for the Second Life ambulance object St George’s, University of London would like to acknowledge Daden Ltd for the PIVOTE web user interface Images of web resources (Skills videos, X-ray, and Key topics) have been created by St George’s, University of London

Editor's Notes

  1. Much of SGUL focus and work is on Virtual Patients These are resources widely used in healthcare education Predominantly web-based Many different models SGUL uses two tools – OpenLabyrinth and vpSim Branching model Problem based Learning sessions Groups of approx 8 students in a room, with a facilitator, working through the case together, learning from discussion The paramedic course at SGUL was distance learning, so students didn’t get the benefit of this collaboration on PBL. Therefore we thought that Second Life might be a suitable solution
  2. PREVIEW project JISC funded Joint project with Coventry University and St George’s University of London Took 2 approaches to the project, will be focusing on the SGUL approach Benefits Active learning space, where students can interact directly with the scenarios; Environment can add context (visual clues e.g. Injuries on patient, motorcycle on floor, crashed car) to scenarios, adding a level of immersion The environment and objects within SL can be manipulated in ways that are not possible with more conventional delivery methods; Patient management decisions can be explored in a realistic, responsive, but safe way; Students engage in open-ended decision processes, much like real life, rather than being prompted by a list of possible options of what to do next; The space is shared, providing a platform for communication and collaboration in real-time, especially relevant for work-based learners meeting remotely.
  3. Students play the role of a paramedic Go to a scene in groups, sometimes with an avatar each Based on the visual clues in the scene and the text content students are asked to make decisions similar to those in a real life case Make judgements Make decisions Act accordingly
  4. [I tend to read these out plus the ‘top’ response – chara did a version where he blocked out the charts he hadn’t got to yet using white boxes, which I think worked well] We ran a number of testing days while developing the scenarios with Paramedic students, most of whom had no experience of SL, some hadn’t even heard of it. We conducted focus groups and questionnaires with these students and I’ll briefly talk you through some of the findings. Overall the response was very positive, from both students and their tutors. All students either agreed or strongly agreed that SL is relevant for their future practice The students were more mixed about whether the scenarios answered their queries. This was probably because the scenarios were designed as a problem based learning resource, and as such there was no direct feedback about whether the choices they were making were right or not. It was designed as a tool to drive their learning, and generate discussion between them based on what they already knew, but also to draw out gaps in their knowledge so they know where they need to focus their attention. SL would reduce the requirement for face to face classes: They felt very strongly that they wouldn’t want a resource such as this to take away from any face to face classes they already had. This particular course (paramedic foundation degree course) has got very little face to face lecture time in it, and what they have is extremely important to the students, and they are protective of it. This kind of resource is not intended to replace any face to face teaching time, and we agree with the students that it should not replace this. Mostly in favour that it would be useful in revision, despite the lack of feedback embedded within them, and this really supports the comment that this sort of resource is relevant preparation for their future practice.
  5. Access – no problems with access, they didn’t feel downloading SL or getting in to the environment would cause them any problems. Some students had trouble with accessing them from their computers in Halls of Residence, but in general they didn’t feel technical problems would stop them being able to access their learning resources in Second Life. Agreed that it would help them to analyse their own clinical performance, despite the lack of direct feedback from the scenario itself. Felt it would help them manage patients with similar conditions, which is a very positive result.
  6. Some more comments here : [I tend to read them out] Top one is about the benefit of doing these as a group exercise - this helped them to get the most out of the scenario Middle one is interesting, and supports the realism and engagement of these scenarios, as they are talking as though they actually did perform treatments, which of course they didn’t! But the environment feels real, and allows them to explore the steps and consequences of being a paramedic out in practice. The final point was actually from the Paramedic tutor, and is a positive reflection on how useful he found the scenarios for his teaching.
  7. As mentioned the initial idea had been to use the scenarios for distance learning users Every user would log in as their own avatar, and they would communicate using text and voice chat Multiple avatars playing role of paramedics However, at SGUL the scenarios were used with students at the Spring and Summer schools, school leaving age Used more traditional PBL approach, with a group of students in a room looking at a shared screen, discussing what to do before making a decision and learning that way. Based on this experience, plan to introduce a scenario into PBL sessions as part of the G4 programme of a VP based PBL curriculum. A A
  8. Medical scenarios to be used for G4 PBL session Very different to paramedic scenarios Follow the patient through from initial presentation of symptoms to a GP, through to diagnosis, treatment etc. Requires multiple locations, over a period of time Also, delivery method is complicated by the fact that we have up to 18 groups running concurrently Planning to achieve this by making each location effectively a separate VP and launching different locations using holodecks This would allow us to use the same space for a whole scenario, just changing the buildings objects around the avatar, and also copy the scenario easily multiple times around the island Also, will no longer give objects to students in their inventory. Instead, all objects will be placed in the scene, eliminating the complication of students needing to know how to use inventory A A A
  9. Mannequin has evolved in response to experiences with people using it In places it was a bit fiddly and hard to click on the intended region. Particularly around the head, where the pupil and airway touch points were in close together and often found the wrong one was clicked. These have been combined into one touch region, which brings up a menu listing the various options for the head. Seperated the limbs into two identical regions. These give the same responses but allow the framework to more closely follow the shape of the mannequin Currently being implemented by Daden, the text chat logic has been moved out of the spine object and onto the web server, as an extension to the MVP standard. This means that the text chat logic is much easier to construct, as previously you needed some knowledge of coding flow control to create it. A A
  10. Because we’d come from the experience of using text-based, narrative driven scenarios, at first we’d planned for students to make decisions at key points using numbered options, similar to the web based VPs. Eventually we concluded that the decision-making process was much more open ended than that, and should rely on the visual cues of the environment rather than narrative based choices. So we simplified the HUD so now there is just a start button, text or media, zoom and help buttons.
  11. Media resources Revising existing scenarios to include more examples of media resources Video resources Images Web resources – including the Key topic learning resources already used at SGUL In some cases we have used resources that wouldn’t be available in real life where they are useful e.g. X rays at paramedic scenes
  12. Overall we’ve had positive experiences of using Second Life. Its visual nature gives it great potential in creating problem based learning scenarios where students have to get in to role and start rehearsing the competencies of their profession in a safe but responsive environment. The visual element also brings about a very open ended decision making model, as instead of restricting the student choices to a set of options presented to them, as in web based virtual patients, in SL the students can decide to use any of the objects at their disposal. From the results of the evaluation conducted so far the students to find scenarios developed in this way to be realistic, and immersive, and we think offer a powerful method of learning – although more research still needs to be done. SGUL Island open , get in contact blah blah . . .