Last night was the second, of three, continuing medical education (CME) events for healthcare professionals conducted in the virtual world of Second Life. This CME program is sponsored by the Cease Smoking Today (CS2Day) collaborative, with the California Academy of Family Physicians as the lead partner. You can read about the instructional design of this workshop series here and about the first event here. One of the event’s observers was live tweeting the session – you can read the tweet-stream here.
Unlike the first event, this second evening was completely devoted to role-play practice. The healthcare professionals (HCPs) were divided into two groups (red and blue) and sent up to two smaller platforms in the sky (sort of like tree houses) to practice their Motivational Interviewing (MI) skills with standardized patients. There were ten HCPs on a platform, along with the coach, a timekeeper, and their patient. The standardized patients were played by Karen Gulliver and Neil Heyden who both did an excellent job of channeling the nuances of their assigned cases. The “coaches” were our facilitators from event #1 – Suzanne Mitchell and Jay Lee. The case was presented in advance (only two cases used) – each one a variant of a smoker, typically encountered in a family practice. The role-plays were ten minutes long, and the limits were strictly enforced.
The HCPs were challenged to put their MI skills to work as they rolled with resistance, developed discrepancies, expressed empathy, avoided argumentation, and supported self efficacy. During the role play, HCPs in the audience were encouraged to provide feedback, comments, and questions in the local chat window. At the role-play’s conclusion, the coach asked the HCP for feedback (“How did you think that went?”); the patient for their thoughts (“How did that feel to you as a patient?”); the other HCPs in the audience (“What did you think?”) and then provided some of their own observations (“You did a very good job of letting Bill know that you heard him, but when you pressed him with information that he wasn’t yet ready to hear, he stopped listening to you.”). The coaches did an excellent job of folding in the local chat feedback with their own (“As the others mentioned, you did an excellent job of expressing empathy in a believable way – the patient knew that you really understood how tough it was to quit smoking.”)
I was struck by the learning power of listening to others. As each successive HCP moved their avatar to the “hot seat” for their role-play, everyone in the room had the opportunity for a new lesson. With the certain knowledge that you were going to be “up soon”, we all listened with big ears. Suzanne and Jay expertly guided the physicians when they fell into the standard traps of slipping into “information provider” role, pushing for a conclusion before the patient was ready, or failing to hear an important cue about the patient’s resistance to quitting. With each successive interview, we all gained new insights and could imagine ourselves making the exact same mis-steps.
The patients’ insights were particularly helpful. To hear a patient say, “I felt listened to”, “I felt that she was rushing me”, or “I felt like he didn’t really understand how wrapped up my smoking was in my social life” were eye-openers.
Here are a few other insights from our standardized patients:
– I was struck by the fact that the discomfort over attempting something new in front of an audience of peers was mitigated by being “behind” an avatar.
– Many of the docs said that they were surprised how fast the time went by.
– They all seemed to grasp the importance of expressing empathy and did that well – the other MI skills were harder to implement.
– The HCPs are all good at direct questioning (“How long have you smoked?”) but the more subtle, iliciting questions (e.g. “Why do you feel that way? or “What benefits do you get from smoking?”), that get at the reasons behind their smoking habit, are tougher to come by.
– I was worried that the character’s bag of tricks would run dry, but because each HCP had a different approach and nuance, it felt new almost every time.
– While the participants are all aware that this is a different model, they don’t quite yet know how to go about it – but they are feeling their way, and its so clear that the practice really helps.
All of the role-plays were video recorded (video in virtual worlds is referred to as machinima), by the amazing Ariella Furman, and will be posted on a blog site for the HCPs and coaches. Their homework assignment, in preparation for event #3, is to watch and comment upon their own video as well as the video of at least one other participant. They are also encouraged to try out their newly acquired MI skills in their practice this week. Between their experience during event #2, their critique of their own and others’ videos, and their real-world attempts, we should have a very fruitful and interesting discussion next Wednesday evening!
Of course, we had our share of technical glitches (to be expected). Incoming participants needing to download updates to the SL viewer at the last-minute, headphones forgotten or not working, and bandwidth issues – to name a few – but all were mastered expertly and quickly by the team’s tireless producers Jenn Forager (Janalee Redmond) and Chimera Cosmos (Liz Dorland).