Eleni Dafli

Exploring Design Requirements for Repurposing Dental Virtual Patients From the Web to Second Life: A Focus Group Study

Background Since their inception, virtual patients have provided health care educators with a way to engage learners in an experience simulating the clinician’s environment without danger to learners and patients. This has led this learning modality to be accepted as an essential component of medical education. With the advent of the visually and audio-rich 3-dimensional multi-user virtual environment (MUVE), a new deployment platform has emerged for educational content. Immersive, highly interactive, multimedia-rich, MUVEs that seamlessly foster collaboration provide a new hotbed for the deployment of medical education content. Objective This work aims to assess the suitability of the Second Life MUVE as a virtual patient deployment platform for undergraduate dental education, and to explore the requirements and specifications needed to meaningfully repurpose Web-based virtual patients in MUVEs. Methods Through the scripting capabilities and available art assets in Second Life, we repurposed an existing Web-based periodontology virtual patient into Second Life. Through a series of point-and-click interactions and multiple-choice queries, the user experienced a specific periodontology case and was asked to provide the optimal responses for each of the challenges of the case. A focus group of 9 undergraduate dentistry students experienced both the Web-based and the Second Life version of this virtual patient. The group convened 3 times and discussed relevant issues such as the group’s computer literacy, the assessment of Second Life as a virtual patient deployment platform, and compared the Web-based and MUVE-deployed virtual patients. Results A comparison between the Web-based and the Second Life virtual patient revealed the inherent advantages of the more experiential and immersive Second Life virtual environment. However, several challenges for the successful repurposing of virtual patients from the Web to the MUVE were identified. The identified challenges for repurposing of Web virtual patients to the MUVE platform from the focus group study were (1) increased case complexity to facilitate the user’s gaming preconception in a MUVE, (2) necessity to decrease textual narration and provide the pertinent information in a more immersive sensory way, and (3) requirement to allow the user to actuate the solutions of problems instead of describing them through narration. Conclusions For a successful systematic repurposing effort of virtual patients to MUVEs such as Second Life, the best practices of experiential and immersive game design should be organically incorporated in the repurposing workflow (automated or not). These findings are pivotal in an era in which open educational content is transferred to and shared among users, learners, and educators of various open repositories/environments.

Virtual Patients on the Semantic Web: A Proof-of-Application Study

Background Virtual patients are interactive computer simulations that are increasingly used as learning activities in modern health care education, especially in teaching clinical decision making. A key challenge is how to retrieve and repurpose virtual patients as unique types of educational resources between different platforms because of the lack of standardized content-retrieving and repurposing mechanisms. Semantic Web technologies provide the capability, through structured information, for easy retrieval, reuse, repurposing, and exchange of virtual patients between different systems. Objective An attempt to address this challenge has been made through the mEducator Best Practice Network, which provisioned frameworks for the discovery, retrieval, sharing, and reuse of medical educational resources. We have extended the OpenLabyrinth virtual patient authoring and deployment platform to facilitate the repurposing and retrieval of existing virtual patient material. Methods A standalone Web distribution and Web interface, which contains an extension for the OpenLabyrinth virtual patient authoring system, was implemented. This extension was designed to semantically annotate virtual patients to facilitate intelligent searches, complex queries, and easy exchange between institutions. The OpenLabyrinth extension enables OpenLabyrinth authors to integrate and share virtual patient case metadata within the mEducator3.0 network. Evaluation included 3 successive steps: (1) expert reviews; (2) evaluation of the ability of health care professionals and medical students to create, share, and exchange virtual patients through specific scenarios in extended OpenLabyrinth (OLabX); and (3) evaluation of the repurposed learning objects that emerged from the procedure. Results We evaluated 30 repurposed virtual patient cases. The evaluation, with a total of 98 participants, demonstrated the system’s main strength: the core repurposing capacity. The extensive metadata schema presentation facilitated user exploration and filtering of resources. Usability weaknesses were primarily related to standard computer applications’ ease of use provisions. Most evaluators provided positive feedback regarding educational experiences on both content and system usability. Evaluation results replicated across several independent evaluation events. Conclusions The OpenLabyrinth extension, as part of the semantic mEducator3.0 approach, is a virtual patient sharing approach that builds on a collection of Semantic Web services and federates existing sources of clinical and educational data. It is an effective sharing tool for virtual patients and has been merged into the next version of the app (OpenLabyrinth 3.3). Such tool extensions may enhance the medical education arsenal with capacities of creating simulation/game-based learning episodes, massive open online courses, curricular transformations, and a future robust infrastructure for enabling mobile learning.

A Virtual Emergency Telemedicine Serious Game in Medical Training: A Quantitative, Professional Feedback-Informed Evaluation Study.

