Academic Staff's Perceptions of Second Life as an Educational Tool within the Faculty of Health and Social Care more

THE UNIVERSITY OF HULL Academic Staff’s Perceptions of Second Life as an Educational Tool Within the Faculty of Health and Social Care being a Dissertation submitted in partial fulfilment of the requirements for the Degree of Master of Education in eLearning in the University of Hull by Katherine Dagleish BA BSc PgDip August 2011 For Sally, my inspirational grandmother ii Table of Contents ACKNOWLEDGEMENTS GLOSSARY OF ABBREVIATIONS ABSTRACT 1 INTRODUCTION V VI VII 1 1 4 6 7 10 12 16 20 21 23 26 27 31 32 33 35 38 38 40 43 43 44 44 45 46 46 47 49 50 50 1.1 Context and Outline of Thesis 1.2 Research Questions 2 LITERATURE REVIEW 2.1 Opportunities for Nursing and Midwifery Training within Second Life 2.1.1 Learning Through Simulation 2.1.2 Making Mistakes and/or Failing Without Consequences 2.1.3 Disabled Learners 2.2 Challenges of Using Second Life in Nursing and Midwifery Training 2.2.1 Technical Skills 2.2.2 Technical Equipment 2.2.3 Dealing With The Unpredictable 2.2.4 Online Identity and Presence 2.2.5 Addiction 2.3 Implementation Issues for Second Life 2.3.1 Costs 2.3.2 Training and Support 3 METHODOLOGY 3.1 Semi-Structured Interviews 3.2 Limitations 4 RESULTS AND DISCUSSION 4.1 Perceptions of Second Life 4.1.1 Virtual Environment 4.1.2 Interaction 4.2 The Benefits of Using Second Life 4.2.1 Student Confidence 4.2.2 Low Risk 4.2.3 Appeal of Technology 4.2.4 New Teaching Tool 4.3 The Challenges of Using Second Life 4.3.1 Identity and Presence Issues iii 4.3.2 4.3.3 4.3.4 4.3.5 4.3.6 4.3.7 Confidentiality and Fitness to Practise Dealing with the Unpredictable IT Skills Access Addiction Costs 52 55 56 58 59 61 62 63 63 65 66 67 73 87 87 88 88 98 98 4.4 Potential Use of Second Life 4.4.1 Reluctance of Using the Environment 4.4.2 Theory and Clinical Practice 4.4.3 Group Work 4.4.4 Soft Skills 5 6 7 CONCLUSION REFERENCES APPENDIX A 7.1 Table 1 Literature Search and Exclusion Criteria 7.2 Table 2 Literature Search Inclusion and Exclusion Criterion 7.3 Table 3 Literature Summary 8 APPENDIX B 8.1 Figure B-1: Reminder about confidentiality posted to eBridge UoH iv ACKNOWLEDGEMENTS I am indebted to the lecturers within the FHSC who set aside their precious time to help with my research. I would like to thank my parents for their encouragement, patience and moral support I would like to thank all my colleagues and friends who provided me with the stimulation and inspiration during our informal conversations, and in particular Dr Mary Laurenson who helped me with my literature review. Most of all, my sincere thanks go to Shirley Bennett, my personal supervisor, without whose help and encouragement this dissertation would not exist. v GLOSSARY OF ABBREVIATIONS 3D CAP ECDL FHSC ICT IP ISP NHS NMC PC SL SP VLE VW Three Dimensional Continuous Assessment in Practice European Computer Driving Licence Faculty of Health and Social Care Information and Communication Technologies Internet Protocol Internet Service Provider National Health Service Nursing and Midwifery Council Personal Computer Second Life Simulated Patient Virtual Learning Environment Virtual World vi ABSTRACT In the context of the UoH, a Higher Education Institution in England, this study investigates academic staff‟s perceptions of Second Life (SL) as an educational tool within the Faculty of Health and Social Care (FHSC). By looking into lecturers‟ perceptions of SL the work explores the benefits and challenges to academic staff in using SL in professional nursing and midwifery training and assesses their potential engagement of this as a teaching resource. The main aim was to identify the knowledge base of staff and whether the application of the SL method could be imbedded into the curriculum to enhance teaching and learning. The results showed that academic staff sometimes confuse SL with other so called web 2.0 technologies. However, they do recognise that SL can be a useful resource to bridge the gap between theory and practice in pre-registration nursing and midwifery training. Other key issues such as online identity, being able to deal with the unpredictable during an in-world class, and information and communication technologies (ICT) skills may also have an impact on academics‟ perceptions and adoption of SL. This research brings to light the importance that student nurses and midwives initially need to be able to practise their clinical skills in a safe environment where they are not putting patients or themselves at risk and that although an immersive environment like SL could bridge this gap, implementing such a system is complex. vii 1 Introduction 1.1 Context and Outline of Thesis I currently work as an eLearning Development and Student Progression Administrator within the FHSC at the UoH, a higher education institution in England. One of my roles involves working with the eLearning coordinator and giving eLearning support and training to students and academic staff. After the UoH moved over to a new virtual learning environment (VLE) in 2009, the eLearning team started to study the development of other online activities and resources in order to improve its courses, attract more students and reduce student attrition. These activities included: Developing and implementing ePortfolios across a range of theoretical and practical modules. Developing and increasing the FHSC‟s use of online assessments. Developing interactive and digital resources. Establishing a team tasked with carrying out research on Enhancing Learning, Assessment and Scholarship through Interactive Communities, also known as the ELASTIC project (Gardiner, 2010). The ELASTIC team is currently evaluating eResources and other online tools that can be used to enhance academic practice and activities through the use of technology within the FHSC. These include all the main Web 2.0 tools such as social networking sites, blogs, Skype and online collaborative tools like GoogleDocs (Baulcomb, 2010). However, they are not taking into account three dimensional (3D) immersive virtual worlds (VWs) like SL. The premise underlying this present study is that nursing students often express concerns regarding not being able to spend enough time in clinical skills workshops and the risks of making a mistake when dealing with real 1 patients1. Pre-registration nursing and midwifery students receive a combination of theoretical and clinical training during their course. Theoretical hours are spent on campus and the clinical practice is carried out within medical centres and hospitals under the supervision of a mentor. They often state that they feel vulnerable when they attend a placement and report feeling that they have not received all the adequate training in clinical skills and from their theory sessions. Other concerns include the fact that the allocated clinical practice areas do not always match the topic of the modules being studied alongside these placements. For instance not all students studying the critical care module can be placed on a ward like the Intensive Care Unit or the Acute Assessment Ward. Some students therefore feel that not being on a relevant placement could lead to not all their learning outcomes being met and therefore failing the module. Although students would never fail on such a basis, the feedback from module and programme evaluations highlights how concerned some students are about their clinical practice. When asked how clinical placements could be improved, students often claim that not having covered all the theory prior to going on practice makes them feel „vulnerable‟ and that they often do not have the minimum training required. Some students suggested that this could potentially put both the patients and students at risk. This issue is often brought up by students who are placed on a ward that is low staffed and where the student may be viewed as a member of staff rather than a learner. This can also lead to the student feeling that they do not receive adequate support from their placement mentor and being „thrown in at the deep end‟. With this issue in mind, an 1 Based on the feedback provided by students in module and programme evaluations (which I collate) 2 increasing number of researchers have recently promoted the educational potential of VWs (Dickey, 2005; Kemp and Livingstone, 2006; Meadows, 2008; Wetsch, 2008; Aldrich, 2009; Hewitt et al., 2009; Martin Mahar and Mahar, 2009; Salmon and Hawkridge, 2009; Schiller, 2009; Campbell, 2009; Dalgarno and Lee, 2010; Savin-Baden, 2010b), with SL being the most popular and highly recommended VW for learning and teaching (Chodos et al., 2009; Herold, 2009) thanks to its 3D immersive images (Lu, 2008) and its potential for learning, collaborating and networking (Skiba, 2007; Thompson and Garetty, 2009). Some Universities have attempted to alleviate this problem by holding some of their clinical skills sessions within SL (Savin-Baden, 2010b). Glasgow Caledonian University is currently using SL in order to deal with its students‟ clinical placement problems. Jacqueline McCallum, senior lecturer in clinical simulation, stated that the University was using SL to help its students with their decision-making (Leach, 2008; McCallum et al., 2009). The University of Kansas‟ Medical Center is also using SL to train its student nurses. Their first-year nursing students are using SL to practise prepping their patients for anaesthetic surgery. David Antonacci, director of teaching and learning technology at the University of Kansas, stated that The application of Second Life in the classroom (…) will allow students to execute complicated procedures in a simple, computer-simulated environment. There‟s no physical interaction; they just have to know the executive routine: what needs to be done and when. (Greenhaw, 2008:1) This view purports that by using an immersive VW, student nurses and midwives could practise scenarios in a safe environment without putting themselves or their patients at risk, which is the main rational for this study. This led to my decision to explore this issue within my dissertation: I wanted to investigate academic staff‟s views on using SL as a training resource for student nurses and midwives. 3 Ertmer et al. (1999) claim that educators hold the key to successful integrations of new educational technologies. However, not many studies have explored academic staff‟s views on such a teaching resource. Hopefully, a critical analysis of lecturers‟ views on the use of SL will help with the implementation of such a resource should the FHSC or the UoH decide to adopt such an immersive training environment for its students. 1.2 Research Questions Currently, the FHSC is using three eLearning environments: eBridge, Authentic World and K2 Medical Systems (K2MS). eBridge is the VLE used by all staff and students within the FHSC to support various programmes and modules. Authentic World is an eResource that helps students develop their Medication Dosage Calculation Skills (Authentic World, 2011). However, K2MS is a mediated environment that is specifically tailored for midwifery training. It allows staff and students to simulate various scenarios that could occur in clinical practice, attempt a diagnosis and write a care plan for a virtual patient. It is mainly used by final year midwifery students as a learning resource for their Complicated Childbirth module. The purpose of this case study was to investigate academic staff‟s perceptions of SL within the FHSC. In order to carry out the research, I decided to focus on four points as part of the investigation. These points were based on my hypothesis that not all academics were necessarily aware of SL, and those who knew about the VW did not necessarily have a positive opinion about it. Hence the work will identify the knowledge base of SL and its application in practice. 4 The research questions for this study were therefore as follows: 1) How would academic staff describe SL to a colleague who was not aware of the environment? 2) What potential benefits could they see in using SL to train student nurses and midwives? 3) What potential challenges did they feel such an environment could present? 4) If they had the opportunity, how would they use SL as a teaching resource? As the Literature Review will illustrate, these categories were also selected in accordance with the relevant research, which highlights the following issues: Academics‟ perceptions of SL: How do academics view SL? Do they perceive it as an educational tool or simply a gaming environment that is irrelevant to teaching? What are their views on identity and presence within SL? Benefits and challenges of SL: Do academics see SL as an innovative tool or a challenge? Do they foresee SL as being able to bridge any current gaps in nursing and midwifery training? What do they view as potential challenges when using a 3D immersive environment for teaching? Potential use of SL: Would academics consider integrating SL into their classes? If so, which topics would they cover within SL and how? 5 2 Literature Review In this chapter I relate the assumptions I had made, prior to carrying out the research, regarding the possible opportunities and challenges affecting the FHSC‟s use of SL. These pre-research assumptions are reviewed based on the relevant literature, and the topics to be researched within my core group of respondents are determined. Hart (1998) asserts that reviewing literature is necessary to acquire an understanding of topic areas to assess knowledge that is already in the public domain, the research undertaken and the main issues, so that gaps can be identified. To find relevant literature on perceptions and the use of SL in nursing and midwifery training the following databases were searched: Google, GoogleScholar, JISC Infonet, ProQuest and Educause. Various combinations of the following key words were used to search these databases: Second Life, virtual world, education, university, nursing and midwifery. A contents analysis of relevant books was also carried out through a book retailer‟s website, and any papers recommended by colleagues were also reviewed for their relevance. The inclusion and exclusion criteria included a date criterion from June 2000 to May 2011 in order to find the most relevant up to date information. Data were reviewed from English speaking countries written in the English language so that the terminologies used were familiar. The exclusion criteria included: the use of SL in secondary or further education; using SL in a higher education sector for purposes not related to education. The search process produced over five hundred hits and the Boolean approach of and/or to the key words to link concepts was used, which helped reduce the articles to one hundred and seventy. The abstracts of these articles were read for their relevance to the topic area under study. Papers selected related specifically to primary and 6 secondary researches relating to the use of SL in medical training. As a result, 139 papers were selected as these were most relevant to the use of SL in nursing and midwifery training (Appendix A). These articles were then fully read through, undertaking a content analysis as Graneheim & Lundman (2004) describe two methods of discerning content as latent and manifest and assert that both deal with interpretation and analysis of the texts, which helped to discover the emerging themes from the literature chosen. Content analysis was therefore used to examine the data and then applied as a critiquing tool to the emerging themes for synthesis of the data to my research question. The emerging themes were: 2.1 Opportunities for Nursing and Midwifery Training within Second Life 2.2 Challenges of Using Second Life in Nursing and Midwifery Training 2.3 Implementation Issues for Second Life These emerging themes were used to structure this literature review and to feed into this research. 