Virtual Worlds, Real Gains
It's clear from the start that this isn’t your standard professional development fare. There’s a replica of the Colosseum, for one thing, as well as a dance floor, an underwater classroom, and chickens wandering freely through the grounds. Welcome to the private, pixelated island where John Wiecha, director of the medical education office and assistant dean of academic affairs at the School of Medicine, is testing the efficacy of virtual world platforms for delivering information to health care professionals and patients alike.
“Motivational interviewing is about engaging you and finding out what your values are and what’s important to you, and why you’d want to change.” John Weicha
Wiecha successfully piloted a postgraduate medical education program in Second Life last year, with results published in the Journal of Medical Internet Research. The most well-established and stable online virtual world platform, Second Life has approximately 18 million users, a terrain comparable in size to the city of Houston, with the bonus of being free. Program participants were trained to use Second Life and given avatar identities. They then logged in from seven states and Switzerland to attend a series of presentations on how to administer insulin in patients with diabetes, led by content expert Dr. Elliot Sternthal. By the end of the study, participants’ knowledge of how much insulin to provide and when had increased, as had their confidence.
“A lot of primary care doctors are a little reluctant to use insulin in patients,” says Wiecha. “So we would have mock patients show up halfway through the program, and the doctors would interview them,” while a screen behind displayed blood sugar values and other relevant patient information. Program participants enjoyed the chance to test their newly acquired skills on mock patients, and also praised the added sense of presence afforded by a representative avatar.
“It’s much different than participating in a webinar, where you can kind of check your email while you’re doing it. Here you really have to stay engaged,” says Wiecha, who is also an associate professor of family medicine.
Another advantage to Second Life is its capacity for constant engagement and feedback between an instructor and participants. A second project by Wiecha, Dr. Suzanne Mitchell, and Robin Heyden—an instructional design consultant who has played a key role in building the site, training users, and converting session content from experts into effective and compelling online presentations—capitalized on this potential by using Second Life to teach motivational interviewing skills to physicians.
“Motivational interviewing is a particular approach to communication around behavior change with patients,” says Wiecha. “Rather than the usual mode—a very top-down, paternalistic approach: ‘You should quit smoking, you should exercise more’—motivational interviewing is about engaging you and finding out what your values are and what’s important to you, and why you’d want to change. It’s much more effective than the usual method, but it’s a particular set of skills that need to be taught and practiced.”
His current project, with co-principal investigator Milagros C. Rosal of the Division of Preventative and Behavioral Medicine at the University of Massachusetts Medical School and funding from the National Institutes of Health, is also based on motivational interviewing techniques. This time, participants in the virtual world will be patients, not doctors: black women with uncontrolled type 2 diabetes. Once patients’ baseline measurements have been taken and they have been trained how to use Second Life, study participants—who are being given Apple laptops and 4G modems—will undergo eight weeks of group and individual counseling sessions to “help them identify what their goals are for lifestyle change, which is the key to diabetes control,” says Wiecha. A control group will participate in face-to-face sessions at Boston Medical Center.
Questions remain: are participants more likely to be compliant in a virtual world than in face-to-face sessions? Will virtual exercise encourage patients to increase physical activity in their own lives?
“When we work and play in these virtual spaces, what impact do those experiences have on our real selves?” asks Heyden. “We don’t know, but we’re very interested in finding out.”