Metaverse Health

Archive for the ‘Education’ Category

In the past week I received a note from Kerri McCusker (SL: Kerri Macchi) about a project completed for the Serious Games and Virtual Worlds Team, University of Ulster in Northern Ireland. Second Lives sets out to demonstrate a more recent approach to dealing with Crohn’s disease: autologous stem cell transplant.

You can view the Second Life aspect for yourself, or the video below explains the project in its entirety. I’ve also appended a section of the in-world notecard explaining the stem cell transplant history in some detail.

It’s yet another example of simulation as a useful adjunct for wider learning experiences. The level of complexity of this simulation is more at the patient education level rather than as a health professional training mechanism, but with further evolution it could obviously achieve both aims. I certainly learned a lot more about newer treatment options for Crohn’s disease. Anyone who’s been involved in the care of an individual with the disease knows that anything that improves health outcomes is a highly desirable thing.

Appendix: Sample of information provided by Second Lives Clinic

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Welcome to Second Lives Medical Clinic.
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This virtual clinic is a showcase of the process of the autologous stem cell transplant in Crohn’s disease.

Cellular therapy with stem cells is revolutionizing the focus of treatment of many serious diseases. Replacing the cells of damaged tissue with other new cells from the same patient is already a reality. This is the basis of cellular therapy and regenerative medicine, the latest great advance in biomedicine. In this line, Hospital Clínic, Barcelona is leading the world in the application of an innovative cellular therapy that uses stem cells to treat Crohn’s disease, a chronic genetic disease that affects 1% of the population in Spain and which has considerable impact on the quality of life of the patients. The procedure is based on an autologous bone-marrow transplant (when patients receive a transplant of their own stem cells) and now constitutes a treatment option to cure an intestinal disease that sometimes does not successfully respond to drugs and requires highly complex surgery that does not provide a cure.

Hospital Clínic, Barcelona is one of the few hospitals in the world to apply this new therapeutic option for patients with Crohn’s disease, and it does so with the guarantee of success experienced in the US and Italy, where the technique has been tested with excellent results: in an average follow-up period of 6 years, 80% of transplant patients are in a phase of total remission of the disease and the remaining 20% have shown considerable improvement following the transplant, and are now responding favorably to drugs. Dr. Julián Panés and Dr. Elena Ricart over the Gastroenterology Department of Hospital Clínic, Barcelona are the driving force behind this therapy in Spain and began to implement regenerative cellular therapy in patients with Crohn’s disease in August 2008. To date, a total of 6 patients are benefiting from this new treatment. The transplant requires several weeks of admission to hospital before patients receive their own cells. The procedure is the same as that carried out in bone-morrow transplants to cure leukemia or myeloma.

Autologous Stem-Cell Transplant: Phases of the Procedure

When the case is detected (that does not respond to drugs or surgery), the patient undergoes an autologous stem-cell transplant, which is a bone-morrow transplant in which the immune system is reset to prevent it from attacking the intestinal flora. The process lasts approximately 2 months and consists of 6 phases:
1. Initial Chemotherapy (Cyclophosphamide + G-CSF). In this initial phase, the reduction of the number of leukocytes (immune-system cells) in the blood is induced in the patient.

2. Migration of Stem-Cells to the Blood. Following the previous immunosuppression, the organism reacts by releasing stem cells from the bone marrow into the blood; these are the cells which will later be used for the transplant.

3. Collection of Stem Cells by means of Apheresis. Apheresis is a technique that separates components of the blood. Here, the stem cells that previously migrated from the bone marrow are separated.

4. Cryopreservation of Stem Cells. When the stem cells have been collected by apheresis, they are frozen and preserved until ready for transplant.

5. Second Chemotherapy. In this phase, total leukopenia is induced; that is, the immune system is left devoid of leukocytes, ready to be reset with the stem-cell transplant.

6. Autologous Stem-Cell Transplant. The patient receives the transplant by means of transfusion with his or her own stem cells. The immune system is reset, leading to remission or reduction of the abnormal inflammatory process of Crohn’s disease.

A comprehensive new resource has been released by the UK’s University of Derby and Aston University, Titled Best Practices in Virtual Worlds Teaching: A guide to using problem-based learning in Second Life, this 40+ page publication covers a lot of ground in an easy to understand way. It’s available as a free download of a little over 6MB in PDF format.

