Global+Learn+2010

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=Redesigning Role-Plays for a Virtual World in Health Education.= 

Penny Neuendorf Centre for Education Excellence Canberra Institute of Technology, Australia Penny.Neuendorf@cit.act.edu.au

Colin Simpson Centre for Education Excellence Canberra Institute of Technology, Australia Colin.Simpson@cit.act.edu.au


 * Abstract: ** Designing effective teaching and learning scenarios for virtual worlds is a challenging new field in health education. This paper explores a Canberra Institute of Technology project intended to reduce some of the logistical challenges of practicum placements in the Allied Health Industry by using role-plays set in health workplaces simulated in Virtual Worlds. While still in a trial phase, this project has already created a deeply immersive and engaging educational environment. One of the core elements of this has been a fundamental re-think of the design of role-plays which has included deepening the knowledge scaffolding approach provided to learners before the activity, increasing levels of health practitioner participation and making more effective use of the technology in the reflection process.

One of the driving forces behind this project was the lack of practicum places available for Allied Health Assistant students in the Canberra region. Allied Health Assistants work alongside healthcare professionals such as physiotherapists, occupational therapists and speech pathologists. The healthcare professional designs therapy programs for clients and it is the assistant’s job to work with the client to complete the program. Allied Health Assistants work in hospitals, aged care facilities, community services (home visits) and rehabilitation centres. Practicum placements put students into these environments to observe and learn from professionals at work. These placements illustrate correct workplace policies and procedures and in latter stages have students participating in workplace activities. Workplace readiness is the aim of practicum placements and they are a powerful tool for developing this, as noted in Wenger’s (2006) writings on Communities of Practice. In an ideal world, practicum places would be available for all students in their choice of workplace however unfortunately this is not the case. Only limited numbers of students are allowed in any workplace at a given time and supervisors in the workplace need free time to train and guide the students. A serious lack of health professionals in the health industry locally means that current practicum locations are understaffed and very busy. Simulation Centres within educational institutions which replicate these physical environments are very expensive to build and still require professionals to leave their workplace. To overcome these issues, we decided to use a Virtual World platform to simulate a health workplace that would familiarise students with some of the environments and situations that they would encounter in professional practice. Virtual Worlds are three-dimensional computer simulations of real world environments. Users generally control a character (known as an avatar) and interact with objects and other avatars in the space. The other avatars are either controlled by other users or by the software. Users are generally able to communicate synchronously with the other avatars by text or voice chat. Virtual Worlds can be accessed on a single computer, through a local network or over the Internet. Given the life or death nature of many aspects of health care that relate specifically to the professional environment, it is crucial that health students are able to develop skills and knowledge that relate directly to this environment. It is often impractical and even potentially dangerous to orientate learners and have them practicing in a live health environment with actual patients. A virtual world enables health educators to replicate real-life environments and make it possible to dramatise the consequences of actions in this space using role-plays and scenarios that provide immediate and meaningful visual/aural feedback to learners. Current research (Clarke and Dede 2005) shows that Virtual World scenarios provide valuable learning opportunities for a wide range of learners. The nature of the virtual world environment also benefits disadvantaged students who are unable to attend classes or live in remote and regional locations. The use of avatars also provides a safe and supportive environment for people who are inhibited, self-conscious and uncomfortable about performing in role-plays within a classroom environment. Educators and other learners are also able to enter an observer mode in these environments, enabling them to monitor the interactions of learners participating in role-play scenarios in the virtual world without distracting them. These interactions can also be recorded to facilitate critical reflection once the scenario has been completed. The ability to easily customise both the virtual space and the avatars means that a range of different workplaces and patient types can be incorporated into the scenarios. These offer learners a much greater variety of experiences and allow to teachers to address specific areas of healthcare that might not frequently arise in a practicum placement as well as those that might be expensive or dangerous. The flexibility of the virtual environment also means that Allied Health professionals from all over the country can participate in scenario role-play activities from a location that suits them. Where more sophisticated virtual environments are used, with computer controlled avatars and scenarios, learners may also be able to access them much more flexibly, at times and from locations that better meet their needs.
 * Background **
 * Why use a Virtual World in Health Education? **