2.1 Opportunities for Nursing and Midwifery Training within Second Life The first part of this chapter aims to review the literature about the opportunities that SL may offer nursing and midwifery training institutions. The FHSC already uses various VLEs to train its student nurses and midwives. However, VLEs do not offer the 3D visualisations and sensory experiences that are available in VWs like SL (Calongne, 2008). Calongne explains Some people learn best by listening to the course content, others by seeing and visualizing the content in context, and the rest by using a hands-on approach. In virtual worlds, we can leverage a mix of content and activity to support all learners: auditory, visual, and kinesthetic. (2008:8) 7 This study is based on the premise that to train nursing and midwifery students to a high standard, it is essential to include unusual illnesses and scenarios that could occur in a medical environment in the curriculum. Lecturers within the FHSC are aware that certain skills and scenarios are difficult to incorporate into students‟ training and can only be simulated. SL‟s immersive environment could therefore offer nursing and midwifery students the opportunity to practise unusual scenarios as well as certain skills they may not feel confident to undertake in real life. Indeed, Thompson (2008) claims that students learn best when they are immersed in the subject they are studying. As well as understanding lecturers‟ perceptions of SL, some writers state the importance of recognising the difficulties of implementing such a new teaching resource. Calongne (2008) claims that when implementing SL in education, a change in pedagogy is also necessary. Because no assessment of the FHSC‟s lecturers‟ views on SL has been carried out before, the impact resulting from the implementation of such a change may not be successful should it not take the findings of this research into account. It is hoped that following the findings from this study, FHSC technology implementers and lecturers will be better equipped to evaluate what pedagogical changes, if any, need to be promoted for a successful SL initiative. The study of academics‟ views on SL should also inform technology implementers on the reasons why attitudes and practice are quite often incongruent (Chou, 2003). Leh (1995) provides an example of such a contrast, claiming that despite several teachers showing a positive attitude towards the inclusion of ICT in the classroom, their actual use of technology was negligible. This incongruence may have also been present 8 amongst lecturers within the FHSC, since they consider themselves to be at the forefront of teaching practices, constantly integrating any necessary changes into nursing and midwifery training2. By studying their perceptions of SL and comparing them with their current practices (non-use of VWs like SL), the researcher intended to explore whether this incongruence existed and if it did, to determine what factors were causing it. Errington (2001) claims that examining educators‟ beliefs can allow the researcher to diagnose any misperception they may have about the pedagogical value of educational technologies. Thackray et al. (2010) add that not knowing what SL can offer education is a disincentive for lecturers, and providing a demonstration of what can be accomplished within SL could lower academics‟ resistance to such a change. Prior to this study, it was the researcher‟s belief that lecturers‟ lack of understanding of SL had an effect on whether they would perceive it as an educational resource or not. Indeed, it seemed likely that FHSC lecturers were in fact unaware of their perceptions of SL, which could result in a potential incongruence between attitudes and practice. As stated by Kennedy and Kennedy (1996), for lecturers to question and ultimately change their beliefs, they need to be aware of them first. The present study‟s aim was therefore to investigate to what extent academic staff within the FHSC viewed SL as a teaching resource, and whether they could see its ultimate quality: being able to simulate an unusual or dangerous medical scenario without worrying about the consequences. 2 Changes are usually recommended by the Nursing and Midwifery Council (NMC) 9 Several factors are said to have an impact on lecturers‟ perceptions of SL. As stated in the Introduction, lecturers‟ approaches to teaching and learning were adopted to research their views on SL as an educational resource. Below follows a list of these perceptions and a review of the relevant literature about them. 2.1.1 2.1.2 2.1.3 2.1.1 Learning Through Simulation Making Mistakes and/or Failing Without Consequences Disabled Learners Learning Through Simulation One issue emerging from the literature that could be pertinent to this research is the use of simulations to train medical practitioners. Lecturers within the FHSC currently take an experiential teaching approach (Nicklin and Kenworthy, 2000) by employing simulations in order to train pre-registration nursing and midwifery students, therefore resulting in learner-centred practices. These include the dummies within the clinical skills building, online simulations of fetal monitoring systems, as well as Simulated Patients3 (SPs) who will act as patients, thus allowing students to practise their communication and patient handling skills. The potential of a 3D immersive environment like SL, which could be used to simulate scenarios that occur in a clinical environment, would thus appear to align with the preferred pedagogical approach of departmental staff. Indeed, Belei et al. (2009) claim that simulation can provide students with real life experiences thanks to its ability to mimic reality. Similarly, some researchers state that compared to other distance and online learning courses, SL provides students with a much richer experience that engages more of their senses, resulting in students being more motivated and inspired (Yair et al., 3 Actors 10 2001; Van Weigel, 2002; Gibson et al., 2007; Joly, 2007; Love et al., 2009; Salmon and Hawkridge, 2009). Savin-Baden (2010b) explains that more immersion equates to more emotional engagement, which leads to better learning. Furthermore, the availability of built in feedback has been shown to accelerate the learning process and lead to a higher retention of skills and knowledge (Murphy et al., 2008). There have also been reports that suggest that using game-based training systems produces a knowledge transfer that is four times greater, and a knowledge retention that is ten times greater than traditional learning methods (Business Wire, 2008). Belei et al. conclude that simulations are “a promising and effective means to bridge the gap between theory and practice” (2009:118). However, some writers have found that facilitators can confuse VWs like SL with games: they assume that because environments like SL look like games and feel like games, these systems must also be games. Because they view them as games (Skiba, 2007), some facilitators refuse to use immersive environments as teaching resources (Savin-Baden, 2010b). Some authors point out that these types of environments have been used for years to train professionals (Murray et al., 2007; Wood 2010b). Wood explains that “pilots spend many hours enhancing their skills in flight simulators and the medical profession uses simulators to practice [sic] critical clinical skills (e.g. surgical and neurological)” (2010b:205). SL could therefore allow students to carry out experimentations that may not be feasible in the „real world‟, such as dealing with child protection or mental health issues, resulting in the use of learner-centred and experiential practices. Indeed, Skiba claims that: SL is all about experiential learning, being immersed in a virtual environment. It adds another dimension to simulations and allows for role-playing, collaboration, real time interactions between students and faculty, and experimentation. (2009:129) 11 Although various writers have stated that simulations should complement current teaching methods used in nursing and midwifery training (Dalgarno et al., 2010; Ellaway and Topps, 2010; Miller et al., 2009; Murray et al., 2007; Savin-Baden, 2010b; Aldrich, 2009; The University of Southampton, 2004), Maguire (2005) argues that some academic staff could be concerned about the possibility of simulations like SL eventually replacing real life practice and may therefore view this as a threat to their job. However, Murray et al. (2007) argue that there are several other simulation tools available for nursing and midwifery training, and that these are not restricted to computer based simulations. These include the use of SPs, manikins and full body scale simulators. Similarly, McConville and Lane (2006) claim that the use of online video clips illustrating nurses dealing with difficult situations offered students effective support as they could review the clips as many times as they wished outside of the classroom setting. Based on the literature just presented, it was therefore important to investigate whether academic staff within the FHSC viewed SL as a feasible learning environment and whether they would implement its use into their teaching. 2.1.2 Making Mistakes and/or Failing Without Consequences Another theme that emerged from the literature was the fact that environments like SL allow students to learn from their mistakes without suffering real life consequences. While students are on their clinical placements, they are allocated a mentor who will support them with their learning. Mentors often use the social constructivist teaching approach (Holly et al., 2008), which allows students to practise their clinical skills on their wards. Constructivism is congruent with how 12 adults learn and allows them to self-regulate their learning, development and reflective thinking skills, which nursing and midwifery students need to develop in order to make decisions in a clinical context (Kuiper and Pesut, 2004, cited in Holly et al., 2008; Peters, 2000, cited in Holly et al., 2008). Skiba claims that SL is a useful teaching resource for social constructive educators: It is an immersive environment where users interact and construct knowledge. (...) If you use constructivist learning theory, then SL is a good fit for you. (2009:156) However, as mentioned in Chapter 1, based on the module and programme evaluations that are completed by the FHSC‟s students, one of their main concerns is that they often feel that they have not been given enough clinical training prior to them going to their placements, an issue also acknowledge by Murray et al. (2007). These concerns can sometimes lead to a fear of making a mistake that could result in serious consequences for a patient, which in turn can lead to mentors and students „playing it safe‟. Savin-Baden claims that Simulations are very effective for trial and error – where skills can be gained through practice, but one of the difficulties is that for the skill to be effective it needs to have been practised across contexts. (2010b:56) Supporting this view, researchers (Heiphetz and Woodill 2010; Miller et al., 2009; Savin-Baden, 2010b; Geteducated.com, 2010) argue that SL offers learners the opportunity to make mistakes without them having to worry about any potential real-world repercussions. Thackray et al. state that SL can also offer students opportunities that are not always achievable in real life: The partner institutions (…) were approached and asked to identify areas of their teaching which sic were difficult, dangerous or impossible to teach adequately in a classroom setting. This resulted in eight projects with foci as adverse as mental health assessment, child protection issues and numeracy for nurses. (2010:141) 13 Dev et al. (2007) added that testing trauma nurses‟ decision-making processes cannot be simulated effectively in real life unless they carry out role-play scenarios. Similarly, Galik (2008) states that students can experience a situation in SL, discuss how to respond and see the repercussions of their decision without risking real life consequences. Bignell goes further, suggesting that The unique virtual world of Second Life could provide an environment where interventions and experiments that may be considered unethical or impossible in real life can be easily conducted whilst assuring the safety of the participants. (Bignell, 2008; quoted in Ball and Pearce, 2009:51) Savin-Baden (2010b) adds that paramedical students valued the behaviourist teaching approach within SL because it allowed them to practise scenarios for their examinations. Aldrich concludes that One should always use educational simulations (and not serious games) when the successful application of the content is critical – as it is with pilots, nuclear power operators, and Wall Street traders. Where failure is not an option, and if the situation can be simulated, instructors will probably already be using simulators. (2009:53) Lecturers within the FHSC may therefore view SL as a useful teaching resource because it allows students to practise skills that may be dangerous or difficult to teach in a real life setting. Some Universities are already using SL to address some of the clinical training gaps experienced by their nursing and/or medical students. It would therefore be valuable to consider some examples of medical training that are currently taking place within SL. For instance, the University of Plymouth temporarily ran a Virtual Neurological Education Centre (The University of Plymouth, 2008; Boulos and Toth-Cohen, 2009) to train medical practitioners and students to recognise the most common symptoms that a person suffering from a neurological disability may encounter. Users were able to select from a range of neurological symptoms (e.g. sensory, motor or balance) that would animate their 14 avatar, resulting in them experiencing certain restrictions such as the ability to move, their independence or coordination. This project was set up in order to make people more aware of neurological disabilities as well as allow those suffering from a disability a place to find out more information and obtain help and support (Boulos et al., 2007). A Virtual Hallucinations tour also offers visitors some insight into what life would be like for those suffering from auditory hallucinations (Second Life, 2011a). Although this will never provide visitors with an experience equal to the „real thing‟, it will certainly offer them valuable insight into the condition. Yellowlees and Burrage claimed that “using traditional educational methods, instructors have difficulty teaching about the internal phenomena of mental illness, such as hallucinations” (2004:11). Yellowlees and his team replicated the experiences of patients suffering from schizophrenia in a VW in order to provide medical students with a better understanding of the mental illness (Yellowlees and Burrage, 2004). Figure 4.1 - The Stomach Museum within SL 15 Other sites in SL allow medical students to study nutrition (University of Ohio, 2007), heart murmurs (Kemp, 2006), DNA (Clark, 2007; Clark, 2009), visit the Virtual Stomach Museum (Second Life, 2011b), or practise helping a patient suffering from a heart attack etc., which are scenarios that students may not be able to practise while they are on their clinical placements. The interactivity and 3D aspects of the stomach illustrated by figure 4.1 could help students who are studying human anatomy and physiology, as it engages their interest in the topic, and could potentially increase their understanding as well as the overall pass rate for such a difficult module within the FHSC4. Considering the literature just presented, it was reasonable to suppose that lecturers within the FHSC could view SL as a resource that could help students increase their confidence by practising simulations of risky procedures, as well as help them practise certain communication skills like breaking bad news to patients and their relatives. 2.1.3 Disabled Learners Because some of the FHSC‟s students have a disability, a further issue arising from the literature that could therefore be relevant to this research is SL‟s accessibility for disabled students. Ball and Pearce (2009) claim that SL offers its members the opportunity to contribute on an equal basis as well as have experiences that would not be possible in real life. Many authors have noted how older or physically disabled users could use SL for entertainment and it could help them combat loneliness and social isolation (Salomon, 2011; Galik, 2008; Joinson, 2003; Norris, 2009; Virtual Ability, 2011; Wood, 2010b; Books LLC, 2010; Boulos et al., 2007). This was 4 Up to 25% of students fail their first attempt for the Human Anatomy and Physiology module 16 backed up by the work carried out by Simon Stevens who suffers from cerebral palsy and now runs the „Wheelies‟ Island within SL. Various authors have cited Simon Stevens as one of the most prominent advocates for disabled residents within SL (RNIB Supporting Blind and Partially Sighted People, 2007; Bray, 2007; Scientist, 2009; Hickey-Moody and Wood, 2010; Salomon, 2011). Simon Stevens explains how “Wheelies has provided thousands of disabled and non-disabled people around the world with a safe, fun and supportive environment” (slentre.com, 2009:1). A Wheelies fan explained how one of the main advantages of the Island was the fact that “it‟s OK to be disabled or not-disabled. You can feel at ease with someone different while having fun together” (slentre.com, 2009:1-2). SL can also help some disabled students who may not be able to attend a class that is held on the university‟s campus (Molka-Danielsen, 2009; Martin Mahar and Mahar, 2009), although this advantage could also be applicable to other online teaching environments (Salmon, 2003). But some members of staff may view the accessibility of SL for disabled students as a barrier to their learning. 