Background Serious games involving virtual patients in medical education can provide a controlled setting within which players can learn in an engaging way, while avoiding the risks associated with real patients. Moreover, serious games align with medical students’ preferred learning styles. The Virtual Emergency TeleMedicine (VETM) game is a simulation-based game that was developed in collaboration with the mEducator Best Practice network in response to calls to integrate serious games in medical education and training. The VETM game makes use of data from an electrocardiogram to train practicing doctors, nurses, or medical students for problem-solving in real-life clinical scenarios through a telemedicine system and virtual patients. The study responds to two gaps: the limited number of games in emergency cardiology and the lack of evaluations by professionals. Objective The objective of this study is a quantitative, professional feedback-informed evaluation of one scenario of VETM, involving cardiovascular complications. The study has the following research question: “What are professionals’ perceptions of the potential of the Virtual Emergency Telemedicine game for training people involved in the assessment and management of emergency cases?” Methods The evaluation of the VETM game was conducted with 90 professional ambulance crew nursing personnel specializing in the assessment and management of emergency cases. After collaboratively trying out one VETM scenario, participants individually completed an evaluation of the game (36 questions on a 5-point Likert scale) and provided written and verbal comments. The instrument assessed six dimensions of the game: (1) user interface, (2) difficulty level, (3) feedback, (4) educational value, (5) user engagement, and (6) terminology. Data sources of the study were 90 questionnaires, including written comments from 51 participants, 24 interviews with 55 participants, and 379 log files of their interaction with the game. Results Overall, the results were positive in all dimensions of the game that were assessed as means ranged from 3.2 to 3.99 out of 5, with user engagement receiving the highest score (mean 3.99, SD 0.87). Users’ perceived difficulty level received the lowest score (mean 3.20, SD 0.65), a finding which agrees with the analysis of log files that showed a rather low success rate (20.6%). Even though professionals saw the educational value and usefulness of the tool for pre-hospital emergency training (mean 3.83, SD 1.05), they identified confusing features and provided input for improving them. Conclusions Overall, the results of the professional feedback-informed evaluation of the game provide a strong indication of its potential as an educational tool for emergency training. Professionals’ input will serve to improve the game. Further research will aim to validate VETM, in a randomized pre-test, post-test control group study to examine possible learning gains in participants’ problem-solving skills in treating a patient’s symptoms in an emergency situation.

Re-use and exchange of an Opensim platform based learning environment among different medical specialties for clinical scenarios

Recent technological developments have enabled the use of virtual three dimensional platforms for educational uses. In this paper, an application based upon the Opensim platform for use within medical education and development of clinical skills is presented together with its associated repurposing so as to reconstruct and change this environment so that it fits different medical specialties. The objective of this work was to present the repurposing aspects of modifying a learning environment and adapting it to the needs of different medical specialties in an effort to reuse (and therefore share) learning content among several specialties. Initially, a 3-Dimensional environment was created by using the Opensimulator platform for use in the era of cardiology. Thereupon, the virtual environment was modified so as to be oriented to the needs of psychiatry educational needs. The reconstruction of the learning environment and context and the reformation of the educational scenario offer the ability to reuse it adapted to the needs of each medical domain. In tandem, educational standards were adopted, specifically, the IEEE Learning Object Metadata (LOM), to enable the description of this medical content and to support academic teachinng. The long term scope of this work within the overall developments in the area of advancing the repurposing of medical educational content is discussed.

Design and Development of a Pilot on Line Electronic OSCE Station for Use in Medical Education

The aim of this work is to present the technical issues around the design and implementation of an OSCE station (Objective Structured Clinical Examination) in electronic format, so as to be used in the fields of medical education. The presented e-OSCE examination - through the interactive web pages developed - is aimed to be used to assess applied knowledge, clinical reasoning and professional attitudes in the context of a basic clinical skill: intravenous cannulation. Candidates are rated on their medical knowledge of the physical and psychological issues involved in the questions. They are also rated on their ability to manage the issues raised in this case and perform the procedure appropriately and competently with regard for the patient safety and comfort. Two programs, complementary to each other were used for the design of the electronic OSCE; VUE, for the design of the logical path, and OpenLabyrinth, as an activity modeling system. They allowed the schematization and the creation of the on line interactive educational activity. OpenLabyrinth had to be installed in the local server and be configured. Moreover, the application is compatible with the latest technological standards proposed by MedBiquitous, which allows the interoperability, accessibility and reusability of the educational content.

Versatile mixed reality medical educational spaces; requirement analysis from expert users

Education has tapped into gaming to increase engagement and facilitate knowledge retention through experiential modalities. There have been several high technological intensity digital laboratories where learners are engaged with the subject matter through various activities. There are also several low intensity web-based solutions that familiarize learners with curriculum material but in less experientially intensive manners. A ubiquitous approach to highly impactful, low cost, high reusability gamified educational approach is a versatile mixed reality educational environment. Using prolific technologies such as inexpensive augmented reality (AR) headsets and a versatile low maintenance database (DB) back-ends, a real-world environment can be transformed with 3D graphics and audio to various educational spaces of highly impactful content. Such a simple implementation is presented here for virtual patients in medicine. A simple DB back-end supports a presentation front-end developed in Unity, utilizing the “vuforia”-mixed reality platform. Based on this implementation, future directions are explored.

Design of Novel Teaching Episodes in Medical Education Using Emerging Experiential Digital Assets: Technology Enabled Medical Education Beyond the Gimmicky

Medical education has always been about experiential hands on training to prepare future doctors to create the necessary skillset to deal with the sensitive and immediate nature of their work. Contemporary experiential technologies such as Virtual and Augmented reality offer a realistic but consequence free test-bed in which to interact safely and cope with emotional challenges pertaining to the realistic tasks simulated through these media. This work describes the design guidelines and workflow for incorporating these novel virtual assets in medical education through serious role play learning episodes. This approach consists of the case selection, the identification of roles, information flow and narrative requirements, implementation of technological narrative tools and implementation of the learning episode. Using a specific example of case transfer through this model we describe the process, outline implementation, assessment and technological considerations. Finally rationale for this work as a counterweight to technological hype fluctuations and integration of these media into the mainstream curricula is discussed.