Tag Archives: Second Life

It’s a Wrap!

On the Boston Medical Center Island in Second Life

Last night concluded our three-part Motivational Interviewing for Smoking Cessation CME Workshop for practicing physicians in the virtual world.  And we did it in spite of hurricanes (three of our participating docs volunteered to help out in Joplin, MO) and tornadoes (breaking weather here in New England, as the third event got under way). You can read about the first two events of this continuing medical education series here and here.

Despite the biblical weather, we all arrived in Second Life at the appointed hour with surprisingly few technical glitches.  No doubt the able problem solving skills of Chimera Cosmos and Jenn Forager, during the previous two workshops, had well prepared everyone to triage all those handy steps themselves!

Dr. Suzanne Mitchell and Dr. Jay Lee

But before our participating healthcare professionals arrived at this third event, they had a homework assignment.  We posted machinima (videos shot in Second Life, created by Ariella Furman) of their event #2 role plays onto a community blog site which they were asked to visit, watch their own video, comment, and then comment on the video of at least one other participant.  Our instructors, Suzanne Mitchell and Jay Lee, also posted coaching comments on each video entry.  There was something powerful about watching those role-plays collectively.  Patterns quickly emerged (oh, the power of video!) and it was amazing to see the variation in approach with just a few patient scenarios.

* The HCPs were very, very good at expressing empathy – reflecting back to the patient how hard it is to quit smoking, how frustrating it can be.

* Less in evidence was the knack of developing discrepancy with the patients, a key motivational interviewing skill (e.g. “On the one hand smoking is a very social thing for you, but on the other hand you are concerned about your breathlessness and coughing”).

* Rather, they relied heavily on information giving (e.g. “Let me tell you about treatment options…”)

* Repeatedly you hear the HCP’s use of the pronoun “we” when talking about what the patient will do (e.g. “WE’RE going to need to get that blood pressure down”  or “What WE should do…”).  This phrasing side-steps the patient self-efficacy that underlies MI.

So event #3 started with recap of those role play videos and a conversation – what did you learn from watching your own video?  What patterns did you see?  I was particularly taken with one HCP who said that she was surprised to discover the mismatch between her actual role-play and what happened in her own head.  After that, Jay Lee lead us through some helpful treatment, quit plan, and pharmacological information and then it was up to the role-playing platforms to try it all again.

Role playing up on the small group platform

This time we stuck with the same cases from event #2, starting with the assumption that the patient was returning, after hearing all the medical information they needed, and the object of the role-play was specifically to discuss their smoking.  Jay and Suzanne gave each HCP their opening line with the patient.  For instance, “Glad you’ve got your blood pressure under control, Bill, that’s great.  I remember the last time we talked about your smoking, is it alright if we continue that conversation today?”  This way each role-play focused like a laser beam on exploring and excavating the reasons why this patient smokes and what they want to do about it.  You could almost hear the mental wheels turning.

There was an observable shift in the patterns observed during event #2 and some dramatic changes in approach.  During the role play, the audience members typed their thoughts and suggestions in local chat and the coaches gave advice and support.  “Nice job showing empathy…” , “Try reflecting back what the patient is telling you…”  “Point out the discrepancy in what she is saying…”   “Be careful of making comparisons with other patients.”   After each role play, the coach asked the HCP how they thought it went and asked the patient how it felt to them.

Only 8 minutes in length, it was amazing to see how much progress could be made on the smoking issue in each role play!  I was struck by two things:  1) how much could be learned from just watching the other HCPs doing their role play and 2) how very difficult it is to use motivational interviewing well.  As Cynthia Kear, this project’s leader, put it so well, “like a lot of complex things in life – it sounds simple on the surface, but when you get in there to actually do it, it’s more difficult than you imagined”.

A little Second Life dancing

After the hard work of role-playing, we all teleported down to the ground level, chatting about the experience and – what else? – dancing.  It was great to hear everyone’s pleasure over something so simple and fun.

All in all, a very succesful workshop series. If you’d like to read more, you can read a from-the-event, live Twitter stream on CS2Day’s Twitter feed.  The program’s sponsor CS2Day, with the California Academy of Family Physicians as the lead partner,  should be very proud of their visionary leadership as they explore unchartered territory in continuing medical education.


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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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Reflections on Learning in Second Life

Our working Second Life working space

Last week we conducted a pilot Second Life training with two “test” subjects for our forthcoming health behaviors study, to be conducted in the virtual world of Second Life.  I’ve blogged about this project in an earlier post.  In a nutshell, this is an NIH-funded health behaviors study with African-American women who have uncontrolled diabetes type 2. The project team has finalized the curriculum, set out a plan for subject recruitment and secured the IRB approval.  My part of the project is everything to do with the subject cohort who will experience the program in Second Life.  To that end, in anticipation of the program’s start in May, we have built out the Second Life space (shown above), trained all of the educators, designed Second Life activities, and designed an SL orientation for the subjects.  It was that orientation that we tested last week.

It is unlikely that any of this program’s subjects will have virtual world experience.  In fact, for the most part, our subjects will not have all that much computer experience.  So we will start with

Spiral Theas, my avatar

the basics.  Their orientation consists of two, two-hour in-person sessions. The first one is an orientation to the laptops and the wireless modem they will use for the program (Macbook laptops and Verizon USB modem devices).  At the conclusion of that first session, I take them into Second Life in what I’m thinking of as a passive, “first-look” view.  I projected my computer onto the room’s media screen, dimmed the lights, and encouraged them to just sit back and enjoy.  I logged into SL and introduced them to Spiral Theas, my avatar.  She waved.  They gasped.