The pivotal section for me is the one on making problem-based learning work in Second Life, with the succinct message being:

The possibilities for education within Second Life are limitless and one must be careful not to use this resource for the sake of it. Any teaching resources provided within Second Life must be embedded within traditional learning methods and fulfil a direct need within the course. Simply using Second Life for the sake of it will require time and effort from students and staff that is unwarranted and provides no additional benefit. There must be a direct applicable benefit to the material contained within Second Life, so purpose-driven use is advised rather than speculative-use.

As I’ve mentioned previously, the documentation of teaching methods in virtual environments continues to improve, and this document provides a superb overview for those new to the approach. From a health viewpoint, some good examples of Psychology projects undertaken in Second Life are given.

Thanks to Virtual World Watch for the heads-up

Coming from a nursing background myself, I’m always fascinated by the work going on in virtual environments in regards to nurse education. To some extent it’s a natural fit in that clinical simulation is a pivotal part of the education process for nurses anyway – using virtual environments is simply an extension of recognised practice.

Evelyn McElhinney (SL: Kali Pizzaro) is a Nurse Lecturer in the post-registration department of Glasgow Caledonian’s School of Health. She teaches a number of advanced practice modules including modules within the Nurse Practitioner pathway. She joined the university full time 3 years ago, and was a lecturer/practitioner working in an advanced practice role within the National Health Service prior to that and has worked in a number of acute care areas including anaesthesia.

Evelyn also happens to be active in the use of Second Life in Nurse Practitioner training, so I caught up with her to discuss her work to date and some broader issues around collaboration.

Lowell: From a nursing education viewpoint, what are your key areas of professional interest / research focus?

Kali: Advancing practice, physical examination, clinical simulation, and recently the use of virtual worlds for Nurse Practitioner Education.

Lowell: When you say nurse practitioner, can you define that a little? I’m assuming you mean someone undergoing their undergraduate nursing education?

Kali: Ah no in the UK Nurse Practitioners are Registered Nurses who are advancing their practice. A nurse who takes a history, physical examination, diagnoses, prescribes and treats.

Lowell: Ok, that’s similar to Australia then. So are there particular advantages for using virtual worlds with more experienced nurses like practitioners rather than nursing students?

Kali: The advantages are that they need flexibility as they have competing demands on their time. So any medium that allows for extra practice in a time conducive to them is attractive. However, virtual worlds can do more than the usual virtual learning environment.

Lowell: When did Second Life become a consideration in your work?

Kali: I considered Second Life after seeing a project by one of my colleagues. I had know about it’s existence as the University had a project exploring it’s use for marketing. That was in March this year.

Lowell: Can you describe the work you’re doing in Second Life and how it links to the University’s CU There initiative?

Kali: I am trying to develop a virtual patient which will be used by Nurse Practitioner students to practice history taking. I have also embedded heart sounds into the avatar’s chest to enable the student to link the history to the heart sounds they hear. They must click on the correct anatomical position to hear the sounds. This work links to the CU There project as it fulfills the criteria for use of virtual worlds in education. By creating an AIML bot/bots the students have the flexibilty to practice at any time either as an individual or as a group. I plan to have a number of patients and to build on the sceanrios to create longer problem-based learning scenarios. The bot we use were developed by myself and the School technician Andy Whiteford aka AndyW Blackburn.

Lowell: So what level of work has been required to get the lab to this stage and how much more is involved to get it to where you’d like it to be?

Kali: The clinical skills lab was designed by the CU There team with guidance from the head academic in charge of the simulation lab . The build was done mainly by a computer student who is seconded to the team. There are plans to build an ITU for a scenario for 3rd year students. For my scenario it is mainly me thinking of ways to expand each scenario in alignment with the needs of my students.

Lowell: The most common feedback I’ve gotten from nursing academics is a skepticism on what virtual worlds offer that a well integrated curriculum with comprehensive leraning management tools can’t, that is, aside from the advantage of not needing to get students to a real-world simulation lab, are there other benefits of working in environments like this?

Kali: The immersive environment enables authentic scenarios to be developed. There is also the ability to offer syncrounous text and voice communication, as well as the ability to show the whole class videos etc. We can also simulate things that would be difficult in real life.

Lowell: Is there an example of that you currently use?

Kali: Not at the moment. However, for undegraduates it could be useful for them to be inside a heart or lung to understand the anatomy and physiology. It is also much more interactive than other VLE’s.

