Experience with using second life for medical education in a family and community medicine education unit

The Second Life Metaverse and Its Usefulness in Medical Education After a Quarter of a Century

The immersive virtual world platform Second Life (SL) was conceived 25 years ago, when Philip Rosedale founded Linden Lab in 1999 with the intention of developing computing hardware that would allow people to immerse themselves in a virtual world. This initial effort was transformed 4 years later into SL, a universally accessible virtual world centered on the user, with commercial transactions and even its own virtual currency, which fully connects with the concept of the metaverse, recently repopularized after the statements of the chief executive officer of Meta (formerly Facebook) in October 2021. SL is considered the best known virtual environment among higher education professionals. This paper aimed to review medical education in the SL metaverse; its evolution; and its possibilities, limitations, and future perspectives, focusing especially on medical education experiences during undergraduate, residency, and continuing medical education. The concept of the metaverse and virtual worlds was described, making special reference to SL and its conceptual philosophy, historical evolution, and technical aspects and capabilities for higher education. A narrative review of the existing literature was performed, including at the same time a point of view from our teaching team after an uninterrupted practical experience of undergraduate and postgraduate medical education in the last 13 years with >4000 users and >10 publications on the subject. From an educational point of view, SL has the advantages of being available 24/7 and creating in the student the important feeling of "being there" and of copresence. This, together with the reproduction of the 3D world, real-time interaction, and the quality of voice communication, makes the immersive experiences unique, generating engagement and a fluid interrelation of students with each other and with their teachers. Various groups of researchers in medical education have developed experiences during these years, which have shown that courses, seminars, workshops and conferences, problem-based learning experiences, evaluations, teamwork, gamification, medical simulation, and virtual objective structured clinical examinations can be successfully carried out. Acceptance from students and faculty is generally positive, recognizing its usefulness for undergraduate medical education and continuing medical education. In the 25 years since its conception, SL has proven to be a virtual platform that connects with the concept of the metaverse, an interconnected, open, and globally accessible system that all humans can access to socialize or share products for free or using a virtual currency. SL remains active and technologically improved since its creation. It is necessary to continue carrying out educational experiences, outlining the organization, objectives, and content and measuring the actual educational impact to make SL a tool of more universal use.

On the advantages and disadvantages of virtual continuing medical education: a scoping review

Introduction

With the COVID-19 pandemic, most continuing medical education activities became virtual (VCME). The authors conducted a scoping review to synthesize the advantages and disadvantages of VCME to establish the impact of this approach on inequities that physicians face along the intersections of gender, race, and location of practice.

Methods

Guided by the methodological framework of Arksey and O'Malley, the search included six databases and was limited to studies published between January 1991 to April 2021. Eligible studies included those related to accredited/non-accredited post-certification medical education, conferences, or meetings in a virtual setting focused on physicians. Numeric and inductive thematic analyses were performed.

Results

282 studies were included in the review. Salient advantages identified were convenience, favourable learning formats, collaboration opportunities, effectiveness at improving knowledge and clinical practices, and cost-effectiveness. Prominent disadvantages included technological barriers, poor design, cost, lack of sufficient technological skill, and time. Analysis of the studies showed that VCME was most common in the general/family practice specialty, in suburban settings, and held by countries in the Global North. A minority of studies reported on gender (35%) and race (4%).

Discussion

Most studies report advantages of VCME, but disadvantages and barriers exist that are contextual to the location of practice and medical subspecialty. VCME events are largely organized by Global North countries with suboptimized accessibility for Global South attendees. A lack of reported data on gender and race reveals a limited understanding of how VCME affects vulnerable populations, prompting potential future considerations as it evolves.

Training Scientific Communication Skills on Medical Imaging within the Virtual World Second Life: Perception of Biomedical Engineering Students

Second Life is a multi-user virtual world platform which enables online learning through immersive activities. This study evaluates the perception of third-year biomedical engineering students about learning activities complementary to a biomedical imaging course carried out within Second Life and focused on training in the public presentation of scientific content to their peers. Between 2015 and 2017, students gave oral presentations on medical imaging topics selected from the proposals of their classmates. Participants were invited to complete an evaluation questionnaire. In the three years of the study, 133 students enrolled in the course (48, 46, and 39 consecutively), and 97 of them delivered the questionnaire (48%, 83%, and 92%, consecutively). Attendance at the sessions ranged between 88% and 44%. The students positively value the experiences, especially the teacher, the educational content, and the virtual island environment, with mean scores greater than or equal to 8.4, 7.7, and 7.7, respectively, on a 1-10-point scale. Overall, they valued Second Life as an attractive and suitable environment for their training in science communication skills, in which they gain self-confidence and are less afraid of speaking in public. Second Life enables students to present scientific content effectively to their peers, receiving hands-on training in the tasks of collecting, organizing, and presenting data, with the benefits of remote access, collaborative work, and social interaction.