3D VWs could cause navigation or accessibility problems for older people or individuals with physical disabilities as they currently require good dexterity. However, the tools used to interact with VWs like SL can be altered/redesigned for such users (e.g. larger screens, voice navigation, eye-tracking control or special joysticks) (Boulos et al., 2007; Novint, 2011). People who suffer from paralysis can socialise and work within SL thanks to a new interface that was developed to allow users to manipulate their avatar (Sharp, 2008). Hansen et al. also cite the brain-computer interface designed by the Biomedical Engineering Laboratory at Keio University in Japan, as illustrated by figure 4.2, which enables users to control the movements of their avatar within SL 17 through a headset that contains electrodes. They explain how “the electrodes monitor electrical activity in the motor cortex, the region of the brain involved in planning, executing and controlling movements.” (2008:43). This interface could therefore help people with severe mobility problems. Figure 4.2 Mind control of an avatar in SL (Science Blogs, 2007) Conversely, accessing SL could be a big challenge for members with visual impairments because it is a 3D visual environment. However, a number of sound doplar or sound proximity schemes have been developed in recent years in order to assist these individuals (Jaime, 2007; Jaime and Mauricio, 2005; Milena et al., 2007; Hansen et al., 2008; VirtualWorldsNews, 2007; Salomon, 2011). Dr Denise Wood of the University of South Australia is also working on a project designing an interface that will assist members with visual impairments (Scientist, 2009; Salomon, 2011; Wood, 2010a). Its features include a virtual guide dog „Max‟, illustrated by figure 4.3, alternatives to a mouse driven interface, and audio notifications that assist the visually impaired residents to move around SL. Moreover, Linden Labs have implemented their own voice system within SL. They explain how 18 This technology uses spatial awareness, taking distance, direction, and rotation into account, for a more realistic experience. Basically, you‟ll be able to tell who is talking in a group since the voice will sound like it‟s coming from that direction. We‟re also working hard on an initial set of avatar animations, which change and trigger according to the intensity of speech. (Linden, 2007:1) Figure 4.3 – An illustration of „Max‟ the guide dog who will lead his user to an avatar or a place when they have typed in the name of the individual or location (Essid, 2009) However, since Linden Labs have implemented speech within SL, some disabled residents, especially those with a speech impediment, voiced concerns claiming that they would feel disadvantaged (Morse et al., 2009). But in spite of this, many researchers have cited how SL is a good leveller (Ball and Pearce, 2009; Jaime, 2007; Jaime and Mauricio 2005; Boulos et al., 2007; Salomon, 2011). Abrahams states that Second Life is a place where everyone is as able as each other. This may well be one of its major shortfalls as it removes some of the diversity of Real Life that makes it such an interesting place. On the other hand, it does give people the opportunity to experience, even somewhat vicariously, being one of a bigger crowd. (2006:1) 19 Bearing in mind that some students within the FHSC have a disability, it was therefore logical to find out whether lecturers would view SL as a helpful learning environment for these individuals. 2.2 Challenges of Using Second Life in Nursing and Midwifery Training The second part of this chapter aims to review the literature about the challenges of using SL as a training resource. Although the FHSC uses various eLearning resources as part of its blended learning approach, it has not adopted the use of a 3D immersive environment such as SL. It is therefore highly likely that both staff and students would need training in how to use such an environment. However, simply providing staff and students with access to the technology is not enough. Jones (2001) claims that it is not the mere presence of technology in the classroom that determines its educational effectiveness, but academics‟ readiness to use the resource as part of their teaching. Baylor and Ritchie agree, claiming that Regardless of the amount of technology or its sophistication, technology will not be used unless Faculty members have the skills, knowledge and attitudes necessary to infuse it into the curriculum. (2002:4) Some lecturers may also need to adapt their teaching methods in order to use SL‟s immersive environment (Carter, 2009; Lu, 2011), thus increasing their use of Dewey, Piaget and Vygotsky‟s learner centred approach (Huang, 2002). Savin-Baden (2010a) concurs, claiming that lecturers may be concerned about the possibility of SL resulting in a role change for academic staff. Considering the current literature, some of the many challenges that relate to the educational uses of SL have been selected to cover this section. These issues are as follows: 2.2.1 Technical Skills 20 2.2.2 2.2.3 2.2.4 2.2.5 2.2.1 Technical Equipment Dealing with the Unpredictable Online Identity and Presence Addiction Technical Skills Another topic that emerged from the literature, which could be pertinent to this research was the technical skills members required in order to take part in a session within SL. Because academic staff within the FHSC write the majority of their work on a personal computer (PC), such as teaching plans, student feedback, communication with their students via email and through the VLE, one can assume that the majority of these lecturers are computer literate. However, this does not mean that they are experts with regards to online teaching resources. Anderson (2009) claims that instructors who use SL are familiar with the environment and provide students with detailed direction on how to navigate around the VW. But on the other hand, Anderson also states that “some students may equate an instructor‟s use of Second life as a function of laziness or inability to effectively teach a face-to-face class” (2009:110). Due to a high proportion of nursing and midwifery students being mature students, it seemed very likely that the technical skills of students would be an issue for lecturers. The older students may not all be at ease with some of the resources they are required to use as part of their course, like word processing or presentation software. Having to also learn how to use environments like SL could make accessing higher education an even steeper learning curve for mature students (Lamont, 2006; Anderson, 2009). Younger students who will have recently left college would probably find it a lot 21 easier to use SL (o‟Toole, 2006), or may already be members of SL themselves. Supporting this view, Wood states that It is fair to say that the legitimacy of this technology is more likely to be questioned by non traditional students – those that are perhaps part of an earlier generation. For these students the idea of virtual world learning will be viewed as “unusual” and they may be apprehensive about using it. (2010b:205) Hewitt et al. (2009) added that graduate students had limited VW exposure and experience. This issue therefore places added demands on the Faculty and technology support professionals who have to prepare students for the new learning environment because “the typical student‟s inexperience with virtual worlds requires just-in-time technical support that is not usually available from help desk staff” (Hewitt et al., 2009:4). Similarly, Carr et al. suggested that some students found taking part in discussions within SL difficult, and concluded that “participating in discussions in SL with confidence is an acquired skill” (Carr et al., 2010:26). Rufer-Bach (2009) concurs, claiming that discussions can sometimes lag within SL due to the range of participants‟ typing abilities. Aldrich explains how There is a tacit but predictable „threshold to quit‟ for different end-learners; if the experience dips below the threshold, the learner will opt out of the course with a negative bias. (2009:41) However, not all students will necessarily opt out due to a lack of technical skills. Studies suggest that students may view the time constraints and technical restrictions as an issue, but this does not necessarily stop them from completing their in-world projects within SL (Belei et al., 2009; Hewitt et al., 2009). In the Belei et al. study, one student stated that The technical aspect was one limitation in executing our strategy. There were some things we wanted to do in our strategy, yet were unable to because we did not have the technical know-how. (2009:131) 22 Belei et al. (2009) conclude that when integrating SL into the curriculum, it is important to avoid the interference of technical limitations because students can be very critical about „external constraints‟ and are rarely able to differentiate between technical issues and project related factors. 2.2.2 Technical Equipment Various authors noted that because SL constantly streams in visual content surroundings as the user moves around and interacts with the environment, it is an application that can be very bandwidth hungry (Atkins and Caukill, 2009; Sant, 2009). Nursing and midwifery students within the FHSC are expected to use a word processor for their assignments and regularly access eBridge as part of their course. However, this does not necessarily mean that they have these resources at home, especially a powerful PC, a decent graphics card and a fast broadband service. Some students may live in a remote area, where their Internet Service Provider (ISP) may not offer broadband (cable.co.uk, 2011), which could result in them not being able to access SL from home as it does not work with dial-up connections (Atkins and Caukill, 2009). Boulos (2008) illustrates the importance of a decent graphics card for SL users (see figure 4.4). A low-end graphics card could result in the user experiencing poor ripple water and sunlight reflections, a staircase affect of the image, but also problems with the in-world smoothness and speed of movements. Sherblom et al. (2009) concur, claiming that although students find SL a versatile learning environment, they sometimes experience challenges in gaining access, coping with distractions within SL, and managing computer lags and its detrimental effects on the continuity of their group discussions. Sant also claims that 23 As with any other synchronous communication over the Internet, lag or signal delay is a serious problem that can get in the way of planned events and hinder the execution of live online performance. (2009:146) Schwarzwalder (2008) concluded that it was important not to overload a site with content because this could lead to the system freezing, thus resulting in the facilitator losing valuable time as well as their students. Figure 4.4 – “A Tale of Two Graphics Cards in Second Life” (Boulos, 2008) With recent developments within SL, Boulos (2010) illustrated what he defined as “the Windlight version of Second Life” (see figure 4.5). This version of SL requires a very powerful graphics card in order to process the high quality graphics, which requires users to select the “Atmospheric Shaders” and “Water Reflections” settings 24 within their preferences. Similarly, Jæger and Helgheim state that environments like SL can require network support beyond what is usual in typical Internet connections not only due to the substantial bandwidth requirements, but also because of the lack of quality-of-service guarantees in the contemporary Internet. (2009:121) Hewitt et al. concur, claiming that “many of the students interviewed use older computers that do not have the graphics cards required to support Second Life.” (2009:4). Figure 4.5 – “The Windlight version of Second Life” (Boulos, 2010) Another issue is the fact that some Universities‟ highly secured firewalls do not always allow participants to access SL on campus. Time may therefore have to be invested in setting up on campus computers in order to allow them to bypass an institution‟s firewalls (Broadribb et al., 2009). However, research has shown that in spite of these technical issues, students enjoy learning through 3D immersive 25 environments like SL (Dillenbourg et al., 2002; Strangman and Hall, 2003; Nonis, 2005). 2.2.3 Dealing With The Unpredictable Being able to deal with the unpredictable in order to manage the class is important to academic staff (Oliver and Reschly, 2007). Lecturers within the FHSC will want to control what students do during their lesson and may be concerned about using a new public environment like SL. They may think that certain situations could occur within SL, which would not happen in a face-to-face environment, or within a restricted virtual environment like eBridge. Concerns about managing student and patient confidentiality could also be raised (Carlowe, 2009; Dudeney and Ramsay, 2009; Rose, 2009; NMC, 2011). Like the Internet, SL is classed as a public world and is therefore open to the general public (Wood, 2010b). Because of this, some lecturers have voiced concerns about the lack of security and privacy within these environments (Johnson, 2008). Indeed, according to some studies, facilitators are becoming concerned about being able to control their lessons within SL as members of the public interrupt ongoing classes (McKeown, 2009; Stott, 2007; Sant, 2005; Sant, 2009). Broadribb et al. explain how Tutors were beginning to use public spaces for formal tutorial and teaching sessions with their students and sometimes found themselves with an inquisitive audience: bystanders who were on the island to socialize rather than study. (2009:206) Some members of the academic community have also voiced their concerns about higher education institutions‟ legal and ethical responsibilities towards their students when using VWs as teaching resources (Bugeja, 2007). However, there are various solutions available to resolve these privacy issues. Usernames and passwords can be allocated to staff and students if an institution owns 26 an entire Island within SL, therefore restricting access to members of the public (Savin-Baden, 2010b). But Wood (2010b) provides a more detailed solution to this problem. His suggestions include screening VWs for student use, providing training sessions so that students and facilitators can deal with any potential privacy issues, restricting access to the environment to registered users only, and presenting students with a disclaimer when they access the VW. Linden Labs have also launched a new product, SL Enterprise, which could solve privacy problems. SL Enterprise allows institutions to run SL behind their own firewall, therefore denying access to any individuals who are not part of their organisation (Wood, 2010b). 2.2.4 Online Identity and Presence Another key issue emerging from the literature was how students would manage their online identities within VWs. Dealing with online identity and the safety of students within SL may be an issue to lecturers within the FHSC. Some authors found that some facilitators were concerned about how online identity and the anonymity associated with it can change the way in which an individual behaves. This view is supported by Turkle (1996) who states that online identity is a problematic issue, claiming that the computer culture has lead to some viewing identity as a multiplicity. Waggoner (2009) adds that members of VWs handle their identity in different ways depending on whether they are classed as a “hardcore gamer”, a “casual gamer” or a “non-gamer”. But this theory of multiple identities does not appear to be new. Burke and Stets‟ (2009) identity theory claims that people derive different identities from their different roles in society, mainly their home and work identities (Markus and Nurius, 1986; Deaux, 1996; Gergen, 1991). Moreover, Savin-Baden (2010a) reported that some facilitators had questioned the extent to which SL identities had 27 spilled over into individuals‟ home or work identities, and as a result prompted reformulations of other identities in other worlds. Savin-Baden explains that The difficulties of understanding the shifts and changes of identity in the context of teaching in Second Life and the impact that these are having on staff roles have not yet been explored in-depth. (2010b:74) Another aspect of online identity that lecturers queried during an „Away Day‟ within the FHSC was whether the individual online is who they claim to be. Student identity can be manageable when using a private environment like the UoH‟s VLE eBridge, however this can be more problematic when using a public world like SL (Wood, 2010b). Richardson and Molka-Danielsen (2009) add that currently, there is no widely-available or acceptable way of establishing an individual‟s identity online. Collins concurs, claiming that “many technical hurdles remain, including how to address security and authentication issues” (2008:6). This issue can make the facilitator‟s task of identifying students within a public environment like SL a challenge. However, these identity problems can be overcome. Students can be required to submit some personal information while they are in-world in order to confirm who they are, or the students could have some personal contact with the facilitator prior to the in-world session. Another option would be to ask for one or two „secret digits‟ of the student‟s enrolment number, which they will be given when they first register with the University (Richardson and Molka-Danielsen, 2009). This would allow the instructor to check an avatar‟s real life identity before starting an in-world session or assessment. But Richardson and Molka-Danielsen (2009) also claim that the validity of an in-world assessment may be questionable due to the possibilities of identity fraud. They back this up by suggesting 28 Imagine (…) that I am a Russian with a brother who is a mathematical genius with time on his hands. If we wanted a qualification in mathematics from a Swedish university, it would not be too difficult to send him to Sweden in my place with a piece of my ID (…). You could argue that it is difficult to imagine who would go to such lengths, just for a qualification from Sweden. But the same argument applies to net-based courses. (2009:51) However, Richardson and Molka-Danielsen (2009) also claim that some of the obstacles to success associated with SL-based courses (e.g. technical skills) could make it less likely that fraudsters would choose such a course due to the possibilities of discovery being much higher. The importance of how students deal with their online identity has been discussed by several writers. There have been claims that the anonymity associated with eLearning has lead to some students „flourishing‟, especially those who tend to be quiet in a traditional teaching environment (Salmon, 2003). But according to informal observations, some educators within the FHSC have also claimed that some students are „lurkers‟ and do not participate in online sessions. They believe that in some cases, this is due to them not wanting to repeat what another student has just stated, or not being willing to participate, which can also occur in a face-to-face educational setting. However, lecturers have also suggested that some students may have bigger issues with online identity. Some academics believe that some students do not participate in online sessions due to a fear of posting something wrong, and that this mistake will be seen by everyone who has access to the environment. They claim that making a mistake in a face-to-face conversation is a lot different to making a mistake online because once something has been posted online, it will be there forever. But Love et al. (2009) claim that this issue can be resolved as a result of the instant messaging option within SL, which allows instructors to have private conversations with their students, allowing the conversation to remain confidential. 