On Tuesday (10.26.10) Boston University Medical School hosted a pilot medical education event in the virtual world of Second Life. This event was part of a larger experiment to sharpen family practice physicians’ Motivational Interviewing (MI) skills through a series of online, skype and virtual world components. Baseline interviews, online articles, coaching calls, and questionnaires were interwoven with two, synchronous in-world events.
Motivational Interviewing is a client/patient-centered counseling method designed to enhance a patient’s intrinsic motivation for making behavior change. Whether its weight loss, smoking cessation, or increased exercise, medical and health professionals use this research-based model to amplify a patient’s ambivalence and get them over the hump with “change talk”.
There were 15 family practice doctors (from all over the U.S.) attending, an MI expert, and a number of us on the production crew. Those of us on the producing end of things gathered in a computer lab on the Boston Medical Center campus – a decision that turned out to be a wise one. Though certainly one of the advantages of conducting sessions in the virtual world is geographic freedom, it really helped with coordination to be able to signal each other, pass notes, solve technical problems, and intervene when necessary. Here are a few shots of us, hard at work.
The doctors were recruited for the pilot through medical listservs, screened in order to draft only those with sufficient computer/internet power and no previous exposure to MI. In advance of the event, the participating doctors got up to speed on Second Life through a self-directed tutorial living on a wiki site. We scheduled regular office hours so they could phone in for help with questions. Days before the first event we scheduled short (10 minute) skills check-out sessions, conducted in-world and by phone, to insure that they could manage the basics required for participation.
The docs gathered at the SL venue at 5:30 pm and we spent the first 20-30 minutes getting everyone settled, testing sound, and lining them up with technical support. Chimera Cosmos and Jenn Forager were our technical gurus for the evening. Looking elegant and professional in black business suits, they stood at the front of the amphitheater for easy identification. They were each responsible for half the docs – friending them and sending them IMs to establish contact.
The event consisted of a 30-minute lecture from the MI expert – including some meaningful interaction with the doctors via local text chat. Once the basic information transmitted, the doctors were divided into two small groups (red and blue) and teleported to two different sky platforms in order to conduct practice interviews with standardized patients.
The two standardized patients (Karen Gulliver and Neil Heyden) did a fabulous job. They had been given their medical scenarios in advance (written by the Principal Investigator, Suzanne Mitchell) and rehearsed in order to present just the right amount of resistance. Enough to give the doctors something to work with, but not so much as to prove frustrating.
One by one, the doctors tried their hand at the technique, moving into the “hot seat”, while their colleagues looked on and learned through observation. After each trial, the MI expert would offer coaching suggestions – commenting on what worked and what new things they might try next. Doubtless, the anonymity of being “behind” an avatar helped give the doctor’s freedom to experiment with this new and unusual (to them) method, maybe even helped them take a few risks? No one was shy and I was particularly struck by the serious intent with which they all approached the challenge.
Of course, we had a few technical snafus – some of the doctors neglected to buy (or bring) their headsets resulting in echoes and nasty feedback (Jenn and Chimera managed that by asking people to toggle on/off and to lower their volumes). A few doctors had trouble logging in when they innocently tried to join the session from a work computer (with a firewall that blocked Second Life). When we first arrived at the BU computer lab, we couldn’t get the sound to work on any of the computers in the room (despite having tested them two weeks earlier!). The speaker found it troublesome to multitask with so many pieces at once – his talk, the local chat, not being able to “see” his slides, and the commotion in the room. But, really, overall, the session went extremely well. We will make adjustments for event #2 (scheduled for 11.3.10) and see what the next step brings.