The Development of a Virtual World Problem-Based Learning Tutorial and Comparison With Interactive Text-Based Tutorials

Collaborative learning through case-based or problem-based learning (PBL) scenarios is an excellent way to acquire and develop workplace knowledge associated with specific competencies. At St George's, University of London we developed an interactive online form of decision-based PBL (D-PBL) for our undergraduate medical course using web-based virtual patients (VPs). This method of delivery allowed students to consider options for clinical management, to take decisions and to explore the consequences of their chosen actions. Students had identified this as a more engaging type of learning activity compared to conventional paper-based/linear PBL and demonstrated improved exam performance in controlled trials. We explored the use of Second Life (SL), a virtual world and immersive 3D environment, as a tool to provide greater realism than our interactive image and text-based D-PBL patient cases. Eighteen separate tutorial groups were provided with their own experience of the same patient scenario in separate locations within the virtual world. The study found that whilst a minority of students reported that the Second Life experience felt more realistic, most did not. Students favored the simpler interaction of the web-based VPs, which already provided them with the essential learning needed for practice. This was in part due to the time proximity to exams and the extra effort required to learn the virtual world interface. Nevertheless, this study points the way towards a scalable process for running separate PBL sessions in 3D environments.

A team-based competition for undergraduate medical students to learn radiology within the virtual world Second Life

Background

A multi-user competitive game within the virtual world Second Life for undergraduate radiology learning was adapted for team participation. This study aimed to assess student perception, impact on learning, and eventual correlation of game results with post-exposure tests and course grades.

Methods

The game consisted of six weekly stages, dedicated to thoracic, abdominal, and musculoskeletal radiological anatomy and semiology. Participants had several days a week to review self-guided radiology educational content and then complete individual multiple-choice tests and solve team tasks to progress through the game's ranking. Additionally, they completed a cognitive load test, a questionnaire about the experience and a post-exposure knowledge test.

Results

Fifty-two students organised into 13 teams participated in the game and assessed different aspects of the experience with a mean score ≥ 7.8 on a 10-point scale, highlighting the participation of the teacher (9.3 ± 1.1), the educational contents (8.8 ± 1.4) and the usefulness for their education (8.7 ± 1.4). Participants obtained better post-exposure test results (p < 0.007) and better course grades (p < 0.021) than non-participants did.

Conclusion

A multi-user game adapted to team competition to learn radiology in Second Life was very positively perceived by third-year medical students, who highly valued its content, organisation, and usefulness for their training. Most of the participants agreed that they had collaborated as a team and that playing in competitive environments helps them learn better. The best post-exposure and academic results compared to non-participating students indicate the potential impact of the game on learning.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13244-021-01032-3.

Game-Based Learning in Virtual Worlds: A Multiuser Online Game for Medical Undergraduate Radiology Education within Second Life

Game-based learning can have a positive impact on medical education, and virtual worlds have great potential for supporting immersive online games. It is necessary to reinforce current medical students' knowledge about radiological anatomy and radiological signs. To meet this need, the objectives of this study were: to design a competition-based game in the virtual world, Second Life and to analyze the students' perceptions of Second Life and the game, as well as to analyze the medium-term retention of knowledge and the potential impact on the final grades. Ninety out of 197 (45.6%) third-year medical students voluntarily participated in an online game based on self-guided presentations and multiple-choice tests over six 6-day stages. Participants and non-participants were invited to perform an evaluation questionnaire about the experience and a post-exposure knowledge test. Participants rated the experience with mean scores equal to or higher than 8.1 on a 10-point scale, highlighting the professor (9.5 ± 1.1; mean ± SD) and the virtual environment (8.9 ± 1.1). Participants had better results in the post-exposure test than non-participants (59.0 ± 13.5 versus 45.3 ± 11.5; P < 0.001) and a lower percentage of answers left blank (6.7 ± 8.4 versus 13.1 ± 12.9; P = 0.014). Competitive game-based learning within Second Life is an effective and well-accepted means of teaching core radiological anatomy and radiological signs content to medical students. The higher medium-term outcomes obtained by participants may indicate effective learning with the game. Additionally, valuable positive perceptions about the game, the educational contents, and the potential benefit for their education were discovered among non-participants.

