New Media and Health Communications at TCNJ

Spiral Theas Visiting Students at The College of New Jersey

Yifeng Hu, a friend that I met in Second Life, invited me this week to pay a visit to her College of New Jersey’s New Media and Health Communications course (Comm345).  But I didn’t have to fly to New Jersey to meet with Yifeng’s students, I just had to fire up my computer and teleport to her virtual world classroom.  That’s me, in the photo above, looking out a the group of eager and virtual faces.

In advance of my visit, Yifeng had given them access to a Journal of Medical Internet Research article that I co-authored (with my colleague John Wiecha) about a continuing medical education (CME) pilot that we had recently run in the virtual world (involving role play with standardized patients).  She hoped that I could talk with her students about our experiences conducting CME in-world, describe a few of our future projects, and answer their questions.

I was very impressed with the students questions…

Did the doctors know each other before the session?

Does role play work just as well in SL compared to reality?

How do you monitor the real life success of those in SL?

Do you think it’s important to couple SL interactions with real world interactions?

They were thoughtful, pertinent, and right on the money.  Like a hot knife through butter, these undergraduate students got right to the meaty challenges that my colleagues and I have been struggling with as we attempt to design effective and impactful learning experiences for busy physicians.

After I attempted to answer their questions, I asked them a few.  Specifically, I wanted to know what advice they had for me to help acclimatize people, new to virtual worlds, and help them be succesful.  Here’s what they told me:

People have trouble knowing where they are, help them get oriented.

Set a home location so you don’t get lost.

Figure out how navigate to specific places using a map.

Give them time to get used to SL before doing anything formal.

Have someone around to help you right then and there.

Excellent advice.  Thank you, Comm 345.



Filed under Teaching with Technology, Virtual Worlds

32 responses to “New Media and Health Communications at TCNJ

  1. Eboni Wingo

    In addition to the article that we read by Robin, which I felt offered a lot of information about Continuing Medical Education; we also attended a Second Life speech, which was even more insightful. In her speech Robin mentioned many of the new plans and projects that her and her team are considering in regards to CME. I feel that many of her ideas can be beneficial to help doctors become more knowledgeable and understanding of their patients and to also be more capable of catering to their patients.
    In my opinion, utilizing virtual worlds is a great way for doctors to complete their CME training because it can be done from the comfort of their own personal computer and can also be quicker than regular trainings, however, I do strongly believe that there are certain procedures and/or trainings that should be taught in the formal way (for example: in the hospital setting with real people). On another note, I do feel that the role playing is a great way for doctors to be able to practice how they interact with patients, mostly because of the anonymity (doctors can feel more comfortable if they give a response that may not be correct with their identities hidden) and it gives them a chance to be able to respond to, as well as answer questions that they have never heard before from their normal patients.
    I also think that the new study taking samples of 50 women in real life and 50 women to participate in SL to monitor their health as they complete daily activities will prove to be interesting. The study is designed to show that if you engage in behaviors on SL, then you may continue the same healthy behavior in real life. The women participating in SL will be compared to those participating in real life to see if their health really does improve in the same way as those participating in real life. In my opinion, this is the most interesting study, and one of the more interesting uses of Second Life that I have seen thus far, because it will be measuring success in SL to success in real life.
    I also agree that at this point in time it is most beneficial to host these events/trainings/studies on smaller scales because it is easier to work out technical issues on a smaller level, and easier to track the results, but I would love to see these types of events hosted on bigger scales and as Robin mentioned I do also agree that as the technology for these types of programs improves and becomes easier to use the thought of hosting a larger event will be more realistic.

    • rheyden

      Thanks for this, Eboni. I really enjoyed coming to talk with your class. I think you’re right about the anonimity angle with the doctors and role-playing. It’s interesting in that I think it allows them to take more risks and experiment with a new idea. As you say, a great way for them to practice. Also agree with you that there are certain procedures (in many professions!) that really must be done in the real world – with real people. As usual with technology, the best answers are hybrid answers, made up of multiple modalities.