29 In contrast with these views, some researchers view identity as a positive aspect of SL. Calongne claims that students are rarely anonymous, in spite of them having an alias within VWs. She explains that “one reason is that students want information, education, feedback, and grades from their instructor, and they want to know who is responding to them” (2008:6). She adds that students share a sense of community within VWs, and mentor each other as they learn how to use the resource in order to complete their individual or groupwork. According to studies, users refer to the “embodied social connection” with other residents and the immediacy of social co-presence as one of the main advantages of SL (Childs, 2010; Jarmon, 2009; Jarmon et al., 2009b; Schoeder, 2002; Robbins, 2008). In 2009, Jarmon et al. (2009a) carried out a study that found that SL‟s three dimensionality facilitated tangible experiences and a sense of personal presence that enhanced their students‟ learning. Health researchers Gorini et al. suggested that Compared with conventional telehealth applications such as emails, chat and videoconferences, the interaction between real and 3-D virtual worlds may convey greater feelings of presence, facilitate the clinical communication process, positively influence group processes and cohesiveness in group-based therapies, and foster higher levels of interpersonal trust between therapists and patients. (2008:2) Lu (2011) added that one of the advantages of SL was the fact that it allowed its members to change their appearance, switching to the forms of animal, monster, or human avatars. Lu (2008) explained how students who were able to choose their digital identities within SL were able to have more open and honest discussions because they did not associate participants with their avatars. Calongne concurred, claiming that the ability to customise their avatar was a high priority for students who 30 were learning and participating in VW classes because it “enhanced their learning experience and perception of self” (2008:7). In light of the literature just presented, it was therefore crucial to investigate how lecturers within the FHSC viewed online identities in an immersive world like SL, and whether questions around the validity of an individual‟s pseudonym could be a challenge for nursing and midwifery educators. 2.2.5 Addiction Another aspect of SL highlighted in the literature was the fact that immersive environments like SL can lead to addiction. Some of the authors who have acknowledged this issue include Savin-Baden (2010b), Thackray et al. (2010), Smith (2009), Boellstorff (2008), Kelly (2004), and Joinson (2003). Savin-Baden (2010b) explains how some academic staff view SL as a game and therefore object to using it for teaching purposes. Thackray et al. (2010) stated that one of their students became a very active user of SL and suggested that some students may become addicted to the environment as a result of using it as a learning environment. Smith emphasises that From addiction to theft to divorce, careless behaviour in virtual worlds can lead to real consequences. (…) When obsessed players put virtual rewards over real jobs, relationships, and chores, lives get ruined. (2009:1) The Swedish National Institute of Public Health carried out some research on the addiction of VWs, resulting in their researcher Sven Rollenhagen warning that VWs were the “crack cocaine of the computer gaming world”. This report was commissioned as a result of 15 year old Swedish boy being hospitalised due to “an epileptic-type seizure brought on by sleep deprivation, lack of food, and too long a stretch of concentrated game playing” (Telegraph.co.uk, 2009:1). It recently emerged 31 that a Korean couple let their own baby starve to death while they were raising a virtual baby online. It was suggested that this was as a result of the couple losing the will to live a normal life because they did not have jobs and their baby was born prematurely (The BBC, 2011; Telegraph.co.uk, 2011). However, in spite of such potential consequences, Thackray et al. (2010) did conclude that very few students became over-involved in SL as a result of using it as a learning resource and that the amount of responsibility that educators have with regards to their students‟ involvement in a VW was still open to discussion. Considering the fact that academics within the FHSC all come from a medical background where they may have encountered patients suffering from these symptoms, the fact that SL could be seen as an addictive environment could be an important issue to lecturers within the FHSC. 2.3 Implementation Issues for Second Life The final part of this chapter aims to review the literature regarding the issues related to the implementation of SL. Although the FHSC regularly updates its pre-registration nursing and midwifery programmes, as well as its teaching resources, it is important to manage such implementations appropriately. This includes holding consultations with relevant staff and offering the appropriate training and support. When implementing a new teaching resource such as SL, it is important to persuade senior management of its value as well as convince academic staff of its educational benefits (Galik, 2008). The initial plan should focus on bringing together interested parties within the institution and providing support in terms of funding applications and staff development (Savin-Baden, 2010b). Galik adds that 32 For SL to succeed on campus, we realize the support and involvement of the faculty is critical. The best way to gain this support is to discuss and demonstrate as widely as possible. (2008:157) Once the new teaching resource has been implemented and all parties have received the appropriate training, the long term strategy should then focus on developing and sustaining online activities within individual Faculties and across the University as a whole (Savin-Baden, 2010b). Considering the current literature, the following list of implementation issues has been selected and reviewed within this section: 2.3.1 2.3.2 2.3.1 Costs Training and Support Costs The financial costs associated with the adoption of SL was emphasized by some writers, which may be pertinent to this research. When the FHSC adopts a new system, this usually has cost implications for the senior management team. Individuals wishing to purchase a resource consequently have to submit a request for financial support along with a rationale for adopting the tool. It would therefore be reasonable to assume that this issue would be important to academic staff when considering the adoption of SL as a new teaching resource. Although there does not appear to be much literature available on this issue, Love et al. (2009) do acknowledge that funding for such projects are often missing within Higher Education Institutions. Galik also claims that Primary for SL are the technology, bandwidth, and monetary concerns, which all boil down to money. No administrator would consider entering SL without considering the cost involvement in this virtual environment. Administrators want to know how much it will cost, in both real money and other costs, such as staff time. (2008:162) 33 Recent financial pressures within the Higher Education sector and the National Health Service (NHS) have lead to financial cutbacks within the FHSC. The cost of using a new online resource could be an issue for academic staff, as well as senior management (Thackray et al., 2010). But Savin-Baden (2010b) suggests that providing a three to four year strategic plan and an immediate implementation strategy can help to convince the senior management team that adopting SL as a teaching environment is a feasible project. Currently, there does not appear to be much literature on the financial implications of running an Island or a building within SL, and how to convince senior managers that SL is worth the investment. Of those who have researched the financial implications of implementing SL in Higher Education, Galik (2008) explains the costs associated with running a building or an Island on SL. Although most members, like students, have a basic membership that is free, individuals wishing to purchase land are required to have a premium membership (Wood, 2010b). Other additional costs include the monthly fee, buying the land, furniture, buildings and objects. However, Robbins and Bell (2008) point out that streaming content, such as a PowerPoint document, onto SL is free. But in spite of these costs, Aldrich claims that Given how many tools are expensive, dangerous, finicky, inaccessible, or fragile, virtual worlds can give students experience with more tools than in traditional class. Virtual tools can be not only cheaper but also better, with the ability to do such things as provide views into their inner workings. (2009:51) Moreover, Savin-Baden (2010b) argues that the cost of maintaining and renting an Island on SL is relatively inexpensive. Instead, she claims that what is more demanding is the initial set up and design of an Island. 34 However, Wood (2010b) states that institutions that only occasionally use VWs as a teaching resource do not need to purchase a virtual estate. Instead, he claims that facilitators should consider borrowing or renting sites from other groups or Universities. Another solution would be for institutions to apply for a SL Land Grant, which is available on the SL website for “Educators”. These temporary (semester long) land grants offer facilitators interested in sampling SL as a teaching resource temporary access to a virtual estate (Wood, 2010b). Considering that the implementation of a new teaching resource within the FHSC often requires the input of senior management and the finance coordinator, lecturers may perceive this as a challenge when considering the use of SL in teaching and learning. 2.3.2 Training and Support An important aspect that was highlighted within the literature was the provision of training and support during the implementation of SL. It seems obvious that providing academic staff and students with the appropriate training is essential so that they can use SL as a teaching and learning environment. Not providing the necessary training and support could result in the non-adoption of SL as a teaching resource (Camargo, 2007). Although the majority of lecturers have the necessary skills to manage their sites on eBridge, not many of them know how to navigate a VW like SL. The literature on training and support appears to be limited, but Savin-Baden explains that Even if funding to support Second Life introduction is supplied by senior management, ensuring that the innovation is guided by lecturing staff and supported by learning technologists is vital. (2010b:19) 35 However, Heiphetz and Woodill (2010) emphasize that at the beginning of any new project, it is essential to start by “training a trainer”. Belei et al. (2009) recruited an expert in SL in order to train their staff, as well as some of their students. They claim that the combination of interactive workshops, in-world support and access to technical assistance resulted in a positive relationship between the tutors and students. Similarly, as well as holding two orientation sessions and emailing students, Hewitt et al. (2009) sent their students copies of “Second Life for Dummies” (Robbins and Bell, 2008; quoted in Hewitt et al., 2009:3), which made their students feel more comfortable with the technology. But Kelton suggests that with the online community being an essential part of SL, many developers have made their resources freely available to SL members, including their buildings, tools, scripts and clothing. He concludes that “mastery of these advanced skills is not essential for an instructor to hold a class” (2008:4). When training students on how to use SL, some of them will not require any more guidance other than the introductory lecture and demonstration. Other students may need additional support and training. Facilitators can use a variety of online resources available to beginners. These include an assortment of video tutorials, a quick start guide, the Second Life for Beginners Wiki and weekly in-world beginners‟ sessions (Wood, 2010b). However, dealing with a group of „newbies‟ can be time-consuming and sometimes confusing. This could be managed by staggering the arrival of the beginners within SL and having a group of „experts‟ there to help. But if the availability of competent staff is an issue, volunteers on the Help Island within SL could help (Johnson, 2010; Savin-Baden, 2010b, Martin Mahar and Mahar, 2009). Fellow students who are already members of SL could also help their peers 36 familiarise themselves with the environment (Aldrich, 2009), and take on the role of what Thackray et al. (2010) define as the “lead learner”. All VWs have a members‟ code of conduct policy, which is usually available on their homepage. Facilitators should provide students with a copy of this document, and potentially impose some additional guidelines drawn up by the Institution. For instance, instructors may want to remind students about the importance of their professional behaviour when representing their institution in-world (Wood, 2010b). They should also be provided with information on how to keep themselves safe within SL (Thackray et al., 2010). But most importantly, Molka-Danieldsen stated that students come from different technology ready backgrounds. She concluded that it was necessary to Identify clear user support roles so that the students would know where they could go to get help and to make it clear that they did not have to fear asking for help. (2009:23) Lu concurred, claiming that with the appropriate technical training and learning activities, students will achieve learning success. She also added that she preferred to “teach the basics and walk [the students] through, and provide individual assistance when needed in class” (2011:215). This allowed students to learn effectively, save time and avoid unnecessary frustration (Lu, 2011). Similarly, Calongne stated that introducing students to the environment during the first class could result in some students exiting the software and vowing never to return. She suggested that Rather than startle students, the first class needs to show them the benefits of using virtual worlds, demonstrate what students of all ages have accomplished in only a few days, and provide a brief introduction on how to use the tool effectively. (2008:3) 37 3 Methodology This chapter details the methodology that was used to carry out this research. The purpose of this study was to evaluate lecturers‟ perceptions on the use of SL as a teaching resource, within the FHSC at the UoH. This would not only examine whether academic staff would use SL for teaching and learning, but also how they would use this resource to train pre-registration nursing and midwifery students. One possible methodology would have been a literature review of other Higher Education Institutions‟ use of VWs as an educational tool. However, due to this research being based around the opinions of academic staff within the FHSC, I decided to carry out the research using a qualitative approach that would allow me to include staff‟s perspectives on this topic. A social constuctivist approach was therefore adopted because by asking broad and general questions, participants were able to construct the meaning of the situation, thus providing their own perceptions on the topic being discussed (Creswell, 2009). 3.1 Semi-Structured Interviews It was initially decided that focus groups would be adopted for this study because they would allow the researcher to gauge people‟s opinions and gather as many points of view as possible. However there can be some challenges in using this methodology. Grudens-Schuck et al. claim that “even when incentives are provided, such as refreshments, child care, or stipends, no shows are common” (2004:2). This problem occurred when this research was piloted and an attempt to hold an initial focus group was made within the FHSC. Not many individuals responded to the emails that were sent Faculty wide, asking for volunteers to take part in a focus group that would discuss their perceptions of SL in nursing and midwifery training. 