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Checking up on virtual patients

May 2009
Caren B. Les,

As part of a research project on game-based learning, third-year medical students at Imperial College London have practiced diagnosing virtual patients in a respiratory ward within the Web-based 3-D simulated world of Second Life. They have gone through the process of logging in to the world, creating their avatar persona and navigating it to reach the specially designed virtual hospital.

There, at the reception area, the students-as-avatars begin their training in protocols for the diagnoses of patients with respiratory illnesses. Having picked up their assignment, they go to the patient’s room, where they can access information such as a recording of a real-life patient’s breathing. They also can call for x-rays if needed and can base their diagnosis on the results. Investigations are halted if students forget a part of the protocol, such as hand washing.

Game-based learning

The Faculty of Medicine at the college has been developing the virtual hospital in Second Life with the aim of providing game-based experiential, diagnostic and role-playing learning activities supporting patients’ diagnosis, investigation and treatment.

Opportunities for students to train in tandem with real-life patients have decreased. There is less time for face-to-face teaching because of a shortage of doctors and an increase in the number of medical students. Medical educators are exploring digital technology as an option for clinical teaching, taking into consideration that most students in their 20s are game-literate, having grown up with technology such as video games, DVD players, mobile phones and the Internet. Investigators at Imperial College are assessing the feasibility of virtual medical training and assessing student attitudes toward it.

Phase 1 of their project was carried out with the delivery of one virtual patient following a game-based learning model in Second Life. The study was conducted in March 2008 with 42 student participants. Divided into two groups, the students were selected based on their gender and their level of experience playing video games.

One group of 23 students was given access to the game-based learning activity for a virtual patient on respiratory medicine developed in Second Life, and the other group was given access to the same virtual patient, covering the same content but delivered as an interactive e-module.

Students in both groups were asked to complete surveys to record their feelings about their respective learning experiences. Still in progress, the Phase II project involves a multipatient approach and 50 students who have been exposed to the environment on a controlled learning activity.

In the digital world of Second Life, a medical student-as-avatar approaches a virtual patient as part of a project to evaluate the feasibility of game-based training in the medical field. Photos courtesy of Imperial College London.

Attitudes vary

“We found that students had various attitudes toward using game-based learning to access virtual patients in Second Life,” said Maria Toro-Troconis, senior learning technologist for the Faculty of Medicine at Imperial College. She noted that the investigators have not finished analyzing the data collected during the second pilot study, but that during the first study, they found no significant differences between high- and low-experienced gamers in relation to their attitude when learning in this environment. No significant differences in attitude were found in relation to gender either, which contradicts the general view that games are for boys and not for girls, she said.

The main advantage is having a 24/7 immersive environment available to students in which collaborative activities can take place, said Toro-Troconis, adding that the main disadvantage is the tedious process of getting students enrolled in Second Life. Another current disadvantage is the unfamiliar interface, which makes learning challenging until students become familiar with it. “We envisage expanding our game-based activities,” Toro-Troconis said.

A medical student-as-avatar participates in a training session in a virtual hospital.

To find links, additional information and video demonstrations of the inworld (avatars representing people from all over the world) project, visit Imperial College’s site at The virtual respiratory ward is open to the public and gets about 70 visits per day, according to Toro-Troconis.

Created in 2003 by Linden Lab of San Francisco, Second Life is a virtual world that can be accessed via the Internet. Inworld avatars live, work, shop, socialize, play music, attend classes, sell real estate, conduct business and participate in conferences and job interviews. They communicate in real time and are not bound by the constraints of geographical location.

Another article on Second Life was published in the October 2008 issue of Photonics Spectra and can be viewed at

To explore Second Life, visit


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