  2. Jennifer L

    Robin spoke to us about the three projects she is working on. They revolve around continuing medical education and health behavior training. I found Robin’s discussion of role-playing and health behavior training most interesting and will further elaborate on these two topics.
    During the CME, physicians in Robin’s sessions act out ten-minute role-play sessions. I was interested in learning about how role-playing in the virtual world differs from real life, and why Robin feels it is more effective in the virtual world. In the virtual world, both participants are anonymous and can follow their instincts without judgment. After watching the short clip of a patient doctor role-play about colon cancer screening, and listening to Robin’s commentary on role-playing, I was able to see how effective and brilliant it is to use virtual worlds for purposes such as these. Virtual worlds can help doctors improve their discussion techniques with the patients and receive valuable feedback from other healthcare professionals also participating in the program.
    I was also curious to learn about the Health Behavior Training for patients that Robin will be running in May 2011. The sample will consist of 50 African American women that are of a low socioeconomic status. Spiral stated that this might be the first time some of them will use a computer. I wonder if that will be a hindrance to the study or an obstacle that is easily overcome. I was very interested to learn that all the avatars of the participants will be the same and reflect the physical appearance of the participants: overweight African American women between the ages of 40 and 60. After several weeks in the program, the women will be able to change their avatar. If they are feeling better about their appearance and weight, it should be reflected in the appearance of their avatar.
    Overall, I enjoyed Robin’s discussion about health behaviors and use of virtual words for continuing medical education. I really liked using the chat to ask questions during her lecture. I only wish we saw the role-playing clip earlier in the lecture!

    • rheyden

      Thanks for your comment, Jennifer. I agree, the role-playing in the virtual world is one of the best applications of the technology that I’ve seen. Like you, I’m worried about the lack of exposure to and comfort with computers on the part of our new study’s participants. I’m hopeful that the visual nature of the online world will help immerse and enthuse them. Let’s hope!
      Good suggestion to show the video clip earlier – I’ll do that next time.

  3. Alexis Hankh

    Last week our class had the opportunity to listen to a speech by Robin Heyden about her experiences in Second Life. Not only was this speech interesting, it was very informative as well. During Heyden’s speech, she discussed the technique of motivational interviewing though CME, a topic I had not been familiar to prior to this event. Through her explanation, I learned that motivational interviewing is a technique that many health practitioners use to discuss problems with their patients that are detrimental to their health. One popular topic that many health practitioners apply this procedure to is smoking. In such a situation, the health practitioner and patient would discuss the reasons the patient has for smoking and will eventually lead the discussion on the track to induce behavior change. All in all, motivational interviewing provides health practitioners with the ability to provide motivation, skills, advice, and medications that will benefit their patients’ health in the long run.
    During Heyden’s speech, she also introduced us to the ways in which health practitioners are using virtual worlds to practice and complete their CME training. With this, she showed us a video of two trainees practicing their skills through role-playing, which I found to be very interesting. In this situation, one person was acting as the doctor and the other as the patient. As they were discussing a controversial topic, the patient introduced many conflicting ideas and beliefs that would be commonly brought up by many patients in this situation, and the doctor would try to find a way to change their beliefs and, ultimately, their behavior. On the whole, I feel as though this act of role-playing in virtual worlds can be beneficial for doctors in completing their CME training. Not only does it allow them to do so in the comfort of their own homes, it also allows them to meet with many other doctors from differing locations that they probably would not have had the opportunity to meet elsewise. My question is, however, in such situations where doctors are practicing role-playing, is it common for doctors from differing geographical locations to participate in these activities together or is it normally doctors only from one area practicing together? I ask this because I feel as though meeting and role-playing with doctors from different locations would introduce them to unfamiliar viewpoints that are not commonly brought up in their usual discussions with patients from the same geographical location. Thank you for your insight!

  4. rheyden

    Thanks for your post, Alexis. Your question about doctors from different geographical areas in a CME training event is a good one. I think it varies widely – some CMEs are more national (with people attending from different locations) and some are more local (with all the attendees coming from the same town, or even the same hospital). We try to keep our CME virtual world events focused on the issues most commonly encountered by any family practice physician.

