Game-based learning for virtual patients in Second Life®

Abstract: In the field of medicine, various representative simulations have been developed to support the decreasing number of learning opportunities with real patients; the use of virtual patients is among them. Virtual patients are real-life clinical scenarios used for the purpose of medical education. They usually follow a linear or branching approach and they are usually accessed via a computer browser or as part of a computer programme. The purpose of this thesis was to design, and develop a platform for the delivery of virtual patients following a game-based approach in the virtual world of Second Life®, investigating attitudes and gender differences among medical students at Imperial College London. Virtual worlds, such as Second Life®, are 3D spaces in which users meet and interact and in which learning opportunities can take place. Second Life® was selected for this study due to its popularity among UK Higher Education Institutions at the time of the development. The virtual patients’ activities were designed following game-based learning and pedagogic principles. The technical infrastructure was designed following a Component-Based System (CBS) structure as a distributed three tier architecture presenting information via a Heads-Up-Display (HUD). The first study carried out concentrated on the survey “My feelings when playing games” developed by Bonnano and Kommers (2008). The survey was comprised of 21 statements. Six statements related to the affective component, five statements are about perceived usefulness, six statements about perceived control and four statements about behavioral components. Two groups were involved, one accessing a virtual patient via Second Life® and the other via an e-module. This study involved 42 Year 3 undergraduate medical students (21 years old). The gender distribution of the respondents was 42.85% female (n = 18) and 57.14% male (n = 24). The tendency encountered in each group towards the different attitudinal components was analysed as well as gender-related attitudes. Both groups showed very similar results in relation to the Attitudinal Components. In general, females demonstrated a more positive attitude overall for the perceived usefulness component. Other studies looked at and contrasted, provided interesting thoughts and reflections on gender tendencies and game play. It was concluded that more inclusive and holistic studies in this area ought to be carried out in order to identify game play tendencies in professional-level simulation with adults at university level, which may counteract outdated perceptions about age and gender differences in game play. The second study described the use of the Nominal Group Technique (NGT) to assess students’ attitudes again. Two groups of undergraduate medical students (Yr 3, n=14) were invited to participate. The research question posed was: “In your opinion what are the advantages and disadvantages of learning in Second Life® compared with other methods?” The results provide a different perspective to the ones highlighted in the first study. Results from the first group focused on the learning experience highlighting its importance for clinical diagnosis as a structure for learning. The second group focused on the clinical exposure although they were ambivalent about the advantages of this type of delivery mode. In general, learners did not find the virtual patient activities challenging enough. The results of this thesis show that although a game-based learning approach was followed in the design of the virtual patient activities and interfaces, the repetitive linear presentation of the cases did not motivate the students enough, targeting only low-end Cognitive skills which may be more suitable for students in Year 1 and 2. The use of more challenging branching learning experiences, such as the ones developed by the PIVOTE authoring system are suggested for the delivery of virtual patients in clinical years. All the programming code used in the CBS has been released as open source, licensed under a Creative Commons Attribution-Non Commercial 3.0 License, in order to stimulate other interested parties in the development of similar applications in the virtual world of Second Life®.