Our project considered a number of different platforms for development of the Virtual World before deciding on a platform developed by a locally based company. This related largely to the functionality that we required from the platform in terms of privacy, accessibility and customisation. In consultation with Allied Health practitioners, the project team developed a number of virtual world learning scenarios. Discussions with these practitioners indicated that one of their primary concerns was developing effective communication skills in the workplace. It has been frequently noted that ineffective inter-professional communication can seriously impact the quality of health care (Kreps 1985, Croteau 2003, Saboor 2009). For this reason individual and inter-professional communication skills were chosen as the focus for the scenarios in the virtual environments, the project reference committee determining that developing these skills would help to make the students more job ready. The process of scripting and structuring the role-play exercises for the virtual world involved re-thinking the way that we had previously run these in a classroom setting. The virtual world offers a richer environment with a wider array of characters and potential outcomes. To make more effective use of this, we drew on ideas from Constructivism (Pahl 2002, Wilson 2008, Darvasi 2008), Situated Learning (Lave and Wenger 1991, Wenger 1998) and Critical Reflection (Brookfield 1995). We decided to create deeper scenarios with much more involved character descriptions and motivations for participants. Our intention was to provide learners with a base of scaffolding knowledge of communication techniques through classroom discussions and activities and then let them discover the most appropriate use of these in the virtual world. In keeping with Wilson’s (2008) //Designed in scaffolding// model we developed three scaffolding layers: 1. The first layer provides support with the learning scenarios, teaching the participants how to move and function in a virtual environment. 2. The second layer starts with simple one to one scenarios (with or without teacher participation) to help the participants to become immersed in the roles and to be able to develop their role playing skills in a safe, non judgemental environment. As the course progresses and the complexity of the material increases, one to one scenarios also increase in complexity. 3. The third level of scaffolding is where the support starts to be removed and the participant is given the opportunity to “show off” these skills and knowledge in more complex multiplayer scenarios. Equipping teachers with the skills to facilitate and train in a virtual environment has also a scaffolding component. This process starts with the teacher participating in simple scenarios, with lots of instructor support, and moves to them designing and delivering multiplayer scenarios. We have primarily been using three scenarios for this project to date. ** Tunnel Vision Activity: ** this activity uses the Virtual World to give users an example of the difficulties faced by people with a disability. In this case, the user interacts with the world in first person perspective. They see the space from the point of view of their avatar which has tunnel vision i.e. the loss of peripheral vision with retention of central vision, resulting in a constricted circular tunnel-like field of vision. This condition can result from a large number of causes, including glaucoma and retinitis pigmentosa. It highlights the difficulty in navigation and locating objects that is characteristic of this condition and is intended to instil greater empathy for vision impaired clients. This is an individual activity involving participants navigating around part of the Virtual World environment, firstly with full vision and then with the tunnel vision effect turned on. It is also used to introduce learners to the keyboard and mouse controls needed to use the virtual world. ** Angry Client Activity ** : This is a two person scenario role-play. In this activity participants take on either the Health Care/Community worker role or the role of an angry client. The aim of the activity is to train participants in communication skills and dealing with difficult clients. Designing our virtual environment to represent a legitimate workplace enables the participants to become involved in a “community of practice”. (Wenger 1998) We encourage teachers (and ideally visiting practitioners) to take the lead role in the role plays while the learners watch before having the learners enter the scenarios themselves. Lave and Wenger (1991) refer to this as “legitimate peripheral participation” and it is a key element of situated learning in communities of practice. This situated learning also encourages serendipitous learning, meaning that while the students/participants are in a world playing in a scenario they will learn and develop skills without knowing it. This is where a debriefing and critical reflection stage is essential in highlighting these skills and bringing them to the students’ attention. The post scenario debrief is the most important part of the learning. This is where critical reflection is employed. The de-briefing process will allow the teacher to guide the students through the experiences by focusing on their actions, thoughts, values and beliefs. (Brookfield 1995) This then allows participants to reflect on their experiences and analyse the skills they have developed. This should then provide students with the means to change their behaviour and beliefs when dealing with similar situations in the future. The debriefing process is an authentic process that embeds learning from the role play scenario. Trials so far have indicated that participants analyse and reflect on virtual experiences for weeks after the scenario. The scenarios are recorded and are used as a classroom or online resource to help with the de-briefing process as well as provide valuable resources for future students. Lessons learnt ** Student responses has been varied, overall they have enjoyed learning in the virtual environment and feel that it will be a great addition to a blended delivery of their practicum placements. They have provided some useful suggestions about improvements for this virtual environment and the role-plays. Teachers and health professionals can also see the value of the environment and have observed that students tend to participate less self-consciously in this type environment. During the course of the project it has been apparent that we need to ensure that teachers and learners are comfortable with the technology before activities commence. We also need to develop processes for teachers to develop new role-play activities and new content for the environment (interactive and static models/objects, new avatars and even new buildings)
 * Major aspects of the project. **
 * Anger Management workshop: ** This role-play can be undertaken by between four and eight participants and is used to provide experience in counselling roles as well as to explore different forms of communication. Participants are given instructions and a brief on their role and they then spend up to 10 minutes performing the role play.
 * 

Ultimately we intend to have some “bots” (automated avatars) programmed with simple decision tree based scenarios to enable the students to work through role plays at any time, increasing the flexibility of the virtual environment. To increase the authenticity of these “bots”, health professionals have expressed great interest in writing the scripts. We are also investigating options to more effectively record role-plays for critical reflection as well as the possibility of presenting multimedia content and/or editable wikis within the spaces. In terms of structuring participant interactions within the worlds during the exercises, we are also considering options for some kind of virtual breakout room / lobby for students to use before and after role-plays to communicate, be part of a community and debrief in.
 * Future plans **

Kreps, G.L. (1985) Interpersonal Communication in Health Care: Promises and Problems. Resources in Education, 20, //ERIC Clearinghouse on Reading & Communication Skills//, ED 258297 Croteau, R.K (2003) Poor Communication is a common cause of errors; communication critical, says JCAHO official. //Joint Commission on Accreditation of Healthcare Organisations Access// Nov 2009. [] Saboor, S & Ammenwerth, E. (2009) Categorizing communication errors in integrated hospital information systems. //Methods of Information in Medicine//: 48(2):203-10. Epub 2009 Feb 18 Clarke, J. and Dede, C. (2005) Making learning meaningful: An exploratory study of using multi-user environments (MUVEs) in Middle School Science Retrieved November 18, 2009 from [] Wenger, E. (2006) //Communities of Practice – Learning, Meaning and Identity,// Cambridge University Press, UK Pahl, C. (2002). __An Evaluation of Scaffolding for Virtual Interactive Tutorials__. //World Conference on E-Learning in Corporate, Government, Healthcare, and Higher Education// Chesapeake. Wilson, S. (2008). Components of Cognitive Apprenticeship: Scaffolding, 2009, from [] Darvasi, P. (2008). "3D Virtual Learning Environments." 2009, from [] Brookfield, S. (Ed.) (1995//) International Encyclopaedia of Education//. Oxford Pergamon Press. Lave, J., & Wenger, E. (1991). //Situated learning: legitimate peripheral participation//: Cambridge University Press. Wenger, E. (1998). "Communities of practice." 2009, from [|http://www.ewenger.co]
 * References **