  5. Phoebe Ling

    Hi Robin, thanks for guest lecturing our class in SL last week. I really appreciated learning about the various research projects you’ve worked on. I particularly liked hearing about motivational counseling and actually seeing it in practice through role play on SL via the YouTube video. The technique really focuses on the patient and tries to understand why the patient is acting a certain way. Undoubtedly, I believe it is a very valuable and essential technique for physicians to learn and apply in order to best help their patients.
    It was also very interesting to hear about the study on females with type 2 diabetes. The study sounds like a great idea and I am extremely curious to see how SL will affect the participants, and how behaviors will differ between those who are using SL and those who are not. I hope the Proteus Effect will be found to occur, and the activities in the virtual world will translate into behavior changes in the real world. If the study finds SL to be effective in helping women deal with diabetes, it will be interesting to see how then everything could be used in the real world and even help patients deal with other diseases. The implications and practical applications could be endless; SL holds so much potential for future medical education and health intervention.

  6. rheyden

    Hi Phoebe. Thanks for your post. I totally agree, the implications and possibilities for practical applications in the virtual world are endless! So much to explore and experiment with!

  7. Katie Louie

    One bit of information I did not really know what that there are many techniques in understanding certain information on diseases. As an example, for diabetes management, the program focused on a thing called “motivational interviewing”. I have never heard of that type of interviewing before. She went on to explain that in motivational interviewing, it was a type of counseling that was developed by psychologists for drug use. In motivational interviewing, it explains to the person about their behavior, and the reasons behind their habits. This technique is used by bombarding the recipient with facts. I thought it was interesting that people are able to use these types of techniques in a virtual world and other sources of online technology. We actually got to see a clip of a questioning session between two people role playing. Not only can people interact through local chat, they are able to use the microphone and listen to what the other person is saying. In the future, it can set up sessions online that can occur at opposite points of the world. As the virtual world technology advances, the more innovation medical education can have an impact on patients and the average person.

    • rheyden

      I agree, Katie. As the virtual world technology improves (and the access and navigation get easier), there will be all sorts of positive and exciting impacts on people!

  8. Caitlin McNab

    In last week’s guest lecture, I learned a lot of information that I didn’t fully understand before. We got the chance to hear about CME and motivated interviewing, and see samples of how these techniques can be applied I a virtual world. Before this lecture, I did not know what motivated interviewing was. Robin explained that it is a way for doctors to find out why their patients engage in a behavior that can be harmful to their health. She showed an example of how motivated interviewing is taught in virtual worlds. After watching a video of a role-play in second life, where a doctor was speaking to a patient about colon cancer screenings, we were able to see how this technique can be effective.
    We also learned about a future study in which 50 African-American women in real life, and 50 women in SL will be monitoring their health. The study will be used to see how real life vs. SL compare in changing behaviors. Will the women in SL perform better or worse than the women in real life?
    I was very interested in the information presented and enjoyed learning about the different ways virtual worlds can be used. It was helpful to see examples to understand more about how the programs worked.

    • rheyden

      You’re right, Caitlin – it’s always helpful to see specific examples, isn’t it? We are starting our first pilot group in the African-American diabetes study next week – I’m so eager to find out how it goes. Keep your fingers crossed for us!

  9. Domenick Wissel

    I thought the lecture was very informative and allowed me to learn about Second Life’s practical uses. The lecture itself was a good example about the benefits, as well as the setbacks, of Second Life. The main benefit was that we were able to have you deliver a multimedia presentation to us with no travel required, which has the potential to be incredibly valuable to educators. The main setback occurred when we did not have the appropriate Second Life viewer and could not view your video over Second Life. However, we were able to view the video over YouTube. It’s clear that when it comes to using technologies like Second Life, the main component to success is adaptability.
    What struck me most during your lecture was the idea that Second Life works well in conjunction with real life interactions. When it comes to Second Life, there is this preconceived notion that it must be completely detached from the real world and used almost as an escape. Through taking the New Media and Health Communication course, I have come to realize that the line is much more blurred, and this lecture helped to further that idea. People in the same room can be using Second Life as a supplement to any type of treatment or lecture that is taking place. There are certainly advantages, such as the ability to think questions through and type them out privately instead of having to verbalize a question on the spot in front of a group of people. I think people tend to be much more hesitant to speak up during face-to-face interactions, and therefore Second Life gives people a sense of comfort and allows them to be more willing to speak up.