Lowell: I suppose that’s the crux of the challenge for nursing educators using virtual environments: convincing others that things have moved beyond the gimmicky, would you agree?

Kali: Yes, you need to show them something that is pedagologically sound, something they can see is useful.

Lowell: On pedagogy, what do you see as the key foundations in your work and in virtual environments more broadly?

Kali: Constructivism and social constructivism are the key learning theories in my work. By linking history and heart and lung sounds to other parts of a clinical scenario, I am building on the students previous knowledge to create new knowledge. People in simulations tend to act the same as they do in real life. The ability to capture the text allows for reflection on the decision-making of this particular group.

Lowell: What has the feedback been from students?

Kali: Positive- they can see they value. They feel they are in the sceanrio. However, it is early days. We have only had a few folk through as a pilot. We will be using it more in the next two semesters.

Lowell: Are there formalised evaluations planned on clinical skills training in Second Life ? Will there be comparative studies on those who used such tools versus those who didn’t and their subsequent outcomes?

Kali: Yes, a number of academics are evaluating their projects and one is plannning to compare in-world and out-of-world simulation. Some of these are through a University scheme, Caledonian Scholars.

Lowell: What’s your take on nursing research in virtual environments internationally? Is it fair to say it’s still very early days?

Kali: Yes, there are a number of good projects. However, it is still in it’s infancy. Simulation seems to be the most popular project.

Lowell: Is there any research completed or underway that has particularly interested you?

Kali: Many projects have impressed me. For example the work of John Miller at Tacoma, the Imperial College in London and the Ann Myers Medical Center. However, any project which is being used by students impresses me. With regards to research most are evaluations, however, my own university has just completed some research into student nurses’ clinical decision making (Dr. Jacqueline McCallum, Val Ness, Theresa Price, Andy Whiteford).

Lowell: Can you discuss what it’s found?

Kali: It’s still in publication, however a lot of what the students said was that they wanted to experience areas they had not been to, and that they also found the scenario exhausting. Interestingly, they did not do a single observation in an hours sceanrio in a busy surgical ward. They also did not know what to do with a patient who was demented and kept leaving the ward. I think they were too busy thinking what to do next, this was despite being prompted to do observations.

Lowell: You raise a very interesting point – perhaps virtual environments make a more natural stage for making errors as there isn’t the stress of the educator looking over their shoulder?

Kali: Maybe, although this sceanrio had educators involved. Although that is the beauty of simulation – make mistakes and no-one dies

Lowell: For the nurse who has been working in either a hospital or community setting for five years or more, how do you make virtual environments like Second Life an appealing and logical extension of their professional development needs?

Kali: By making the scenarios authentic and as realistic as possible. Also they must be available at all times to ensure maximum flexibility. The student must see the value to be motivated to take part. If they are fun, then great.

Lowell: Do you think Second Life is at a stage of usability that it can achieve that now?

Kali: Not yet in the UK – it is still not widely know as a social tool. However, if it is introduced in education they may see more value, as it helps them to learn.

Lowell: On usability though – it’s still quite a learning curve to actually use, particularly for those not as net-savvy as others?

Kali: Well you could say that about any VLE, and it is really only arrows and clicking. Changing clothes is not mandatory for education. Well, not all education. I think most folks would get it in a short space of time with some guidance.

Lowell: Again specific to nursing, is there any great degree of collaboration going on internationally in regards to projects like these? How do you think nursing faculties could further improve collaboration?

Kali: We are exploring a couple of collaborations. I know Scott Deiner in New Zealand has collaborated with American colleges. However, there is the potential for major collaboration both nationally and internationally. Although you need to have a firm idea about what you want to collaborate on. Also there is still a little bit of folk finding their feet, so to share is still scary methinks.

Lowell: Do you think there’s the critical mass for organised collaborative structures such online journals or other formats for working together?

Kali: There could be, and the Virtual World Watch here has opened up avenues for collaboration by highlighting the people who are involved with virtual worlds, although there is a bit to go.

Lowell: So for a nursing academic looking to integrate virtual environments into their teaching or research, would you have any simple advice?

Kali: Make sure you think about what you want to use it for. Script the scenario and look around at other people’s work to find out what the virtual world is capable of. Also visit educational areas and talk to other academics or join a group. Make sure there is a strong pedagogical structure to your idea and show it to folks when you have something to show!! Seeing is believing.

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To view the publicly accessible clinical skills laboratory in Second Life, go here.