Medical Students' and Family Physicians' Attitudes and Perceptions Toward Radiology Learning in the Second Life Virtual World

OBJECTIVE. The purpose of this study was to evaluate 3rd-year medical students' attitudes and perceptions toward a radiographic interpretation course inside the virtual world Second Life during their formal training in radiology and to compare their attitudes and perceptions with those of family physicians exposed to the same course. SUBJECTS AND METHODS. Forty-eight 3rd-year medical students voluntarily participated in a 3-week course held in Second Life during a 4-month course on general radiology. The course consisted of six 2-hour synchronous sessions and four asynchronous tasks. Fourteen family physicians voluntarily participated in a specific version of the same course. Participants completed an evaluation questionnaire about the project. RESULTS. All participants rated the experience positively and found the environment attractive and the initiative, the course, and the intervention of the professor interesting, adequate, and appropriate for their medical training (mean values ≥ 4.2/5). Participants reported little previous knowledge about Second Life but were willing to participate in future similar experiences. Family physicians self-rated their own participation as less active and rated lower interaction with their peers than did the medical students (p = 0.018 and p < 0.001). CONCLUSION. The combination of synchronous sessions and asynchronous tasks to learn radiographic interpretation in Second Life was well received by undergraduate and postgraduate attendees, who had positive opinions and attitudes; the virtual sessions and tasks minimized the costs of travel for learners and teachers, making their use financially effective. Participants perceived Second Life as an interesting and useful online tool for complementary undergraduate radiology learning and postgraduate continuing medical education.

Exploring the Potential of Undergraduate Radiology Education in the Virtual World Second Life with First-cycle and Second-cycle Medical Students

RATIONALE AND OBJECTIVES

Virtual worlds have a remarkable potential for effective teaching and learning, providing immersive, realistic, and engaging online events. Previous studies have explored online education of health professionals in Second Life (SL), the most widely used virtual world, but none of the previous learning experiences were related to radiology. The purpose of this study was to explore the potential use of SL for undergraduate radiology education and the involvement of students in SL learning activities.

MATERIALS AND METHODS

We delivered a 4-week voluntary undergraduate radiology education program in SL, based on synchronous sessions and asynchronous tasks, with two modalities: introduction to basic radiology for first-cycle (first- to third-year) students and case-based clinical radiology for second-cycle (fourth- to sixth-year) students. Participants completed an evaluation questionnaire about the experiences after the learning program.

RESULTS

Forty-six students (20 first-cycle and 26 second-cycle) participated in this study. They found the contents of the course appropriate (mean ≥ 4.53/5), the initiative interesting, and the environment attractive (mean ≥ 4.32/5), and they were willing to participate in future SL experiences (mean ≥ 4.63/5). All students highly rated the organization, the content, the benefit to their medical education, and the professor (mean ≥ 9.05/10).

CONCLUSION

Online radiology education using SL is feasible and well received by medical students of all year groups. The students participated and engaged in this activity very positively and rated the experience highly. The potential of using SL for radiology education includes promising expectations regarding collaborative learning and gamification.

Possibilities of the three-dimensional virtual environment tridimensional Second Life® for training in radiology

Three-dimensional virtual environments enable very realistic ludic, social, cultural, and educational activities to be carried out online. Second Life^® is one of the most well-known virtual environments, in which numerous training activities have been developed for healthcare professionals, although none about radiology. The aim of this article is to present the technical resources and educational activities that Second Life^® offers for training in radiology based on our experience since 2011 with diverse training activities for undergraduate and postgraduate students. Second Life^® is useful for carrying out radiology training activities online through remote access in an attractive scenario, especially for current generations of students and residents. More than 800 participants have reported in individual satisfaction surveys that their experiences with this approach have been interesting and useful for their training in radiology.

Using Technology to Meet the Challenges of Medical Education

Medical education is rapidly changing, influenced by many factors including the changing health care environment, the changing role of the physician, altered societal expectations, rapidly changing medical science, and the diversity of pedagogical techniques. Changes in societal expectations put patient safety in the forefront, and raises the ethical issues of learning interactions and procedures on live patients, with the long-standing teaching method of "see one, do one, teach one" no longer acceptable. The educational goals of using technology in medical education include facilitating basic knowledge acquisition, improving decision making, enhancement of perceptual variation, improving skill coordination, practicing for rare or critical events, learning team training, and improving psychomotor skills. Different technologies can address these goals. Technologies such as podcasts and videos with flipped classrooms, mobile devices with apps, video games, simulations (part-time trainers, integrated simulators, virtual reality), and wearable devices (google glass) are some of the techniques available to address the changing educational environment. This article presents how the use of technologies can provide the infrastructure and basis for addressing many of the challenges in providing medical education for the future.

