Tag Archives: cs2day

Summing It Up With Video

In earlier posts (here and here), I’ve written about the continuinng medical education (CME) programs we’ve been conducting in the virtual world of Second Life. The most recent of these – Smoking Cessation with Motivational Interviewing – was a three-event series (sponsored by CS2day) that ran in June, 2011.  Working with the enormously talented machinima artist, Ariella Furman, from Framed in 3D, we put together a summary video of the program:

I love the way this video captures the feeling of the workshop – the presence you feel from the avatars listening, the tentativeness of their attempts at role-play (and how hard that is), the sense of the physical space where the events took place, and the dynamism in the facilitator’s explanations of motivational interviewing technique.  Considering the fact that this program ran for six hours in real time, you get a pretty darned good take on it in three minutes.

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Smoking Cessation Medical Training in Second Life

The first of Cease Smoking Today (CS2Day)’s three-event, Smoking Cessation Continuing Medical Education (CME) workshop program took place on May 18th, 2011.  But the healthcare providers attending this CME workshop didn’t have to drive or get on a plane in order to obtain their CME credit. From the comfort of their offices or living room couches, they fired up their computers and joined the workshop in the virtual world of Second Life.

The program consists of three, two-hour, successive events (May 18, 25, and June 1) where participants attend and interact as avatars in this immersive, 3D virtual world.  Intended for healthcare professionals (family medicine doctors, nurse practitioners, and residents), this CME program focuses on the technique of motivational interviewing to help HCPs help their patients to stop smoking.

At this first kick-off event, participants were given an overview of the Motivational Interviewing (MI) technique from the workshop’s facilitators, Dr. Jay Lee and Dr. Suzanne Mitchell.  There were 34 attendees at the session coming into the virtual world from all over the United States (with one attendee from Indonesia, where it was 5:00 a.m.!).  The overview focused on the MI skills of rolling with resistance, expressing empathy, avoiding argumentation, developing discrepancy, and supporting self efficacy.  The session slides are archived here.

The program facilitators enlivened their talk with a few intriguing, virtual world simulated effects.  In this photo you can see Jay Lee demonstrating how many cigarettes a smoker with a pack-a-day habit would smoke in one year.

How many cigarettes would you smoke in a year with a pack-a-day habit?

And in this photo you can see Suzanne Mitchell demonstrating the significance and impact of issue and relational resistance.  These unique effects demonstrate the high visual impact offered by the virtual world  – seeing what you might only imagine in your mind’s eye as a metaphor or an explanation.

The distinction between "issue" resistance and "relationship" resistance.

In addition to the special effects, Suzanne and Jay used the local chat function to full advantage. Throughout their talk, they posed questions to the healthcare providers, asking them to type their answers in local chat. The HCPs quickly caught onto the value of the local chat stream, not only giving feedback to the speakers but also commenting on each other’s thoughts and opinions and connecting with each other.

The virtual world offers an interesting alternative to standard face-to-face continuing medical education.  Virtual world settings provide constructivist and connective approaches to learning where participants can interact, simulate, role-play, and reflect with their colleagues and instructors in a cooperative and context-rich environment from the comfort of their own homes.

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Motivational Interviewing for Smoking Cessation CME: Event One

"Opening Night" Event #1 of the CS2Day CME Program

Last night was the first of our three-event, Smoking Cessation Continuing Medical Education (CME) workshop program in the virtual world of Second Life.  The program is sponsored by Cease Smoking Today (CS2Day), an educational collaborative made up of nine partner organizations. Intended for healthcare professionals (family medicine doctors, nurse practitioners, etc), this CME program focuses on the technique of motivational interviewing to help HCPs help their patients to stop smoking.

The in-world events, which began last night, will take place on three successive Wednesday evenings (May 18, 25, and June 1).  At last night’s kick-off event, our participants were given an overview of the Motivational Interviewing (MI) technique from the workshop’s facilitators, Dr. Jay Lee and Dr. Suzanne Mitchell.  There were 34 attendees at the session coming into the virtual world from all over the United States (with one attendee from Indonesia, where it was 5:00 a.m.!).  The overview focused on the MI skills of rolling with resistance, expressing empathy, avoiding argumentation, developing discrepancy, and supporting self efficacy.  You can view the session slides here.

How many cigarettes in a year? (effect by Electric Pixels)

Our facilitators enlivened their talk with a few intriguing, virtual world special effects.  In this photo you can see Jay Lee demonstrating how many cigarettes a smoker with a pack-a-day habit would smoke in one year.