It’s great to see the research base for virtual worlds continuing to grow. A new addition is the Journal of Virtual Worlds and Education. It states its mission simply:

The Journal of Virtual Worlds and Education is a trans-disciplinary academic journal that offers a publication venue for articles and authors examining issues, ideas, and research inspired by the intersection of emerging virtual worlds technologies and education. The Journal maintains the highest standards of peer review and seeks to attract and engage new and emerging authors and scholars across the globe.

The call for papers for the first issue (to be published online early 2010) is already out. Given the dynamism of Australian educators in virtual worlds, I’d be surprised if this neck of the real world woods isn’t well represented in future issues.

For the past couple of years I’ve been aware of the work going on in New Zealand with midwifery training and Second Life, mostly thanks to the updates over at SLENZ.

Machinima maker Pooky Amsterdam dropped me a line about a film she’s helped produce that explains the role of Te Wāhi Whānau – The Birth Place in Second Life. The lead educator on the project is Sarah Stewart (SL: Petal Stransky), with SLENZ Project co-leader, Terry Neal (SL: Tere Tinkel) and Scotland based Russell (Rosco) Boyd also heavily involved.

After walking through the actual build and after watching the machinima, the main impression I’m left with is how midwife-driven this project is. What I mean by that, is the birthing unit is so much better than most in existence in the real world. As a Registered Nurse (but not a midwife), I’ve witnessed half a dozen births and even from that limited perspective I can totally appreciate how much better a birthing environment Te Wāhi Whānau is compared to even the better hospital-based birthing units. As a clinical simulation for midwives, I can see its power as a key adjunct to lab-based learning and practicums. The gamut from initial assessment of labour to initiating breastfeeding and perineal care is covered in a comprehensive way.

Take some time to watch the 6-minute machinima:

The SLENZ team deserve major kudos for their work over the past couple of years – they’re some of the true pioneers in virtual worlds and health.

You can of course view the birthing unit for yourself here.

The Journal of Virtual Worlds Research continues to go from strength to strength, and the current edition is devoted to health and virtual worlds. I’ll be writing about some of the specific pieces in coming weeks, but you’ll see the full table of contents below:

Table of Contents

Editor’s Corner

Musings on the State of ‘3-D Virtual Worlds for Health and Healthcare’ in 2009

Maria Toro-Troconis, Maged N. Kamel Boulos

Abstract | PDF

Invited Articles

Virtual Worlds in Health Care Higher Education

Constance M Johnson, Allison A Vorderstrasse, Ryan Shaw

Abstract | PDF

Peer Reviewed Research Papers

The Growth and Direction of Healthcare Support Groups in Virtual Worlds

John Robert Norris

Abstract | PDF

Development of a Virtual Reality Coping Skills Game to Prevent Post-Hospitalization Smoking Relapse in Tobacco Dependent Cancer Patients

Paul Krebs, Jack Burkhalter, Shireen Lewis, Tinesha Hendrickson, Ophelia Chiu, Paul Fearn, Wendy Perchick, Jamie Ostroff

Abstract | PDF

Does this Avatar Make Me Look Fat? Obesity and Interviewing in Second Life

Elizabeth Dean, Sarah Cook, Michael Keating, Joe Murphy

Abstract | PDF

Research Papers

Development and Evaluation of Health and Wellness Exhibits at the Jefferson Occupational Therapy Education Center in Second Life

Susan Toth-Cohen, Therese Gallagher

Abstract | PDF

Research-in-Brief Papers

Development of Virtual Patient Simulations for Medical Education

Douglas R Danforth, Mike Procter, Richard Chen, Mary Johnson, Robert Heller

Abstract | PDF

“Think Pieces”

Virtual Worlds, Collective Responses and Responsibilities in Health

Rashid M Kashani, Anne Roberts, Ray Jones, Maged N. Kamel Boulos

Abstract | PDF

Pitfalls in 3-D Virtual Worlds Health Project Evaluations: The Trap of Drug-trial-style Media Comparative Studies

Maged N. Kamel Boulos, Inocencio Maramba

Abstract | PDF

Towards a virtual doctor-patient relationship: Understanding virtual patients.