    • rheyden

      Well put, Domenick, and thanks for your thoughtful comments. I like the way you put that – that the line between real and virtual experiences is blurred. The key is for the person designing the instruction to think carefully about when to use which (and for what purpose) – the virtual world should be used for the things that the virtual world does best.
      You’re also right that the technology hurdles often get in our way – sound problems, different versions of the SL viewer, connectivity problems….but if everyone can be adaptable and flexible (as you all were!), then it all works out.

  10. Jane Ebner

    I really enjoyed lsitening to your presentation. I think everyone should be role playing their problems because it can be helpful.WhenI asked you how do you know if your methods would work? I meant was if it did not work the way you wanted to what would you do? Find other ways or try to fix the problem you may have with the methods.

    • rheyden

      Hi Jane. Thanks for your comment. Yes, I think that if our approach/methods don’t have the results we hoped for, we’ll make adjustments – try to find ways to fix the problems and go with a new approach.

  11. Erin P.

    Going into this presentation I did not think having doctors attend presentations in Second Life to fulfill their continuing medical education hours would be beneficial to them. Based on the readings from class I felt that there were more limitations than positives. I believed that there are some aspects of real life that cannot be replicated in a virtual world. From this point of view I believed that doctors should have to fulfill CME hours in a real life setting. Robin’s presentation helped me better understand what doctors experience in these interactive seminars and ultimately changed my perspective.
    The You Tube video of the role playing conversation gave me a better understanding of how it works. I realized that doctors could get a lot more out of this role play than I expected. As virtual worlds allow doctors to have some anonymity they can have a better focus on the conversation as compared in real life when role playing would take place in front of a live audience. Even if doctors are not as comfortable role playing in a virtual world, the online access allows for individuals to have more chances of practicing. I also found it interesting that although these sessions are lengthy, doctors stayed after to continue talking. This really showed me that there is a lot to get out of these CME sessions. Overall Second Life proves itself to be a great education platform and I am excited to see where future medical education will go.

    • rheyden

      Thanks, Erin. I appreciate you remaining open-minded to new information and am really glad that the video helped to make it clear to you how these role-plays have worked. I think that video is a very powerful tool.
      Like you, I am very excited to see where the future of education will go!

  12. Victoria S.

    I really enjoyed this lecture. I definitely feel a much stronger understanding of the concepts and ideas that are involved in medical and health behaviors in the virtual world. In particular, I found the project on smoking cessation very interesting. The idea that the more a patient practices healthy habits in a virtual world eventually produces healthy habits in the real world really struck me. After we saw the quick clip Robin shared with us, I also was able to clearly understand the idea of role playing in the virtual world also.

  13. Louis Orth

    Our class had a great lecture from Robin about the virtual world and how they are helping patients out through the virtual world and how effective it really can be. I was really impressed by what she was presenting, but I also had a lot of questions, unfortunately, I had to leave early. One thing that I really enjoyed about the lecture was about the quit smoking campaign. I thought it was really interesting how they set everything up for the patients and how well the patients actually responded to what they were learning about.
    What was really interesting to me was the role-play that Robin talked about. I figured this was a redundant idea. Because how can you role-play in a virtual world, aren’t you already role-playing, by being in a virtual world? However, Robin had pointed out that it was much easier for people to role-play in the virtual world because the other people didn’t know who they really were, so it was much easier for them to act. And because of this, the results were much higher than they were in real life. Which is a great thing for the people who are trying to quit smoking. Through Robin’s lecture, I feel much more at ease knowing that this study had actually worked people. I think the virtual world is finally going to get some more recognition in the next couple of years and can definitely become apart of a patients experience while visiting doctors in the virtual world.

    • rheyden

      I agree, Louis, I think that the virtaul world is going to be much more a part of our lives in the years to come. You’re right to point out that it is sort of funny to think of a role-play within a role-play…like mirrors within mirrors!