38 Furthermore, it was impossible to find a time when all volunteers concerned could meet together for the exercise due to their teaching and personal commitments. It was therefore decided that participants should be interviewed individually because this seemed to be the most feasible approach. Semi-structured interviews were used in order to have some flexibility with the questions (Polit and Beck, 2006). During the interviews, academic staff were asked about their perceptions of SL, and what they viewed as opportunities and challenges of using this environment for teaching and learning. Participants‟ answers were recorded by writing down their responses in verbatim. At the time, note-taking seemed to be a logical way of recording the data, with the researcher having worked for six years in Higher Education and having seven years‟ experience of recording respondents‟ answers5 in the market research industry. Had these interviews been recorded, not all of the interviewees‟ opinions or ideas on the topic would have necessarily been aired due to their awareness of the session being taped. However, in retrospect, these interviews should have been recorded (Watson et al., 2008) as they would have registered any comments that may have been missed during the note-taking, including other aspects of the interview that would not have been noted, such as the tone used by the respondent when answering the questions. However, an interviewer could unconsciously influence their respondents‟ answers, and thus invalidate the research (Opie, 2004; Creswell, 2009). Open-ended questions were therefore used as often as possible in an attempt to alleviate this validity issue. But on the other hand, Parahoo claims that 5 By typing respondents‟ answers while interviewing them over the telephone 39 The validity of responses in semi-structured interviews is enhanced by the presence of the researcher, who can clarify the questions and seek clarification from the respondents. (1997:296) In semi-structured interviews, respondents are asked the same questions, but the researcher does have some flexibility in the order and phrasing of the questions (Hutchinson and Wilson, 1992) as words do not necessarily hold the same meaning for every respondent (Barriball and While, 1994). Due to this flexibility, semi-structured interviews are said to have elements of quantitative and qualitative research. Parahoo states that If the researcher departs from the list of questions she comes with and starts probing deeply, the interview can be said to be focused and thus qualitative. The degree of standardisation or flexibility can provide clues to how quantitative or qualitative a semi-structured interview is. (1997:296) There was no time limit allocated to this activity because the interviewer‟s goal was to find out as much as possible about academic staff‟s opinions and perceptions on using SL for nursing and midwifery training. If there had been a time limit for these interviews, not all ideas would have been explored should the interviewees have had an interest or experience on a particular issue related to VWs and education. However, if there had been a time limit, this may have provided more spontaneous or „gut feeling‟ answers (Camargo, 2007). It should also be noted that this study only included seven members of academic staff within the FHSC, making it a small study, one of the limitations of this study, which will be reviewed in the following section. 3.2 Limitations Some limitations should be stated about this core group. One of them is the fact that the majority of participants have a lot of experience as nurses/midwives and lecturer practitioners, and could potentially not be open to new ways of training nursing and 40 midwifery students. Only two of the lecturers left the nursing or midwifery profession in the last eighteen months or so in order to start a career in higher education. Academic staff within the FHSC have an average of 15 years‟ experience in teaching nursing and midwifery. In spite of gender not being one of my selection criteria as I did not want to turn away any potential volunteers, six out of the seven lecturers who participated in this research were female. Although this could be a limitation with regards to analysing the results, it also reflects on the make-up of the FHSC‟s academic staff as nursing and midwifery appear to be predominantly female professions (Nevidjon, 2001), with 76.5% of the FHSC‟s academic staff being female. However, during a research project, Bruestle (2009) found that male and female responses on their use of eLearning applications were very similar and that their attitudes towards ICT were almost identical. Such findings suggest that although almost all interviewees were female, gender bias would not necessarily invalidate the results of this research. Another aspect that could be of concern is the age of the respondents. Jegede (2009) claims that older academics are more wary of ICT and that their disposition can more often than not be described as “you cannot teach an old dog new tricks”. Hawthorn (2000) also claims that the effects of age become more noticeable once a person reaches their mid-forties and that these individuals do not simply belong to another minority group but form an important segment of the population. As part of her research, Lam (2000) also found that four out five respondents who used computers were aged between 25 and 35, whereas three out of five participants who did not use a computer were aged between 36 and 50. However, Jegede (2009) did state that age 41 did not affect academics‟ use of ICT. The younger respondents in Jegede‟s research tended to use ICT to write their thesis and educational programmes, whereas the older age group would use it to write and publish papers. Similarly, some academics within the FHSC may not feel entirely at ease with ICT, suggesting that there could be some negative views on this issue. However, the individuals with whom I held one to one interviews were all aged between 36 and 54 years of age and all seemed very much at ease with ICT and VLEs. This replicated the make-up of staff age groups within the FHSC as 85% of their staff fall into the 36 to 54 age group. These attitudes towards ICT and eLearning were also repeated during the big debates that were held as part of the FHSC‟s away day in July 2009, which was based on “Changing The Way You Think About eLearning”. Another limitation that should be acknowledged is the potential „power play‟ between the participant and the interviewer. Some members of academic staff could have an issue with the fact that the research was being carried out by a member of support staff, whose pay grade was three or four grades lower than their own (Sikes, 2004). Moreover, these members of academic staff may not be able to accept that (a) member(s) of support staff may “have some expertise” in a subject on which they have minimal knowledge. This could therefore influence the reliability and validity of the interviews. However, participants were provided with a copy of the Findings and asked whether their views were fairly represented within the document in order to validate the research. 42 4 Results and Discussion In this section, I describe and analyse the results obtained from the research within the interviews, and relate them to the assumptions made prior to the research, which are informed by the data from the Literature Review. I used the qualitative method of semi-structured interviews, which was described in the Research Methodology chapter, to investigate academics‟ perceptions of SL as an educational tool within the FHSC. The topics included Academic staff‟s perceptions of SL What they viewed as potential benefits of SL for nursing and midwifery training The potential threats and challenges of using SL for nursing and midwifery training How they would use SL as a teaching resource if it was available In spite of my planned structure for researching the above topics, some unexpected but important aspects related to the issues being investigated emerged. For instance, discussing the benefits of SL brought up the good points as well the bad points of identity and presence. Similarly, when considering the use of SL as part of their classes, some lecturers‟ fears or late adopter attitudes were brought up as well as their innovative ideas. 4.1 Perceptions of Second Life This first area – academics‟ perceptions of SL - forms the basis of my analysis since perceptions can have a significant impact on the success of technology implementation. My study is based on the premise that VWs have the potential to be very useful educational tools, especially in vocational areas such as nursing and midwifery where students can learn through their mistakes, but without putting 43 patients at risk (Savin-Baden, 2010a). Immersive learning environments such as SL could therefore be seen as part of a set of virtual learning systems used to train pre-registration students (Savin-Baden, 2010a). 4.1.1 Virtual Environment All of the lecturers knew that SL was a virtual environment where members had to create their own profiles or avatars. Perceptions of the SL setting included an array of „sizes‟, from a location as small as a village to something as large as a world. These included online villages, virtual towns, and VWs: “It’s like a virtual town, you create your profile yourself” (Respondent 2). “It’s a virtual online village. It uses characters and different/changing environments” (Respondent 3). “A virtual world where people can create their own avatars, be what they want to be” (Respondent 6). “An artificial environment online, used as a teaching tool, and can replicate issues seen in clinical environments and within educational institutions” (Respondent 7). “It’s a virtual environment where you could create an avatar, create yourself into anything you want to be. (…) It’s a virtual world, a second world, this world on a computer. But you need to go and see for yourself” (Respondent 1). 4.1.2 Interaction Some lecturers were aware of the potential of using SL as an educational resource, defining it as a VW, an interactive environment and a teaching tool. They viewed it as an environment that could be used to engage students and facilitate their learning: “A virtual learning tool with characters” (Respondent 3). “A virtual world, with avatars, businesses that some Higher Education Institutions use for teaching” (Respondent 5). 44 “You can use it to (…) facilitate students’ learning” (Respondent 1). “A tool that Universities are subscribing into to make eLearning more fun and engage students with it” (Respondent 2). It was suggested that SL could be compared to learning through play and could therefore be a great asset as it would motivate or engage some students. One lecturer viewed SL as a social networking environment, stating that: “You could interact with people by talking to them but you need a keyboard. You travel to all sorts of interesting places, ride, go to the desert. It may appeal to some people but not to others. But it will appeal to generations brought up with technology, who interact with multimedia and gadgets” (Respondent 1). This conclusion is supported by o‟Toole (2006), who claims that younger students may be classed as „digitally native‟, whereas more mature students may not see the appeal of such a resource. 4.2 The Benefits of Using Second Life This second area is a more detailed description and discussion of what academic staff view as beneficial aspects of using SL as a teaching resource. The use of SL in Higher Education has been widely reviewed (Broadribb et al., 2009; Dalgarno et al., 2010; Johnson, 2008; Savin-Baden, 2010b) and can be quoted as examples, especially within the arena of medical education (Ellaway and Topps, 2010; The University of Southampton, 2004; The University of Plymouth, 2008). It was therefore my belief that a resource such as SL could be a good educational tool for both staff and students within the FHSC. 45 4.2.1 Student Confidence Lecturers felt that using SL as a teaching resource could give their students more confidence, resulting in them participating more often in class and feeling more confident when they attend their clinical placements. In addition, some lecturers thought that if the real identity of the person behind the avatar was only known to the student and their facilitator, then the student would probably feel a lot more confident about taking risks as they would not feel embarrassed if they made a mistake in front of their peers. One lecturer summarised this by stating that: “It’s a safe environment to explore issues without peer pressure” (Respondent 7). This theory is supported by various writers within the Literature Review. Savin-Baden (2010b) claims that facilitators could allocate avatars that had already been created to their students, thus resulting in the removal of any potential peer pressure that could take place during a session. Furthermore, this could also give some students who would not always interact in a face-to-face environment the confidence to ask questions, as nobody would know who had asked a particular question. This theory is also supported by Ellaway and Topps (2010) who found that anonymity was one of the big attractions of VWs like SL and compared them to real life situations like Alcoholics Anonymous. They claimed that some individuals were more likely to open up if they were in an anonymous environment. 4.2.2 Low Risk One aspect that seemed to appeal to academic staff was the fact that SL could be used to allow students to practise certain medical and/or surgical procedures without risk. Two lecturers defined it as a safe environment where students could practise 46 scenarios they may encounter on clinical placements, but without the risk of exposure that could occur in real life, thus giving the students more confidence to deal with these situations before they go into clinical practice: “It would provide an environment where students would feel safe. They can practise virtual scenarios” (Respondent 3). “You could use it for clinical procedures, practise without exposure, not exposing clients to initial procedures. They can gain more confidence prior to going into clinical practice” (Respondent 2). As discussed in Chapter 1, students currently practise some clinical procedures within the UoH‟s clinical skills suite prior to them going into clinical practice. However, based on student feedback, they often state that they are not given enough opportunities to practise certain clinical skills before they commence their clinical placements. Based on these statements and as shadowed in the Literature Review, it is therefore possible to conclude that having a clinical skills teaching environment within SL could bridge some of the skills that students may feel they need to improve upon before they go into clinical practice. The analysis of these results leads to a conclusion that is supported by Ball and Pearce‟s (2009) suggestion that SL could allow student nurses to learn/or specialise in a safe environment that would also allow them to reflect on their practice once the event is over. Savin-Baden (2010a) also claims that simulations are very effective for trial and error learning. 4.2.3 Appeal of Technology When asked about the potential benefits of using SL as an educational tool, lecturers cited its technological appeal to a certain generation of students. They also noted the advantages of learning through games, enjoyment of interactive learning, the 47 flexibility of eLearning, and how such an innovative teaching resource could improve the UoH‟s reputation: “It’s not like learning, they are more likely to sit down because it’s not structured. It’s a hobby, a relaxation” (Respondent 2). “You could put it into programmes at different points” (Respondent 3). “It’s a familiar online environment like Sims… They learn in an innovative way they may not have experienced before” (Respondent 7). “It could increase the reputation of a University as being up to date with technology and not lagging behind” (Respondent 5). But as one lecturer pointed out, other web 2.0 technologies can also engage the students: “It can appeal to a generation not into sitting in the classroom. Colourful multimedia engages them. It’s not just Second Life, other tools can have that same appeal to that generation” (Respondent 1). There were also several other advantages associated with most eLearning tools that were cited. These included the availability of immediate online feedback and the savings associated with distance learning, mainly time and money: “You could save with travel expenses and time if you hold an online meeting within Second Life” (Respondent 4). “They’ll be able to access information and teaching material without having to travel” (Respondent 1). “The feedback facility suggests innovation” (Respondent 7). “It could be that you can use it as a long distance learning tool, it’s re-usable, for long distance learners, a wider audience. You can therefore teach more students” (Respondent 3). 48 These comments suggest that some members of academic staff may be confusing SL with other eLearning tools because some of the advantages mentioned, such as saving time and travel expenses, can also be associated with the use of VLEs (Salmon, 2003). This connection confirms the view of Calongne (2008) within the Literature Review, who noted this issue during an SL implementation project, claiming that neither students nor academic staff were familiar with the environment when they were introduced to the system. However, other lecturers did appear to have a better awareness of SL and other VWs. 4.2.4 New Teaching Tool All lecturers viewed SL as “another teaching tool” and stated that this could be a potential benefit to teaching. As stated by one lecturer, “the benefits are not around Second Life itself. It‟s another tool for teaching” (Respondent 1), thus suggesting that the additional resource would help to keep students engaged in learning, especially those from a generation that prefers the use of interactive multimedia to learning in a classroom. There were various other pedagogical advantages cited. One of these was based around classroom management. Based on previous student feedback, students chatting in class often frustrate those who are there to learn. Lecturers cited its versatility, how it can be adapted to different learning styles, and its visual aspect as benefits of using SL as part of their teaching: “ Not being in class and having to discipline students who don’t want to be there” (Respondent 1). “The fact that you can upload presentations is very useful” (Respondent 4). “It provides a visual aspect to learning which can be useful” (Respondent 3). “It’s something students can do individually, it’s not threatening, they all learn in different styles” (Respondent 2). 