Global collaboration and team-building through 3D virtual environments

Certain aspects of healthcare education are difficult to teach in real world environments or in isolated classroom settings. These include, but are not limited to, collaboration and interdisciplinary teamwork skills that are necessary for improved team performance and patient care outcomes. Virtual simulation is a growing field for training and continuous professional development activities and is conducive to local and international clinical training and collaborative projects.

The authors examine theories of collaboration applied to virtual worlds, along with case studies, to demonstrate virtual simulation's applicability to a variety of teaching environments.

In addition, virtual environments have applications to interprofessional healthcare training and team formation. International partnerships for education can benefit from using virtual environments to foster team-building activities without geographic boundaries.

Virtual environments have been instrumental in the growth and sustainability of international networks of educators and, when feasible, should be utilized as a tool for the development of international partnerships.

The cranial nerve skywalk: A 3D tutorial of cranial nerves in a virtual platform

Visualization of the complex courses of the cranial nerves by students in the health-related professions is challenging through either diagrams in books or plastic models in the gross laboratory. Furthermore, dissection of the cranial nerves in the gross laboratory is an extremely meticulous task. Teaching and learning the cranial nerve pathways is difficult using two-dimensional (2D) illustrations alone. Three-dimensional (3D) models aid the teacher in describing intricate and complex anatomical structures and help students visualize them. The study of the cranial nerves can be supplemented with 3D, which permits the students to fully visualize their distribution within the craniofacial complex. This article describes the construction and usage of a virtual anatomy platform in Second Life™, which contains 3D models of the cranial nerves III, V, VII, and IX. The Cranial Nerve Skywalk features select cranial nerves and the associated autonomic pathways in an immersive online environment. This teaching supplement was introduced to groups of pre-healthcare professional students in gross anatomy courses at both institutions and student feedback is included.

Motivational interviewing workshop in a virtual world: learning as avatars

BACKGROUND AND OBJECTIVES

Limited research has been done to understand outcomes of continuing medical education offered in three-dimensional, immersive virtual worlds. We studied a case of a virtual world workshop on motivational interviewing (MI) applied to smoking cessation counseling and its educational impact.

METHODS

To facilitate content development and evaluation, we specified desired MI competencies. The workshop consisted of three sessions, which included lectures, practice with standardized patients, and chat interactions. Data were collected from 13 primary care physicians and residents through workshop observation, and pre- and 3-month post-workshop telephone/Skype interviews and interactions with standardized patients. Interactions with standardized patients were assessed by an expert using a validated MI tool and by standardized patients using a tool developed for this study. For 11 participants who attended two or three sessions, we conducted paired-samples t tests comparing mean differences between the competency scores before and after the workshop.

RESULTS

Expert assessment showed significant improvement on six of seven MI competencies. All participants reported learning new knowledge and skills, and nine described incorporating new learning into their clinical practice. Practicing MI with standardized patients and/or observing others' practice appeared to be the most helpful workshop component.

CONCLUSIONS

The evaluated workshop had positive impact on participants' competencies and practice as related to MI applied to smoking cessation counseling. Our findings support further exploration of three-dimensional virtual worlds as learning environments for continuing medical education.

Scientific Knowledge Transfer Training Through a Virtual World

The aim of this study was to use the virtual world Second Life (SL) to perform a knowledge transfer training to Pharmacy students. The presentation of assignments of different subjects was organized as scientific congress communications. The activities were carried out at the facilities created at the USALPHARMA Island in SL. The content and format of these works, together with their oral presentation and interventions in debates were evaluated. These experiences provided adequate learning results and a high level of student satisfaction. This teaching strategy can foster development of creativity, critical thinking, communication, co-teamwork and digital competence. Likewise, it can facilitate teacher-student relations and relations among the students themselves. It also implies significant savings in time and money, since real facilities and equipment and physical movement of people are not involved. All of this encourages us to recommend this platform to host all kinds of conferences or scientific conferences.

Use of a virtual world computer environment for international distance education: lessons from a pilot project using Second Life

Virtual worlds (VWs), in which participants navigate as avatars through three-dimensional, computer-generated, realistic-looking environments, are emerging as important new technologies for distance health education. However, there is relatively little documented experience using VWs for international healthcare training. The Geneva Foundation for Medical Education and Research (GFMER) conducted a VW training for healthcare professionals enrolled in a GFMER training course. This paper describes the development, delivery, and results of a pilot project undertaken to explore the potential of VWs as an environment for distance healthcare education for an international audience that has generally limited access to conventionally delivered education.