  14. Julie

    Before starting this class I had no prior knowledge about Second Life (other than a CSI NY episode.) I previously may have doubted its benefits and power, but with each reading assignment and guest presentation I am learning more and becoming a “believer” in Second Life.
    When reading the articles in preparation for Robin’s presentation, I was struck by how Second Life seminars can open up many opportunities for physicians. They are able to converse with doctors that they may never have the pleasure to meet in person and can share unique experiences. In addition, the role play in Second Life may include situations that a specific physician has not encountered and is not sure about. Personally, I think that I take more away from an experience when I am able to hear others’ views and am given input.
    Robin mentioned that role play works better in Second Life than in “real life” which I found interesting. I think that it works better because it is easier to not hold back when you are not in the same physical space. You don’t see disapproving facial expressions, and in extreme situations you know you are safe from physical altercations. When explaining diabetes care she explained motivational interviewing, a technique used in counseling where you talk about any health issue with behavior change. She explained the standardized patient avatars used in role play are actors or actresses playing the roles of noncompliant patients. She also explained that it is most effective for physicians to pull solutions out of patients. They don’t need to pour in all of the solutions.
    Finally, Robin explained how in one of the projects, physicians are able to view a recording of their interaction with the sample patient, and then analyze and critique the dialogue in addition to being given input from other physicians and the head instructor. It may be a little embarrassing to critique oneself, but I think that would be very useful in seeing how one actually deals with patients. The presentation was informative, and the visual aids really helped me to combine my previous knowledge with the new information from Robin’s presentation. It was a beneficial experience.

    • rheyden

      Hi Julie – thanks for your thoughtful post. I’m glad that the “real” Second Life measured up to what you’d seen on television 🙂 Yes, I think you are exactly right about the reasons why the role plays work so well in the virtual world. The safety of anonymity – people are willing to risk more. Glad that the visual aids and video helped you to understand the projects. Good luck with the rest of your course!

  15. Victoria Branca

    Robin Heyden was informative in her delivery of a guest speech to our class. I found her interaction with us to be of great value, and it really showed that she was interested in what we, the students, have to say. I think that her visions for Second Life as an educational tool show that she is very focused on future technologies, and regards students like us as part of that vision for the future.
    One of the things I was unsure about in Second Life was the use of the backchat described in Robin’s research article. I thought that it seemed like the physicians thought it to be of some concern when using Second Life for an educational seminar. While listening to Robin speak the other day, I was able to engage in use of this backchat and see for myself if it was useful, burdensome, or if it could be modified. I found that the backchat could get lengthy, but that there was a way to put the chat in a box that can be moved around on the screen so that it stays there at all times, instead of popping up when someone types something new. I also noticed that the chat box could be moved, so that I could still see Robin’s avatar. I was very happy when Robin addressed the issue of the backchat that I had discussed with my classmates and professor, and also in my week’s discussion questions. I really appreciate the fact that Robin took the time to read the questions our professor submitted to her and that she addressed them as being important concerns.
    I also feel very up-to-date on Second Life technology as it is being used for continuing medical education. When reading Robin’s research article, I wondered how the whole process actually worked. Hearing her speak clarified the details regarding the types of activities in which the physicians participated. I really liked the idea of the role-playing in the virtual worlds using avatars. I truly feel that I would be more confident speaking with a physician who has had such great practice. This atmosphere is so conducive to providing comfort for physicians so as they feel they can role-play in a more realistic manner. Hopefully they also feel that when talking with patients they have been more thoroughly prepared by participating in this experience.
    It is truly exciting to think that there are people like Robin working on making this type of experience possible. Not only is it effective, but it seems so much more enjoyable and constitute a lot less hassle for those who must earn continuing education credits. I actually saw a commercial just this weekend for a site called that allows employees to attend a meeting from their computers, without the travel and expense involved in attending a traditional face-to-face meeting. To myself I thought this was very similar to what Heyden’s team accomplishes with Second Life. I think that this a trend that will catch on very quickly. I hope that her team introduces this forum to other professions with great success!