Issue and relational resistance. (effect by Mel Primswitch)

And in this photo you can see Suzanne Mitchell demonstrating the significance and impact of issue and relational resistance.  These unique effects demonstrate the high visual impact offered by the virtual world  – seeing what you might only imagine in your mind’s eye as a metaphor or an explanation.

In addition to the special effects, Suzanne and Jay used the local chat function to full advantage. Throughout their talk, they posed questions to the audience, asking them to type their answers in local chat. The HCPs quickly caught onto the value of the local chat stream, not only giving feedback to the speakers but commenting on each other’s thoughts and opinions.

Here is a typical local-chat exchange, excerpted from the transcript, in response to Suzanne giving them a patient scenario (smoking patient with high blood pressure who feels good and doesn’t think their smoking is a problem) and asking them for their thoughts – what questions would they ask this patient:

[17:34] Bronxdoc: It great that you feel good. Do you have any concerns about smoking?

[17:34] rwmorrowmd: what’s your favorite part of smoking?

[17:34] Abigail Mhia: Sounds like your health has been good

[17:34] Mona Willful: well that’s great that you feel fine, but what are your concerns about smoking

[17:35] jbrow0: you have not felt health effects from your smoking yet?

[17:35] Mar Scientist: I undersatnd you feel fine, but do you have … shortness of breath? does your family complain about your smoking?

[17:35] Boggsly: where do you see yourself in 5 years in regard to smoking?

[17:35] Mona Willful: It seems like he’s scared of something and not telling me, I want to dig into that

[17:35] jbrow0: just restating; not meant in ominouis tone

[17:36] jbrow0: you feel ok; no problems now

[17:39] Mona Willful: I see that this pt is very scared, and is in ambivalence. This is good for change

[17:40] rwmorrowmd: yes

[17:41] ttran72: what have you tried….

[17:41] RadhaLew: So on one hand you see some value in quitting but it sounds like you have a lot of stress in your life right now

[17:41] Bronxdoc: sounds like you would like to quit smoking but you feel that there are benefits as well

[17:41] rwmorrowmd: yes, it’s hard

[17:41] Boggsly: how important is it for you to try to quit right now?

[17:41] Mar Scientist: beating themselves up because they’ve not been successful;

[17:41] ttran72: maybe we can look at those failures and turn them into success by working together

[17:41] familydocwonk: you seem stressed about quitting smoking yet feel that smoking helps relieve your stress

[17:41] jbrow0: quitting smoking is important to you, but you are worried it might increase your stress levels

[17:41] Mona Willful: so you have tried quitting. What are some things you’ve tried? Are there any other things to lower your stress?

[17:41] Abigail Mhia: so on one hand, you feel smoking helps manage stress, but on the other, you see that quitting smoking is something you would like to do.

[17:44] Mona Willful: empathy, rolling with some resistance, support is definitely there

As you can see, the local chat is a great way to get a bead on audience-thinking, find out what they know, and allow everyone to “hear” each other.  It also becomes a permanent record of the exchange – and there was no problem getting these HCPs to contribute!

Although the overall event went very smoothly we, of course, experienced some technical problems.  For the most part, our attendees were brand new to Second Life and had no formal training in advance of the event. Though we had set up a tutorial web site for them, as busy professionals, most of them did not have time to get up to speed in advance. Anticipating this, we had the absolute best in the business on hand to triage and solve anyone’s challenges – Janalee Redmond (SL=Jennette Forager) and Liz Dorland (SL=Chimera Cosmos). And here, sporting our spiffy CS2Day team t-shirts is our fearless crew:

Left to right: Chimera Cosmos, Spiral Theas, Jenn Forager, Cynthia Kear, and Neil Lastchance.

Here were the most commonly encountered technical issues:

– Basic/Advanced Mode.  The latest version of the SL viewer has a toggle option for “Basic” and “Advanced” modes on the log-in screen.  The Basic mode, which gives limited functionality, is the default.  We needed our avatars in Advanced  mode so that they could hear, control the volume, change their view, etc.  Our most commonly encountered technical issue was “I can’t hear.” and it was typically solved by asking them to re-log and change to “Advanced” mode.

– Invisible Avatar.  We had one participant who could not get his avatar to completely appear.  He was showing up as hair and a pair of shoes only. It was comical to see, but I’m sure, not very fun for him.  Turns out it was the “two monitor problem”.  Once we had him shut down his second monitor, he rezzed in full form.