49 “Being able to speak within Second Life is a great opportunity within eLearning. It’s more natural communication and can suit learning styles of mature students or those who lack confidence” (Respondent 4). However, the importance of training the facilitator was highlighted by one lecturer: “The environment will only be of any benefit if the facilitator can interact with it. We need to make it interesting for them” (Respondent 1). 4.3 The Challenges of Using Second Life This third area dealt with the lecturers‟ views on the possible challenges and threats SL could represent if it were to be used in nursing and midwifery training. This issue elicited more discussion than the other three topics discussed as part of the interviews. Academic staff discussed issues related to funding and access to technology, as well as student progression and professional suitability (Dudeney and Ramsay, 2009). 4.3.1 Identity and Presence Issues Identity was one of the main issues that was brought up during the interviews. The fact that users could design their own avatar was viewed by some as a negative aspect. Some of these issues included students‟ self-awareness and the overt sexualisation of their avatars: “You can choose your colour, size. It could promote self-analysis, self-awareness but not in a positive way” (Respondent 3). “I’m not sure of the advantages of the avatars. Avatars I’ve seen in Second Life have often been overtly sexualised and they enable an uncomfortable pretence about people’s true nature” (Respondent 6). 50 This concept of avatars‟ identity and appearance is supported within the Literature Review by Savin-Baden (2010a) who claims that “it is noticeable that almost everyone chooses to be young and beautiful in Second Life” (2010a:59). Another identity related issue that came up was in relation to the logistics of the students‟ character or avatar. One lecturer was concerned about the possibility that students may spend more time on changing their appearance and image within SL, rather than using the system as a learning tool, a theory that is reviewed by Savin-Baden (2010b). They felt that this brought into question the type of image that students would want to portray. One respondent suggested that SL may result in students experiencing a false sense of security: “It may give the students a freedom and a false sense of confidence. It could be a good or bad thing” (Respondent 3). However, another lecturer did state that role-play was not popular amongst students: “We often seem to have to complete role-plays, something that not many people seem to be keen on” (Respondent 6). But Dev et al. (2007) state how testing trauma nurses‟ decision-making processes cannot be simulated effectively in real life unless they carry out role-play scenarios. Coupled with the technological challenges, this issue could therefore make the environment more challenging for the facilitator. Some respondents claimed that some students may not be at ease in a 3D immersive environment. It was suggested that holding a class within SL could lead to some students feeling uncomfortable, anxious or paranoid: “It could cause anxiety for some students” (Respondent 4). 51 “Some students might be quite uncomfortable with the simulated realism, just as they are on remote online forums” (Respondent 6). “Students tend to be paranoid about adding comments on forums. They are more nervous about getting it wrong and looking stupid. They feel they have to say something really poignant to post something” (Respondent 3). One lecturer claimed that this could result in some students „lurking‟ online. They defined it as: “Having an attitude of just sit and be” (Respondent 4). But, it was also suggested that SL could improve students‟ confidence, especially those who do not always participate in a face-to-face environment: “It gives more confidence to talk and interact” (Respondent 3). As was observed in the Literature Review, although academic staff did acknowledge the advantages of online identity within SL, they were more concerned about the more challenging aspects of SL identities. These included students‟ self-awareness, their concerns about their personal image (i.e. their avatar), some students‟ attitudes to 3D simulations, and a tendency of non-participation (Love et al., 2009). 4.3.2 Confidentiality and Fitness to Practise Another issue that emerged in this research was academic staff‟s ability to control confidential information and how this could affect students‟ Fitness to Practise. There were concerns regarding students discussing confidential issues, either about themselves or regarding something that occurred during their practice, within the environment and how this would be controlled. All respondents seemed to view this issue as their main worry. They were unsure about who would provide the 52 surveillance and who would manage it. One lecturer was concerned about the security and confidentiality surrounding online discussions within SL: “It’s data in a computer, even if it’s protected, I don’t know how that would be managed. Someone emails somebody about something. Even if it’s deleted, it’s still data somewhere. Computers don’t delete data. That’s a problem in how it would be managed” (Respondent 1). Currently, students would systematically fail a module if they breached patient confidentiality6. These responses suggested that the environment of SL was viewed as a system that would add to the current confidentiality challenges, which academic staff and mentors deal with during the assessment periods. One respondent summarised this well when they said that: “It might encourage an exchange of information that shouldn’t happen” (Respondent 3). However, these exchanges of confidential information could also occur within other online environments like Skype or through eBridge forums, even with the presence of a facilitator. Indeed, there was a recent breach of confidentiality amongst some students within the FHSC, and comments appeared on Facebook. This was dealt with by a lecturer and a reminder was promptly added onto eBridge (Appendix B). This theory is supported in the Literature Review by Carlowe (2009) who claims that there have been various breaches of confidentiality on social networking sites, which have resulted in some nurses being disciplined and/or struck off the register. One lecturer queried “what would be accepted on site? Should we be encouraging more social 6 A typical example would be when students name patients within their essays, portfolios or CAP documents. 53 networking?” (Respondent 3), bearing in mind that what students do within such environments could affect their career, even if the events occur while they are off duty (Carlowe, 2009). Although SL could lead to a breach of confidentiality, it is not the only online environment where such breaches can occur. Moreover, should a breach of confidentiality occur verbally, academic staff are less likely to be aware of it and would therefore have less control over the situation, even if it may be less damaging than an online breach of confidentiality (NMC, 2011). The NMC is the regulatory body that issues guidelines and sets the standards for Nursing and Midwifery professionals (The NMC, 2004) and recently published the standards of conduct on the use of social networking sites (NMC, 2011). Confidentiality is an issue that could have an impact on whether students and medical practitioners can register with the NMC (Rose, 2009) (Appendix B), in other words their Fitness to Practise. The fact that SL is an American environment (http://lindenlab.com/) led to one lecturer practitioner claiming that the environment may not adhere to the guidelines set by the NMC: “Not following protocols and local guidelines could be a problem. There could be a difference in practices. It’s of American origin. It doesn’t reflect UK practices” (Respondent 2). Conversely, one of the lecturers brought up the governance of student behaviour and confidentiality and queried whether SL could be managed behind the UoH‟s firewall: “Could you adopt a robust system in Second Life as we do here?” (Respondent 1). Participants suggested that SL could be considered as a teaching resource if it was possible to restrict access to UoH students and facilitators only. Similarly, Wood 54 (2010b) states that this can be dealt with by installing SL Enterprise, a private version of SL, behind the Institution‟s firewall. There were also concerns that simulated environments like SL would end up replacing the current „real life‟ training that students gain while on placement and within the UoH‟s Centre for Clinical Skills, rather than being used in addition to this training. One lecturer raised this concern, claiming that: “A threat would be the idea of losing the real world context of midwifery education. A simulation should not replace the real world experiences that students can and should be having” (Respondent 6). But several authors have stated that SL would be used as an additional teaching resource in medical education, and would not replace valuable clinical placements undertaken by students (Murray et al., 2007; Savin-Baden, 2010b; Aldrich, 2009). 4.3.3 Dealing with the Unpredictable Lecturers were concerned with the issue of not being able to identify or deal with potential in-world problems. Two respondents mentioned not being prepared for unexpected problems and not being able to help struggling students as an issue: “With Blackboard you can monitor student participation and their use of the VLE. You can therefore spot those who struggle and fall behind. I have my doubts about being able to do that in Second Life” (Respondent 4). “You wouldn’t identify potential problems until you were there. They could occur at the time, not us predict them. What would the consequences be?” (Respondent 1). This problem was acknowledged by several authors within the Literature Review, including Johnson (2008), McKeown (2009), Stott (2007), Sant (2005), Sant (2009) 55 and Savin-Baden (2010b). However, Wood (2010b) and Savin-Baden (2010b) offer detailed solutions to these problems, including the use of passwords and the adoption of SL Enterprise, which is not open to the general public. 4.3.4 IT Skills Overcoming the challenges of students‟ IT skills was raised during this research. Although schools and colleges appeared to be further ahead when it came to adopting new technologies for teaching and learning, this concern was raised for two reasons. Firstly, it was suggested that nursing students, in the main, come from poorer backgrounds and/or socio-economic groups. It was claimed that this could result in the students not having access to the Internet because a computer was not an option in their home and/or they could not afford the costs of Internet access. Secondly, a number of nursing and midwifery students decide to join the profession later on in life and may not have the necessary IT skills at the beginning of the course. Wood (2010b) concurs, claiming that older students are more likely to question the validity of such a technology and will be more apprehensive about using it. As stated by one lecturer, “Some students who have just started their course have only just had their first experience of IT and digital environments. (…) You have to remember that 25% of pre-registration students are approaching the age of 40. This could add to the burden of study skills” (Respondent 4). Several lecturers went on to claim that students could not be expected to learn how to use several online resources all at once, and were concerned about the anxieties that such expectations could bring upon their students: 56 “You can’t add too many things. There could be a low knowledge base/experience. You could exclude someone because of their skill set. They are not used to Facebook or online chats. There would be delays due to their low typing skills for instance. Some of them may have problems creating their avatar” (Respondent 4). “It could cause anxiety for some students like Turnitin7 and that was only optional to start with. I guess we could get around that by making the use of Second Life optional” (Respondent 6). “Student IT skills may be a problem. The digital generation will be OK, but can we teach the older generation? If students are incapable of finding something on eBridge, what chances do they have with Second Life? It is all down to the ability of the lecturer. Some lecturers will refuse to learn and will be resistant to change. Some academics are still not abreast with Blackboard or eBridge. It may never take off” (Respondent 5). These findings confirm those prefigured in the Literature Review. Aldrich (2009) claims that if a learner‟s experiences dip below their threshold to quit, the student will withdraw from the course with a negative bias. Supporting this view, Lamont states that The biggest obstacle to Second Life taking off is the learning curve involved. If you are not „Net savvy or game savvy‟, be prepared for a very frustrating experience. (2006:1) However, pre-registration students are now given the option to register on the European Computer Driving License (ECDL) course in their first year so that they can gain the necessary skills in order to carry out their coursework. But expecting them to learn another system on top of the current requirements could be overwhelming and lead to student attrition. 7 Anti-Plagiarism Software 57 4.3.5 Access Another issue that was brought up was the accessibility of SL. This included the differing problems associated with accessing SL on UoH campuses, within the NHS or from home. This could be a challenge for individuals living in remote areas, where Internet access in the home could be slow or virtually non-existent, an issue that was supported within the Literature Review by Atkins and Caukill (2009), and Sant (2009). But the government did claim that high speed broadband would be available for every household by 2012 (BBC News, 2010). On the other hand, what the government defined as „available‟ could be open to interpretation. Whether this high speed broadband will be affordable for every household is another matter. Two lecturers stated that the firewalls within the NHS and the University would restrict staff and students from accessing environments like SL: “The firewall within the NHS would restrict access to people” (Respondent 4). “Students could log onto Second Life within the University without any problems. But they often experienced problems when attempting to quit SL, which mostly resulted in them having to restart their computer” (Respondent 1). This was apparently due to the way the University had setup its firewall. However, an enquiry was made about this issue, and staff at the Helpdesk within the UoH said that should there be any problems during a session on SL, the Computer Centre should be contacted and they would provide the necessary technical support. Other Universities who were using SL as a resource were also experiencing access problems, an issue that was also noted by Broadribb et al. (2009). These included not all students being 58 able to join the site, due to some limits imposed by Linden Labs within their contracts, and limits to the number of individuals being able to login on campus due to Linden Labs restricting the number of users to ten for each I.P.8 address (SL, 2011c). Concerns regarding students being able to access SL from home were also raised. Respondents noted the affordability and access to high speed broadband as an issue, as well as SL‟s compatibility with differing operating systems: “Students’ operating systems and ISP would need to be compatible” (Respondent 4). “Ensuring that all students have the requisite computer access could also be a threat” (Respondent 6). “Some students may be poorer than others and won’t be able to afford broadband, which is needed for Second life, or they don’t live in an area where there is a broadband provider” (Respondent 5). For instance if the operating system was not compatible, or the computer was too old or too slow, some students may not be able to access the site from home, a theory supported by Atkins and Caukill (2009), and Hewitt et al. (2009) within the Literature Review. 