    • rheyden

      Hi Victoria, Thanks so much for your thoughtful post – sounds like you really understood the potential for virtual worlds. I so enjoyed meeting with your class and really appreciate the valuable feedback you shared with me.
      Your point about backchat is a good one. When I first came into Second Life, I was quite mystified by it and wasn’t sure I understood the value (I found it distracting). But over time, I’ve come to see it as an extremely valuable way for the audience members/class/participants to interact and make the session more their own. As you discovered, it’s a great way to channel questions or comments to the speaker – – or to share impressions with other members of the class. It takes some getting used to, but it’s well worth it!
      Interesting that you saw that commercial about GoToMeeting – I just tried that service the other day. It worked really well. I agree that virtual worlds are a growing trend that will have a big impact on business and education in the not too distant future.
      Good luck with the rest of your course!

  16. Alison Sotolongo

    Hello Robin,

    Thank you with speaking to our class about continuing medial education through the use of Second Life. I find the use of Second Life for guest lectures to be so fascinating. It it such a new and exciting technology! You also provided such an opening and comforting environment for discussion. Normally I feel insecure about asking questions during a lecture, but this time it was a lot easier, so thank you.

    Also, thank you for sharing with us the different research you have conducted. I cannot wait to hear about the results of your type 2 diabetes study that is going to begin in May. I think that this could really cause behavior change, not only for the patients in the study, but for the medical community overall. It would be so interesting to see if more medical professionals begin to use Second Life to help their patients.

    Another aspect of your lecture that I found particularly interesting was the use of motivational interviewing. My current career aspiration is to become a guidance counselor. As a psychology major, I was wondering if you have seen people use psychological counseling techniques on Second Life? More specifically, I would be very interested in learning if guidance counselors use the program?

  17. Caitlin Capestro

    Before attending our Second Life speech conducted by Robin Heyden, I read the article she co-authored about CME, Continuing Medical Education. The concept itself is fascinating, and I was unaware of such possibilities and opportunities that were present and available through the use of virtual worlds. Not only within the article, but during her speech, Ms. Heyden described for us the benefits of CME such as; enabling doctors to anonymously practice or test new theories through role-play, educate friends and family about diabetes, and even offer help with smoking cessation which is the upcoming project Robin has been working towards.

    She described for us the strong partnership between real and virtual worlds and how the two together can provide greater motivation for certain behaviors and programs. We had the opportunity to take a look at some screen shots of Robin Heyden’s upcoming study including the “Women in Control” research regarding uncontrolled type II diabetes. This study will track the progress of 100 women, 50 in real life and 50 using the aid of Second Life, through an 8 week curriculum. I remember one of the activities the women will participate in, is being faced with different types of foods, and they are given the opportunity to decide which is appropriate for them to eat in regards to their health. Through these self-models and education, these women will hopefully be able to change their behaviors for the better. It is admirable the kind of barriers Robin is breaking in order to provide men and women with accessible help through virtual worlds if they need it.

    Thank you again for the opportunity and insight you provided us!

    • rheyden

      You’re welcome Caitlen, and thanks for your thoughtful post. We are certainly living in interesting times, aren’t we? I like the way you put it – that these programs I’m priviledged to work on have “strong partnerships” between real and virtual worlds. That’s so true.

  18. Traci H.

    Hi Robin! Thank you for visiting our class, I really enjoyed the presentation and learning about Continuing Medical Education for doctors through the use of Virtual Worlds. Before this class and this presentation I had no idea that doctors were able to continue their education through Second Life and think that it is very beneficial for those who live very hectic lives and may not be able to make it to a formal class or would prefer to learn in the comfort of their own homes.
    One tool that I thought was very beneficial in the process was the role playing. I thought this was very useful because it gives doctors an opportunity to put what they have learned to use and to learn how to react to different questions that a patient might have about a health topic. I enjoyed watching the video that you provided us with, especially because it allowed me to better understand how the role playing is done. I was very impressed. One again, thank you for visiting our class!

  19. rheyden

    You are welcome, Traci! And thanks for your comment. I think that video is a really helpful too to conveny a lot of information quickly and efficiently. You’re right, the role playing is really the heart of that SL experience for the doctors.

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