Then I walked around the island, showed them how she could turn right and left, sit, dance, and even fly.  Another gasp.  Then I teleported her to Paris and cammed back to take in the full height and majesty of the Eiffel Tower.  Another gasp.  By this time our test subjects were laughing, joking, asking questions.  “When can we go in?”  “What will my avatar look like”, “Can you climb up in that Eiffel Tower?”  “Are those other people speaking French??!”

We left them there – with lots of questions and anticipation. The next two-hour session, held three days later, was going to be all about Second Life.  They came in, hooked up their laptops, and fired them up.  Without too much trouble, they all got in-world and met their avatars (that we’d prepared for them in advance).  They walked, ran, danced, and sat down.  We went over how to chat, how to speak (fiddled with headsets).  We opened the map (“oooh, it’s like looking down at the world from a plane!”).  We opened their inventory (“where are my clothes?”).  We teleported to another location.

It all went so much more smoothly than we thought it would.  They were excited, interested, and not at all intimidated by the interface or the complexity. There were some confounding gaps in their computer knowledge that tripped me up. Here’s one that took us by surprise:  When we were using local chat to send messages to each other, one of the subject’s messages appeared with no spaces between the words.  She asked me how did I get the spaces between the words and I explained that you just hit the space bar when you finished typing a word in order to advance one blank space and type the next word.  “Where’s the space bar?”.

Another had to do with physical orientation to the space.  I had thought that a projection of my laptop to the front of the room would help them – if they got lost as to what to do, they could look up on the big screen and I could demonstrate.  Instead, they kept referring to the big screen over their own, smaller screen and getting very confused about their “view”.  After a few minutes of this confusion, I disconnected my laptop.  They were then able to focus on their own screens and seemed relieved.  Less to manage.

The navigational task that they found the most challenging were (not surprisingly) controlling their camera view.  We made a program decision to not have a mouse with the computers and rely instead on the track pad.  We figured that since these subjects did not have much in the way of computer experience, learning to use a mouse would be just as much of a task as learning to use a track pad and then we’d have one less appliance to worry about.  The track pad is a bit tricky (one finger or two?  swipe or drag?) but the element that caught me by surprise was that one of the subjects had longish fingernails and it was much harder for her to use because of them.

By far and away, my favorite quote of the session from one of the subjects was, “Well, I can’t dance in real life, but I can dance in Second Life!”

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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.


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Creating Memory Palaces

Image from erinmizrahi.wordpress.com

I just read the most amazing article in the New York Times magazine – Secrets of a Mind Gamer, by Joshua Foer (thanks to my good friend, Louise).  If you haven’t read it – go there now and do it. You’ll thank me later.

If that name sounds familiar to you, Joshua is the younger brother of Jonathan Safran Foer (author of Everything is Illuminated and Extemely Loud and Incredibly Close). What a family.

Joshua Foer is a journalist who began an investigation of so-called “mental athletes” – people who efficiently and expertly memorize great volumes of information quickly – first and last names of dozens of strangers, long lists of random numbers, the precise order of a deck of cards. Apparently there are televised championship tournaments – check out the website for the USA Memory Championship, to be held next month in New York City. By now I’m sure you’re thinking what I was thinking when I started reading the article – who cares?  Who cares about the craft of memorizing long lists of random numbers or decks of playing cards?  Well, I can tell you that it all got a whole lot more interesting when I read Foer’s account of how these memory athletes accomplish their feats.

In true investigative journalist style, Foer decided to try the memorization methods himself and the NYTimes article is the story of his journey (which wound up with him winning the U.S. Championship!).  To put it in a nutshell (his article does a much better job), these memory athletes rely on a centuries old tradition from the ancient Greeks of creating “memory palaces”.  What they do is to construct a building in the imagination and fill it with imagery of what needs to be recalled.  The distinctive objects they place in these imagined rooms are like coat hooks for memories. As you walk through the imaginary edifice and see the distinctive objects (the more distinctive and wild, the better), you recall the material “stored” there. Very cool idea.

This approach to memory is recorded in a Latin book called Rhetorica ad Herennium, written sometime between 86 and 82 B.C.  You can find an outline of the book here and a complete translation of it here. The techniques described in this book were used extensively in the ancient and medieval worlds as a fundamental element of a classical education.  Our Greek and Roman ancestors trained themselves, not to memorize trivia, but to commit foundational texts, ideas, and stories to memory, to become walking indices of everything worthwhile they’d ever read or learned. And they did it by intensively reading (in order to remember) using these visual motifs.

Of course, I can’t help but make a connection between this idea of “memory palaces” and virtual worlds.  Is that, perhaps, one of the underlying reasons why these three-dimensional landscapes are so compelling for us?  Is that why I have such vivid, penetrating, and persistent memories of everything I’ve ever built in a virtual world?  Why I can conjure up clear-as-day mental pictures of the role-playing space I created or the building classroom that Chimera Cosmos and I built over our virtual home on Jokaydia? Relating ideas and concepts to spatial positions, walking around our mind’s eye with our avatars? Is that what we’re doing in there – creating virtual memory palaces?

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