Vanessa Gamboa González

Abstract | PDF

Editor-in-Chief’s Corner

Cultural Identity in Virtual Reality (VR): A Case Study of a Muslim Woman with hijab in Second Life(SL)

Methal Mohammed

Abstract | PDF

Shaping the ‘Public Sphere’ in Second Life: Architectures of the 2008 U.S. Presidential Election

Annabel Jane Wharton

Abstract | PDF

I’m probably stretching the boundaries with claiming this to be a health-related post, but here goes. I’ve covered Second Life’s Relay for Life previously, and it’s actually running over this weekend and appears it will be as big a success as previous years.

One Second Life resident, Laurence Simon created a machinima called Relay for Death, which aside from being humorous, also has a strong message in favour of the Relay For Life fundraising initiatives:

Health professionals involved with virtual worlds will understand the power of machinima. For those still coming to terms with virtual worlds and health, it’s further proof of the growing maturity of the platform to communicate health messages. Having an engaged population generating their own messages to support health is an ideal sought after – this is an example of it in practice, and it’s fun to boot!

As mentioned last month, I had the pleasure of attending a conference on e-health as well as an evening discussion on the formation of a Games for Health special interest group as part of HISA.

Aside from the very exciting outcomes from both those events, which I’ll discuss further in the future, it forced me to try my somewhat amateur hand at creating a machinima showcasing some of the many impressive health presences in Second Life. It’s now available online for viewing:

Being so short it doesn’t do any of the presences featured the justice they deserve, let alone all the ones missed. I’m hoping to make a more substantive piece in the future, so if you have suggestions of other areas to feature, please don’t hesitate to put them in the comments.

The latest issue of the Journal of Virtual Worlds Research has been released, and as usual it’s full of peer-reviewed research papers, plus some discussion pieces and other features. Pedagogy is a key consideration for any educator, and this issue goes some way to establishing a pedagological framework for virtual worlds. Major kudos to the editorial team for the production of such a high quality publication.

Read on for the contents of the issue with links to abstracts and full versions:

Peer-Reviewed Research Papers

Learning in a different life: Pre-service education students using an online virtual world. Chris Campbell Abstract  |  PDF

An integrated framework for simulation-based training on video and in a virtual world David Chodos, Eleni Stroulia, Parisa Naeimi Abstract  |  PDF

Using Second Life for Problem Based Learning in Computer Science Programming Micaela Esteves, Benjamim Fonseca, Leonel Morgado, Paulo Martins Abstract  |  PDF

Beyond the Game: Quest Atlantis as an Online Learning Experience for Gifted Elementary Students Jackie Gerstein Abstract  |  PDF

Virtual Education: Teaching Media Studies in Second Life David Kurt Herold Abstract  |  PDF

Canadian Border Simulation at Loyalist College Ken Hudson, Kathryn deGast-Kennedy Abstract  |  PDF

Using Second Life to Teach Operations Management Peggy Daniels Lee Abstract  |  PDF

Questions and Answers in a Virtual World : Educators and Librarians as Information Providers in Second Life Lorri Mon Abstract  |  PDF

A virtual environment study in entrepreneurship education of young children Angela M Pereira, Paulo Martins, Leonel Morgado, Benjamim Fonseca Abstract  |  PDF

Second Life Physics : Virtual, Real or Surreal? Renato P. dos Santos Abstract  |  PDF

Second Life and Classical Music Education: Developing Iconography That Encourages Human Interaction David Thomas Schwartz Abstract  |  PDF

3D virtual learning in counselor education: Using Second Life in counselor skill development Victoria Lynn Walker Abstract  |  PDF

A Composite Adult Learning Model for Virtual World Residents with Disabilities: A Case Study of the Virtual Ability Second Life® Island Marjorie A. Zielke, Thomas Roome Abstract  |  PDF

Via John Norris, there’s a call for feedback on The Path of Support, which is a great resource in Second Lif that links to health support groups in-world:

Hi all..I’m posting this for the good folks at Indiana University School of Social Work.

Tell us how YOU feel about The Path of Support!

You are invited to attend a S.W.O.T. exercise on SLThursday, April 2, 2009 at 6pm SLT. Join us to talk about the Strengths, Weaknesses,
Opportunities, and Threats of The Path of Support, so that The Path’s leaders can make it better for you and others who use it. The exercise will last approximately one hour and will take place in the Consumer Health Library on Health Info Island.

SLURL: http://slurl.com/secondlife/Healthinfo%20Island/41/138/24

Can’t make it, but want to give us feedback? Please take a few minutes to complete our S.W.O.T. survey

This exercise will be done by MSW students at Indiana University School of Social Work.