Monday, September 14, 2009

Virtual Reality Medical Education in Second Life

Increasing numbers of people are using the Internet for the provision of all sorts of health services, from prescribing, through consulting to setting up automated self-treatment programs. But what about using it for education and therapy? After all, in theory, the ultimate form of cognitive behavioral therapy should be “virtual reality therapy.” By simply wearing your wrap-around sound and vision multimedia headset you can be instantly transported to a cliff edge, soar in a plane thousands of feet above the ground or be surrounded by a gathering of thousands of spiders - depending on your phobia. And the ultimate form of online education should be fully interactive, case based and student driven, all of which I now use in my teaching in Second Life.

The phrase “virtual reality” was coined by Jaron Lanier in 1989 to describe computer simulations of physical environments. Since the mid-1990s, the video game industry and 3D graphics card manufacturers have driven forward the state of personal computer graphics, advancing it far beyond the needs of most business users. These systems range in capability from simple displays of 3D objects to entire virtual cities. Virtual reality systems are now being routinely implemented on personal computers for a variety of activities. One of the most popular virtual reality programs is Second Life, produced by Linden Lab, Inc. Second Life is a general-purpose virtual world accessible through any Internet-connected personal computer. In order to interact in Second Life, users create “avatars”, or animated characters, to represent themselves. Individuals use these avatars to maneuver through various “worlds”, complete with buildings, geographical features, and other avatars. While the system borrows heavily from video game technology, it is not a game – there are no points, no levels, no missions, and nothing to win. It is simply a platform by which people can create virtual communities, model geological, meteorological, or behavioral phenomena, or rehearse events. I have been working in Second Life for several years now.

Users of Second Life include a variety of education organizations, from Harvard Law School to the American Cancer Society. There are currently areas of the virtual world that provide such disparate services as teaching heart sounds and auscultation technique, providing social support for individuals with Asperger's Syndrome, and modeling the effects of tsunami on coastal towns. The system has over 10 million account holders from all over the world, most of them with free basic accounts. Approximately 800,000 of those users are active, with over 80,000 of them connected to the system at any time. Virtual reality programs such as Second Life are increasingly being used for educational purposes in a variety of fields, including medical training and disaster preparedness. Linden Lab currently operates the Second Life Education Wiki which functions as a source of information for educators and trainers in a variety of fields who wish to use Second Life for distance learning or large-scale training purposes. A number of government agencies, including the Department of Homeland Security, the Centers for Disease Control, the National Institutes of Health, and the National Science Foundation, have begun using Second Life to hold meetings, conduct training sessions, and explore ways to make access to information more readily available around the world. A recent comprehensive survey intended to gather information on the activities, attitudes, and interests of educators active in Second Life conducted by New Media Consortium reported that the majority used it for educational purposes such as teaching and taking classes as well as for faculty training and development.

I have been using Second Life as a teaching and learning environment for several years now. With colleagues I have created a "virtual hallucinations" environment, which demonstrates the lived experience of psychosis and allows participants who travel through the environment to experience both visual and auditory hallucinations; visions and voices. We used this environment to teach this experience to our medical and psychology students. With the California Department of Health and other colleagues I have created a virtual bioterrorism crisis clinic to train health workers, and more recently, as part of our Health Informatics Certificate Program, with University of California Davis Extension, we have taught informatics students in a virtual conference center on our own private island; Davis Island. Students find the environment straightforward to learn to navigate, and within a week of our informatics students being introduced to the environment they were able to travel and tour around Second Life with the rest of us with ease.

Second Life and similar multi-user environments offer enormous possibilities in the medical educational world, where such applications are now called "serious games" rather than social or fun software. Students of the future will adapt to them very easily, and it is clear that applications such as Second Life have a great educational future before them. I look forward to continuing to teach classes of medical and graduate students "inworld".

Peter Yellowlees MD blogs at http://informationagehealth.blogspot.com and has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online

20 comments:

  1. As a student in the MHI214 class that has been participating in the Second Life education experience I can say that it has been most enlightening. I have been in healthcare information technology (HIT) for about 15 years. I’ve had some exposure to new ideas over the years, such as Tele-Homecare in the late 1990’s and development of an asynchronous application to bring the clinical information system with the clinician to the patient’s home on visits – which included the Home Health Medical Record. We even had an application using the telephone for care givers to sign in and out of the patient’s home. These were all exciting ideas, but are now pretty commonplace in the Home Health industry.
    Virtual reality however brings a whole new dimension to the use of technology and Health Care. Dr. Yellowlees has already described some valuable and successful uses of Second Life as a virtual reality tool for training and simulation.
    The experience (being much more than just an audio/visual presentation) of ‘Virtual Hallucinations’ on Second Life is an effectual and operative way to educate a provider, or enlighten a family member of a person who experiences auditory and visual hallucinations. My walk through this virtual clinic was moving. By providing a 3D visual, with sound as I walked my avatar through the clinic, I experienced the floor turning to sky, I saw the gun and heard the voice telling me to use it. This virtual world can express beyond words or pictures how it looks - and sounds - and feels to hear the voices and disturbing visions.
    Currently a user must sign in to Second Life and build an avatar, and then learn to move around. While I found it pretty easy, as did my classmates, I know some of my friends would not find it as easy, or be very interested. For today’s Internet and video game savvy users learning to navigate with your avatar is a piece of cake - but what I’d like to see is a little more usability or interoperability with devices more common to more consumers. For example…
    Let’s say I’ve been told I have metabolic syndrome and I must change my diet and increase my exercise or my health will be seriously in danger. Let’s also say that I have a very stressful and busy job which has caused me to miss my exercise classes and continue to eat unhealthy, fast foods. Let’s also say I have a treadmill, but it is so boring that I can’t stay on it for more than a few minutes. Wouldn’t it be great if I could plug my treadmill into my computer, which I have connected to my digital TV and log on to Second Life. From there I could find my exercise class any time of the day or night and hop on a virtual treadmill (which reacted to the activity on my own treadmill) and instead of my avatar getting a good workout on the treadmill - I could too! If there were other people in my virtual exercise class (no matter the time, day or night – or their ‘real’ geographic location) I could interact with them as we walked on our treadmills – we could be on different continents! But we could be in the same exercise class. We could even go to the same diet class and become support for each other as we all worked toward our goals.
    Sometimes it’s difficult for people to attend a weight control class, or exercise class because they’re self conscious – but in a virtual world, not only is time not a factor, you can make yourself look however you want.
    There are so many possibilities – what an exciting technology to add to health care as an educational tool, and not just for providers, for patients too!
    Marie Goddard, MSCIS, RN, BC and UCD MHI214 student

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