4.3.6 Addiction During this research, the psychological aspects of VWs were also brought up by two respondents. One lecturer claimed that the use of SL could result in some individuals having poor social skills: 8 Internet Protocol 59 “I have a colleague who finds it much easier to interact with people in Second Life than in real life” (Respondent 4). Another respondent seemed to take this matter more seriously than the previous participant. There was a genuine concern regarding certain individuals who viewed immersive environments like SL as “the real thing” and were convinced that they really were that avatar, an issue supported by Thackray et al. (2010), Smith (2009), Boellstorff (2008), Kelly (2004), and Joinson (2003). This interviewee claimed that because the power of illusion could be so strong, these individuals seemed unable to distinguish between what was real and what was virtual: “People who could not switch back to real life often had split personalities” (Respondent 4). They suggested that these individuals were suffering from what was known as Internet Addiction Disorder or IAD, a theory that is supported by Kelly (2004). The respondent also brought up the medical aspects/consequences of such an addiction. They stated that spending a lot of time online could lead to mental illness and that some addicts “could run into trouble if they go to the extreme”. In extreme cases this syndrome could lead to epileptic fits, an issue that was confirmed by the Swedish National Institute of Public Health (Telegraph.co.uk, 2009). They stressed the importance of finding the right balance between the real world and the VW and added that: “If the user is not strong, they could not survive very well” (Respondent 5). Smith (2009) concurs, claiming that lives are ruined when individuals allow their virtual lives to take over their real ones. As was shadowed in the Literature Review, this finding confirms that the use of SL as a teaching resource could lead to students 60 being addicted to 3D immersive environments, thus impacting on their student progression and personal life. However, Thackray et al. (2010) did claim that the number of students becoming over-involved in SL as a result of using the environment for educational purposes was minimal. This suggests that the probability of it occurring within the FHSC is very low. 4.3.7 Costs Half of the lecturers brought up the costs of setting up and running SL, in both financial and manpower terms, as a concern. Due to the current economic climate, there were doubts over whether funding would be made available in order to set up and maintain a site or an Island within SL. Two lecturers raised their concerns about the costs of implementing SL within the FHSC: “What about the cost implications?” (Respondent 2). “Management will see it as a costly tool, but it’s only initial costs. The benefits come later” (Respondent 5). Savin-Baden (2010b) concurs with these financial implications, and Galik (2008) claims that senior management would need to see the financial implications and value for money of such a resource before they would consider providing any financial support. It was assumed that if a new teaching environment were to be adopted, then current staff within the FHSC would be expected to take on some of the extra duties that may be required in order to set up and maintain the environment. Participants were concerned about how technology was constantly changing, having to keep up to date with such changes, and the amount of time this requires: 61 “Things change so quickly, you’re always playing catch-up” (Respondent 4). “You have to constantly keep up to date with technology” (Respondent 5). “In reality, setting up virtual environments is incredibly taxing. It requires planning, expertise and hard work, as well as significant time to set up and maintain such a site” (Respondent 6). This conclusion is also confirmed by several studies discussed within the Literature Review, the key ones being Belei et al. (2009), Ball and Pearce (2009), and Savin-Baden (2010b). Other financial aspects that were brought up included students questioning the value of SL as well as its validity as a teaching resource: “Students may perceive SL as a cheaper and more convenient alternative. It’s just their perceptions. They think we can’t be bothered to get patients in, even though it may not be a cheaper alternative. They may question how valid the whole thing is” (Respondent 7). “I’m not sure whether the same things could not be achieved with the use of real actors” (Respondent 6). The validity of SL as a teaching resource was also reviewed within the Literature Review by Anderson (2009) and Wood (2010b). 4.4 Potential Use of Second Life This fourth area - how academics would use SL as a teaching resource - was used to research how the FHSC could use SL should it be implemented as a training resource. Although some lecturers were reluctant to adopt SL, two scenarios emerged within this section. The first one involved training students to carry out specific medical and surgical procedures, which they may encounter in clinical practice. The second one focused on developing students‟ communication skills, thus replacing the current SPs with avatars within SL. 62 4.4.1 Reluctance of Using the Environment There was an obvious reluctance amongst just under half of the academics interviewed regarding the use of SL as a teaching resource. One individual, who was generally risk adverse, stated that they had not considered including SL in their classes. They felt that clinical skills were better when they were practised in real life, a view that is supported by Miller et al. who state that “although virtual worlds are a good way of communicating and interacting between students and teachers, this is not a substitute for actual face-to-face meetings” (2009:31). However, this respondent‟s main concern seemed to be based around classroom management and being able to supervise students: “I’d worry about policing it. Leaving it too open, I’m not so sure. On Second Life I can’t supervise it like I can face-to-face” (Respondent 3). Another member of academic staff was also reluctant to use the environment as part of their teaching. This lecturer seemed to embrace technology and was fully aware of SL and its possibilities. They were extremely interested in using SL, but they stated that they wanted “someone else to try it out first” (Respondent 4). Thackray et al. suggest that this is because not being sure what virtual worlds offer in an education setting is a real disincentive for many educators to exploring the potential of virtual worlds themselves. (2010:143) 4.4.2 Theory and Clinical Practice All academics felt that SL could be used as an effective tool where students would be able to practise certain processes that they would be expected to carry out in their clinical practice. One lecturer was very specific in how they would use the environment to train students, suggesting that there may be a gap in nursing and 63 midwifery training when it came to being able to illustrate certain procedures and illnesses to students. Two lecturers claimed that they could use SL to teach students about the processes of labour or how to ventilate patients: “I might seek to use Second Life to look at the process of labour: the descent of the foetus during labour, the cervix dilates, the baby rotates down the pelvis, all those complicated processes. I could show it in 3D. It would help students, then they could help women more in labour. If they could see it on screen, they could have a better understanding of what they need to do for the women” (Respondent 1). “You could explore different ways you ventilate patients. There are three different ways and one way eventually kills the patient. It affects their lungs if they’re on it month after month after month. It tries to mimic lungs” (Respondent 7). Two lecturers also felt that SL could be very useful to train students to diagnose and treat rare illnesses, and one respondent suggested holding health and safety classes: “You could assess a competency that the students can’t always achieve in practice” (Respondent 2). “Identify hazards, especially in a health environment” (Respondent 7). Some academics felt that SL could be a helpful tool to illustrate some of the topics that students learn as part of their theory modules. Two participants showed an enthusiasm for using SL to illustrate human anatomy and physiology: “Body organs: the way they interact, it would be a nice way to see how they interact. It takes you close up” (Respondent 7). “I’d use it for anatomy and physiology because it would be safe” (Respondent 3). 64 Although there does seem to be an enthusiasm about the development of an educational site within SL, some lecturers appear to confuse SL with other digital technologies, an issue that was also established within the Literature Review. Some of the above suggestions could be facilitated by other digital technologies, for instance YouTube or iTunesU9. An introductory session would therefore need to be held within the FHSC in order to demonstrate and discuss the use of SL, an implementation strategy also reviewed by Galik (2008) and Calongne (2008). While these findings illustrate respondents‟ enthusiasm towards the use of SL within a clinical skills setting, it also suggested that the environment could be used as effectively in other areas, such as softer skills and group work, a theory supported by Thackray et al. (2010). 4.4.3 Group Work When questioned about how they would use SL in their teaching, some lecturers stated that they would use it for self-directed learning or group activities: “You could use it as a discussion forum” (Respondent 3). “I’d give the students some self-directed study prior to a lecture to get them to think through processes. I’d use it as a group activity, set scenarios” (Respondent 2). “I could use it for pharmacology sessions. I’d set some questions and students could answer them/research them online. It really helps with the lecture when students have done some pre-session work. They can see the point of it” (Respondent 4). 9 The iTunes Universities and Colleges site 65 4.4.4 Soft Skills Although the primary use of SL was based around practising clinical skills, two lecturers suggested that it could be used for sessions based around some of the soft skills that students would need to achieve. One lecturer felt that SL could be used for activities that required SPs: “The opportunities of using a system like Second life is the possibility of engaging and interesting virtual learning, where 3D simulations could be used remotely (or in a classroom setting/using a computer lab) to teach students specific (…) communication skills. There is a potential for replicating realism, using simulated patients/actors” (Respondent 6). Conversely, another lecturer did express their concerns about SL being used to replace simulated patients. 66 5 Conclusion This research aimed to obtain a clearer perspective on how academic staff within the FHSC viewed SL as an educational tool. According to the findings that were determined within the Literature Review, the results obtained and discussed within this research were very similar to those illustrated in a variety of educational environments. But it must be stated that the conclusions reached here are specific to the environment of the FHSC. Bearing this in mind, it can be said that there are clear conclusions regarding academic staff‟s perceptions of SL as a teaching resource. The first conclusion is that most lecturers within the FHSC view SL as a 3D game or social network, and in some cases, confuse it with other eLearning environments. These perceptions can have a significant impact on whether academic staff would consider using SL as an educational resource. But this study also shows that although lecturers may not view SL as an educational resource, they have positive attitudes towards its implementation, as long as adequate training is provided, and that it is not adopted with a view to replacing all clinical skills training. Although lecturers viewed SL as a new teaching resource, they were also concerned about some of its potential affects on their students and their role as educators. This included dealing with the unpredictable, such as unwelcome visitors joining in during an in-world class, a concern acknowledged by several writers within the Literature Review (Broadribb et al., 2009; McKeown, 2009; Savin-Baden, 2010b; Stott, 2007; Sant, 2005; Sant, 2009, Wood, 2010b). This research also identified worries about students becoming addicted to the immersive environment, and not being able to 67 control a conversation that could affect a student‟s professional suitability10 (see Appendix B). Interview evidence confirmed that academic staff could see the value in using SL as an eResource within the FHSC. SL was viewed as an environment where students could practise scenarios or clinical skills at their own pace, and therefore not having to worry about any peer pressure. Other advantages that were cited included saving time and money, which are usually associated with travel, although these advantages can also be associated with other forms of distance learning (Salmon, 2003). However, other benefits seemed to be linked to classroom management issues, especially the discipline of younger students who use Web 2.0 resources on a daily basis. These included the interactive and immersive aspects of the environment, the fact that SL makes learning „fun‟, and its appeal to generations brought up with technology. Some academic staff implied that the use of colourful multimedia and interactive tools was necessary in order to keep younger students engaged. This research also showed that the main advantage that participants associated with SL was the fact that it could be used to simulate „real life‟ scenarios that could occur in a medical setting, without either the patients or the students being in danger. This confirmed Greenshaw‟s (2008) claim that SL can be used when the facilitator adopts a behaviourist teaching approach, where nursing students can keep practising a procedure until it becomes second nature. 10 For instance, discussing a confidential matter about a patient 68 Although several educational benefits were identified in this research, interviews also showed what academic staff perceived as the more challenging aspects of the environment. One of the main challenges identified by lecturers was the technical aspect of SL. One of their concerns included the technological equipment required, both on campus and from individuals‟ homes, supporting the findings of Hewitt et al. that “many of the students interviewed use older computers that do not have the graphics cards required to support Second Life” (Hewitt et al., 2009:4). It was also suggested that some individuals, both lecturers and students, may feel uneasy with such a new resource. They may not be able to access the resource from home, due to its high bandwidth requirements, or may not view such an immersive environment as a valid teaching resource. The interview evidence confirms Anderson‟s (2009) findings that having to learn how to use a resource like SL can make accessing education a steep learning curve for certain students. Additionally, the evidence shows that academic staff are concerned about the technical skills that individuals would need in order to access the environment. Therefore, the next conclusion is that effective training and involvement of academic staff plays a crucial part in the successful implementation of SL. This study showed that some lecturers seemed to confuse SL with other eLearning resources. If academic staff are confusing an immersive environment like SL with a VLE, they will not be aware of the educational advantages and the potential use of such a resource. The findings from this research show that some teaching staff fear not being able to control the class within SL, a point made by both Stott (2007) and Broadribb et al. (2009). There is also evidence of lecturers being concerned about replacing real-life practice with simulations and wasting class time dealing with technical problems 69 instead of teaching. But as Belei et al. (2009) point out, most of these concerns can be alleviated by providing a demonstration to staff. However, just providing the initial demonstration and training alone does not suffice. There should be ongoing training, which could include help with integrating the technology into the curriculum, peer support groups, taster sessions, one to one training, and adequate equipment. As illustrated by Calongne (2008), students would also need to be given adequate training and support while they learn how to use what is a new, and possibly daunting, learning environment. Interviews conducted for this thesis identified concerns about the amount of time academic staff would need to invest in the new resource. This included the time they would need to spend attending training as well as the time they would require to develop a resource within the environment. Lecturers would therefore need workload adjustments in order to be given adequate training and to be able to implement the teaching resource into their lesson plans. Some concerns were expressed about being able to access SL on campus without experiencing problems with the institutional firewall. In order to deal with these issues, there will need to be an adequate infrastructure within the FHSC and the UoH, which will provide lecturers with the training and technical support they will require. Another issue that was brought up by academic staff was how individuals‟ online identities would be affected by their use of SL. Some were concerned that SL seemed to put an emphasis on the appearance of avatars, which could result in students spending too much time focusing on their online appearance and not enough time on learning. This theory is also confirmed by the findings prefigured within the 70 Literature Review, notably the reports by Richardson and Molka-Danielsen (2009) and Wood (2010b), who identified problematic issues related to online identities in VWs. This issue could be resolved by giving a member of staff within the FHSC or the UoH the task of setting up some pre-defined avatars (Savin-Baden, 2010b), which would then be used for in-world classes. It would therefore not be necessary for staff or students to invest time in setting up their own avatar, thus saving time that could be spent on learning how to navigate around SL. Overall, the results of this study show that although academic staff may have concerns about SL, they also view it as a safe environment where students can practise complicated or dangerous scenarios without putting patients at risk or failing an assessment thanks to its immersive attributes. This theory is also confirmed by Ball and Pearce (2009), Savin-Baden (2010b) and Galik (2008). Lecturers‟ preconceived ideas about SL can only be changed if they understand the real opportunities this new technology brings to education within nursing and midwifery, and how it would fit in with their current approaches to teaching. With one of the UoH‟s key objectives being to embed innovation into its teaching, the FHSC should consider whether it wishes to adopt SL in order to bridge the gap between theory and practice, an issue that is often brought up by student nurses and midwives. The final conclusion is therefore that the FHSC should pilot some clinical skills lessons within SL in order to determine whether it could be used as a valuable teaching resource. All participants acknowledged the current gap between theory and clinical practice. They therefore viewed SL‟s immersive environment as a good resource that could bridge this gap and allow students to learn important skills using a 71 behaviourist teaching approach, thus resulting in students being able to manage difficult situations should they occur in practice. This reinforced Belei et al.