– Getting messages to new avatars.  As the session began and participant’s needed to solve technical issues (sound problems, view problems) it was difficult to get them to transfer the conversation around their problem from local chat to the less-intrusive IM (instant message)/private chat.  In hindsight, we should have done a mini tutorial on how to send and respond to IMs at the beginning of the event.

In addition to those technical matters, there were a few instructional design items that worked well, in addition to some changes that, in hindsight, we’d make to the instructional design:

– Alter the Landing Point.  All participants were given a SLurl to a landing point just behind the main venue.  We had thought that this would be an unobtrusive point to first appear and had a greeter stationed there to meet the HCPs as they arrived and guide them to the main stage.  Unfortunately, many of them took off running or flying as soon as they arrived.  Not knowing about the map function, they just headed off in any old direction, seeking out their colleagues.  Our poor greeter had to run laps to keep up with them, get their attention and direct them to the location.  It might have been better to position the landing point right near the seating area.

– Instructional Time.  Knowing that our participants were all busy professionals and most likely would not have the time to get up to speed on Second Life, we should have taken a little time at the front-end of the session to show them a few basics.

– Second Life Etiquette.  We spent a bit of time at start of the session, reviewing “SL-etiquette” (try to resist playing with the gestures during the talk, encourage them to use local chat to give feedback and comments) but we could have gone into more detail on this (maybe with some helpful visuals?).

– Technical Help by Color Group.  We divided the participants into two groups (red and blue) and indicated their group membership with color-coded signs.  Jenn and Chimera were each assigned to a group so that they were only (ha!) responsible for the technical issues in that group.  This streamlined the technical support and each HCP knew who to go to for help.

Red and blue signs indicated group assignments

It was a terrific event – great job on the part of the presenters, fulsome participation on the part of all the HCPs, and heroic efforts on the part of the technical crew.  Huzzah!!  And now, onto events 2 and 3 where the HCPs will do role-plays (wth standardized patients) which the amazing Ariella Furman and her crew will video record for evaluation and comment.  Can’t wait to see those!

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Getting Ready for Smoking Cessation CME Program in Second Life

We’re almost ready.  Our Motivational Interviewing for Smoking Cessation Continuing Medical Educationn (CME) program is about to begin.  And what a mouthful of a title that is.  But each word of the title is significant.  The main goal of this workshop program is to help healthcare providers (HCPs) help their patients to stop smoking.  The participants will use motivational interviewing to do that.  And the program provides continuing medical education, for which the attendees will earn AMA PRA Category 1 or AAFP prescribed CME credit. And there is no charge for participation.

The program, sponsored by the CS2Day collaborative, consists of three consecutive in-world events (May 18, May 25, and June 1), two hours each, conducted in the virtual world of Second Life.  Here’s a photo of the event venue:

The Second Life CME event venue

There will be 25 healthcare professionals (nurse practitioners, family practice doctors, and residents) in attendance, along with our team (10 of us).  And here’s the overall curriculum plan for the three events:

CME Instructional Design

As you can see, role-play is a critical program element.  Participating HCPS will have roughly three hours of role play practice, with standardized patients, on a variety of patient cases.  This is a solid application of virtual world technology – a chance to try it out, in a low-stakes setting, where everyone can enjoy the anonymity of role-playing as an avatar. Practice makes perfect, afterall.

But why do this in an online virtual world instead of a webinar?  Virtual worlds give the participants an added feeling of presence – of being there.  We hope that this immersive quality will enhance the effectiveness of the program.

The role play sessions will be preceded by information giving sessions and model interviews, with our two content experts:  Jay Lee (MD, MPH, Director of Health Policy, Long Beach Memorial Family Medicine Residence Program) and Suzanne Mitchell (MD, MS Assistant Professor of Family Medicine at Boston University Medical School).

In between the second and third events, the participants be assigned homework.  They will visit a blog site where videos of their in-world role plays will be posted for review.  They will be asked to review (and comment upon) their own video and the videos of two other participants.  This sort of intentional, thoughtful scrutiny and assessment of their role plays will lead to a fuller and more nuanced understanding of the delicate dance that is motivational interviewing.

Our program includes a companion research portion.  Volunteers HCPs are participating in “pre” and “post” patient/doctor interviews, conducted and recorded via Skype, with a standardized patient.  The difference in their MI-effectiveness (from before the 3-event program to after) will be measured.  Stay tuned for results and details!

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