‟s evidence that SL could provide “a promising and effective means to bridge the gap between theory and practice” (2009:118). The pilot could be carried out by using another Institution‟s teaching resource within SL, or by temporarily renting a virtual building from Linden Labs in order to test the environment, a facility that is offered to educational institutions considering the adoption of SL as a teaching and learning environment. Looking in retrospect, I realise that there were some important issues that could have been researched in more depth, such as how online identity and presence in 3D immersive worlds could affect students and facilitators, and the impact of an in-world breach of confidentiality on students‟ professional suitability and the reputation of the FHSC. Moreover, other factors not covered by this research, such as age, gender, educational background, teaching experience and individuals‟ technology ready background should also prove useful in future studies on the use of SL in nursing and midwifery training. 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Available: http://www.ucdmc.ucdavis.edu/ais/virtualhallucinations/ [Accessed 5 April, 2010]. 86 7 Appendix A 7.1 Table 1 Literature Search and Exclusion Criteria Source Search Criteria “Second Life” AND Education AND Nursing “Second Life” AND Education AND Nursing Nursing AND Midwifery AND Training AND University AND “Second Life” Virtual World AND Education AND Nursing “Second Life” AND Education AND Nursing Returns 41 96 444 12 2 Educause GoogleScholar Google JISC Infonet ProQuest The sources of information illustrated in Table 3 result from the above reference searches (Table 1) in order to ensure that all relevant papers were included. Papers were included if they contained narrative or description reports, which related to issues of education in virtual worlds. Papers were excluded if they did not contain data from reliable sources and if they were reported in a language other than English. Because the adoption of virtual worlds in higher education is an emerging technology, very few papers (if any) were returned from database searches. Google was therefore used to search for any relevant papers and a contents analysis of books was carried out through a retailer‟s website. Papers that were recommended by colleagues were also included if they were relevant to this research. 87 7.2 Table 2 Literature Search Inclusion and Exclusion Criterion Original criteria used Further criteria used Inclusion criteria Seminal literature Exclusion criteria Reports on virtual worlds that were not related to education Inclusion criteria Peer reviewed journals Exclusion criteria Papers on virtual worlds that were published before 2000 Papers on identity that were published before 1985 Papers not published in English Papers with no relation to the research question Primary research Secondary studies The selected papers included seminal literature, primary research, secondary studies and peer reviewed journals (Table 2). 7.3 Table 3 Literature Summary Author(s) Emerging Themes Using Second Life as social and educational environment for disabled members Learning through simulation Technical skills required to use Second Life The cost of implementing and using Second Life in a Higher Education Institution Sources Google search Abrahams, 2006 Aldrich, 2009 Contents analysis of books Anderson, 2009 Technical skills required to use Second Life Online identity and presence Contents analysis of books 88 Author(s) Atkins and Caukill, 2009 Emerging Themes Technical equipment required to run Second Life Learning through simulation Using Second Life to run an health information outreach centre Using Second Life as social and educational environment for disabled members Sources Contents analysis of books Contents analysis of books Ball and Pearce, 2009 Baylor and Ritchie, 2002 The BBC, 2010 The BBC, 2011 Belei et al., 2009 Implementing the use of technology in education Access to high speed broadband Addiction of 3D immersive worlds Learning through simulation Technical equipment required to run Second Life Google search Google search Google search Contents analysis of books Contents analysis of books Contents analysis of books GoogleScholar search Google search GoogleScholar search Bignell, 2008 Boellstorff, 2008 Boulos, 2008 Boulos, 2010 Boulos et al., 2007 Learning through simulation Addiction of 3D immersive worlds Technical equipment required to run Second Life Technical equipment required to run Second Life Using Second Life as social and educational environment for disabled members Using Second Life for Medical Training Boulos and Toth-Cohen, 2009 Bray, 2007 Using Second Life to run an health information outreach centre Using Second Life as social and educational environment for disabled members GoogleScholar search Google search 89 Author(s) Broadribb et al., 2009 Emerging Themes Classroom management and dealing with the unpredictable in Second Life Setting up on-campus computer so that they can access Second Life Sources Contents analysis of books Bugeja, 2007 Burk, 2010 Burke and Stets, 2009 Business Wire, 2008 Cable.co.uk, 2011 Calongne, 2008 Camargo, 2007 Using Second Life in Higher Education Learning through simulation Multiple identities theory Learning through simulation Benefits of offering broadband to rural areas Using Second Life in Higher Education Technical skills required for eLearning Training and support Using social networking sites safely Technical skills required for Second Life Training and support in using Second Life Google search GoogleScholar search Contents analysis of books Google search Contents analysis of books Educause Recommendation Carlowe, 2009 Carr et al., 2010 Google search Contents analysis of books Carter, 2009 Childs, 2010 Chou, 2003 Clark, 2007 Clark, 2009 Collins, 2008 Changes in pedagogy due to new teaching environments Online identity and presence Educators‟ pedagogical beliefs Using Second Life for Medical Training Using Second Life for Medical Training Technical skills required for Second Life Online identity and presence Using Second Life in medical training Multiple identities 90 Contents analysis of books Recommendation Google search Google search Recommendation Educause search Dalgarno et al., 2010 Deaux, 1996 Recommendation Contents analysis of books Author(s) De Freitas, 2006 Dev et al., 2007 Dillenbourg et al., 2002 Dudeney and Ramsay, 2009 Ellaway and Topps, 2010 Errington, 2001 Essid, 2009 Galik, 2008 Emerging Themes Learning through simulation Learning through simulation Learning through simulation Using Second Life in higher education Using Second Life for Medical Training Educators‟ pedagogical beliefs Adaptive tools to help Disabled members use Second Life Learning through simulation The cost of implementing and using Second Life in a Higher Education Institution Sources JISC search GoogleScholar search GoogleScholar search Contents analysis of books Contents analysis of books Contents analysis of books Google search Contents analysis of books Gergen, 1991 Geteducated.com, 2010 Gibson et al., 2007 Gorini et al., 2008 Greenhaw, 2008 Hansen et al., 2008 Multiple identities Learning through simulation Learning through simulation Online identity and presence Learning through simulation Using Second Life as social and educational environment for disabled members Learning through simulation Using Second Life for Medical Training Technical skills required to use SL Contents analysis of books Google search GoogleScholar search GoogleScholar search Google search Google search Heiphetz and Wooddill, 2010 Hewitt et al., 2009 Contents analysis of books GoogleScholar search Contents analysis of books GoogleScholar search GoogleScholar search Contents analysis of books GoogleScholar search Hickey-Moody and Wood, Using Second Life as social 2010 and educational environment for disabled members Holly et al., 2008 Huang, 2002 Behavioural teaching and eLearning Constructivism and e-learning Jæger and Helgheim, 2009 Technical equipment required to run Second Life Jaime, 2007 Using Second Life as social and educational environment for disabled members 91 Author(s) Jaime and Mauricio, 2005 Emerging Themes Using Second Life as social and educational environment for disabled members Online identity and presence Online identity and presence Online identity and presence Training and support in using Second Life Classroom management and dealing with the unpredictable in Second Life Using Second Life as social and educational environment for disabled members Addiction of 3D immersive worlds Sources Google search Jarmon, 2009 Jarmon et al., 2009a Jarmon et al., 2009b Johnson, 2010 Johnson, 2008 Recommendation Recommendation Contents analysis of books Contents analysis of books Educause search Joinson, 2003 Contents analysis of books Joly, 2007 Jones, 2001 Kelly, 2004 Kelton, 2008 Kemp, 2006 Kennedy and Kennedy, 1996 Kuiper and Pesut, 2004 Lamont, 2006 Leh, 1995 Linden, 2007 Love et al., 2009 Learning through simulation Online identity and presence Technical Skills Addiction of 3D immersive worlds Technical skills required to use Second Life Using Second Life for Medical Training Educators‟ pedagogical beliefs Constructivism and e-learning Technical skills required to use Second Life Adoption of educational technology Google search Google search Contents analysis of books Educause search Google search GoogleScholar search GoogleScholar search Google search Google search Implementing a voice system in Google search Second Life Learning through simulation Online identity and presence The cost of implementing and using Second Life in a Higher Education Institution 92 Contents analysis of books Author(s) Lu, 2008 Lu, 2011 Emerging Themes Online identity and presence Change in teaching methods when adopting the use of Second Life as a teaching environment Learning through simulation Learning through simulation Using Second Life as social and educational environment for disabled members Multiple identities Learning through simulation Classroom management and dealing with the unpredictable in Second Life Using Second Life as social and educational environment for disabled members Using Second Life for training Online identity and presence Using Second Life as social and educational environment for disabled members Learning through simulation Learning through simulation Experiential learning Professional suitability and guidelines in nursing and midwifery Using social networking sites safely Learning through simulation Using Second Life as social and educational environment for disabled members Sources GoogleScholar search Contents analysis of books Maguire, 2005 Martin Mahar and Mahar, 2009 Markus and Nurius, 1986 McConville and Lane, 2006 McKeown, 2009 GoogleScholar search Contents analysis of books Google search GoogleScholar search Contents analysis of books Google search Milena et al., 2007 Miller et al., 2009 Molka-Danielsen, 2009 Morse et al., 2009 Contents analysis of books Contents analysis of books Contents analysis of books GoogleScholar search GoogleScholar search Contents analysis of books Recommendation Murphy et al., 2008 Murray et al., 2007 Nicklin and Kenworthy, 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The NMC, 2004 The NMC, 2011 Nonis, 2005 Norris, 2009 Recommendation Google search Recommendation 93 Author(s) Novint, 2011 Emerging Themes Using Second Life as social and educational environment for disabled members Dealing with the unpredictable Technical skills required for Second Life Constructivism and e-learning Online identity and presence Technical skills Using Second Life as social and educational environment for disabled members Online identity and presence The cost of implementing and using Second Life in a Higher Education Institution Professional suitability in nursing and midwifery Technical skills required for Second Life Using Second Life and other VLEs as educational environments for disabled members Online identity and presence Learning through simulation Using Second Life as social and educational environment for disabled members Classroom management and dealing with the unpredictable in Second Life Classroom management and dealing with the unpredictable in Second Life Change in teaching methods when adopting the use of Second Life as a teaching environment Online identity and presence 94 Sources Google search Oliver and Reschly, 2007 O‟Toole, 2006 Peters, 2000 Richardson and MolkaDanielsen, 2009 RNIB supporting blind and partially sighted people, 2007 Robbins, 2008 Robbins and Bell, 2008 GoogleScholar search Google search GoogleScholar search Contents analysis of books Google search Google search Contents analysis of books Google search Contents analysis of books Contents analysis of books Rose, 2009 Rufer-Bach, 2009 Salmon, 2003 Salmon and Hawkridge, 2009 Salomon, 2011 GoogleScholar search Contents analysis of books GoogleScholar search Sant, 2005 Sant, 2009 Contents analysis of books GoogleScholar search Saven-Baden, 2010a Author(s) Saven-Baden, 2010b Emerging Themes Changes in pedagogy due to new teaching environments Using Second Life for Medical Training Learning through simulation Online identity and presence Addiction of 3D immersive worlds The cost of implementing and using Second Life in a Higher Education Institution Training and Support Sources Contents analysis of books Schoeder, 2002 Schwarzwalder, 2008 Science Blogs, 2007 Online identity and presence Technical equipment needed for Second Life Using Second Life as social and educational environment for disabled members Using Second Life as social and educational environment for disabled members Learning through simulation Contents analysis of books Contents analysis of books Google search Scientist, 2009 Google search Second Life, 2011a Recommendations on the Second Life homepage Recommendations on the Second Life homepage Recommendations on the Second Life homepage Google search Second Life, 2011b Using Second Life for Medical Training Technical equipment needed for Second Life Using Second Life as social and educational environment for disabled members Technical skills required to use Second Life Using Second Life for medical training Learning through simulation Constructivist learning theory Second Life, 2011c Sharp, 2008 Sherblom et al., 2009 Skiba, 2007 Contents analysis of books ProQuest search 95 Author(s) Skiba, 2009 Slenter.com, 2009 Emerging Themes Using Second Life for medical training Using Second Life as social and educational environment for disabled members Addiction of 3D immersive worlds Classroom management and dealing with the unpredictable in Second Life Learning through simulation Addiction of 3D immersive worlds Addiction of 3D immersive worlds Addiction of 3D immersive worlds Learning in immersive environments Online identity and presence Using Second Life for Medical Training Using Second Life for Medical Training Using Second Life for Medical Training Learning through simulation Using Second Life as social and educational environment for disabled members Using Second Life as social and educational environment for disabled members Online identity and presence Using Second Life as social and educational environment for disabled members 96 Sources ProQuest search Google search Smith, 2009 Stott, 2007 Google search Google search Strangman and Hall, 2003 The Telegraph, 2009 The Telegraph, 2011 Thackray et al., 2010 Thompson, 2008 Turkle, 1996 University of Ohio, 2007 University of Plymouth, 2008 University of Southampton, 2004 Van Weigel, 2002 Virtual Ability, 2011 Google search Google search Google search Contents analysis of books Contents analysis of books Contents analysis of books Google search Recommendations on the Second Life Homepage Google search Contents analysis of books Google search VirtualWorldsNews, 2007 Google search Waggoner, 2009 Wood, 2010a Contents analysis of books GoogleScholar search Author(s) Wood, 2010b Emerging Themes Learning through simulation Online identity and presence Classroom management and dealing with the unpredictable in Second Life Technical Skills The cost of implementing and using Second Life in a Higher Education Institution Training and Support Sources Contents analysis of books Yair et al., 2001 Yellowlees and Burrage, 2004 Learning through simulation Learning through simulation Using Second Life for Medical Training Google search Google search 97 8 Appendix B 8.1 Figure B-1: Reminder about confidentiality posted to eBridge UoH 98