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Games For Health: Why You Should Care About Virtual Worlds

Why should the health industry be interested in virtual worlds? At the Games For Health conference, researchers from technology and medical fields said studies have found virtual training to be just as effective as physical simulations, and showed how an
The importance of virtual worlds has been frequently declared, both in regards to financial potential as well as cultural significance. During the recent Games For Health conference in Baltimore, four researchers and virtual world entrepreneurs spoke on how the growing segment could be key in health education as well. Tim Holt, Oregon State University Oregon State University assistant researcher (and Day of Defeat developer) Tim Holt opened the session with the question, "Why should you make a virtual world?" He touched on not just the incentives for entering the space, but some of the pitfalls as well. He started off with the basics: virtual worlds are for social interaction, so if your project doesn't demand that, it may be overkill; virtual worlds demand a huge space for reactions between participants; and virtual worlds must have persistent environments as well as persistent character identities. Still, there is a vast amount of range in the segment. Holt noted that when considering online worlds, many immediately think of Second Life - but that full, explorable 3D space is only one possible model. Web-based 2D worlds such as Whyville and Club Penguin are not only equally effective at creating social interaction, he pointed out, but are also much more accessible, requiring only a web browser. On the other end of the spectrum, Holt cited Avatar Reality's ambitious upcoming sci-fi virtual world, Blue Mars, a particularly complex example. Such levels of complexity could be necessary for certain medical simulations, he pointed out. In short, said Holt, virtual worlds come in all shapes and sizes depending on the project's needs. "Don't use a two-ton truck when a bicycle will do," he cautioned. Patricia Youngblood, Stanford University School of Medicine After Holt's introduction to the topic, Patricia Youngblood of Stanford University's Medical Media & Information Technologies (SUMMIT) spoke on her group's experiments with virtual world simulation programs in medical training applications. Youngblood has been interested in virtual worlds since 2004, experimenting with the now-defunct Adobe Atmosphere software. The group's simulation trains people to treat victims of radiological weapons ("dirty bombs"), nerve agents such as sarin, trauma, mass casualties, and other disasters. In the simulation, invisible instructors watch trainees interact with victim avatars and later review performance alongside recorded gameplay footage. This virtual approach has numerous advantages, including the ability to easily replicate layouts of real locations, the ability to model a variety of patient conditions, geographical independence between the trainees and instructors, ease of repetition with multiple trainees, straightforward and accessible recording of performance for later viewing, and overall cost effectiveness. Most importantly, randomized control trials with 30 medical students showed that virtual world training was just as effective as physical simulations in a team training context. It also allows trainees flexibility of hours - as one user said, "It's great because I'm a nurse and I work the night shift, and whenever there's training I don't get to do it." John Miller, RN, MN, Tacoma Community College Echoing many of the sentiments of Youngblood's talk, Tacoma Community College RN nursing instructor John Miller spoke on his experiences using Second Life in his work. Tacoma Community College is a small school with 200 nursing students and a 3-4 year program. Miller said that the real difficulty with physical mannequin-based training at instutitions like his is not in the cost of the materials, but rather in the staff and facilities required to support it. Training in a world such as Second Life, however, is much lower-cost, with a $20,000 grant enough to get a program started. Showing his program to a 92-year-old potential donor generated a lot of interest - "If I can communicate this to a 92-year-old guy who's hard of hearing, I can show it to anyone," said Miller. However, accessibility problems can arise elsewhere - such as with his colleagues. Other professors often have trouble even reliably using email, he said, let alone embracing a virtual world. Part of the solution may be "waiting until everyone retires," he said. Despite that barrier, there are numerous advantages to training in Second Life, which he pointed out doesn't need to be exactly like real life, merely close enough such that the situations are recognizable and useful. In addition to the training advantages, such as those pointed out by Youngblood, there are tangential benefits such as increased awareness of other cultures, nationalities, and languages, an inherent part of online interconnectedness. The fluid nature of online worlds also lends themselves to certain potential real-life situations, such as making a call as to which patient should be treated first when several arrive simultaneously. "Health care has to be intuitive, you can't just follow the manual," said Miller. As an aside, Miller pointed to incident in which a Second Life player was demonstrating suicidal tendencies. Players were unable to deal with the situation through traditional means because they did not know where the person was located in the physical world, but there was an actual suicide prevention group within Second Life that was brought to bear. James Bower, Whyville Dr. James Bower is a neuroscientist and professor at the University of Texas at San Antonio, but he is also chairman and CEO of Numedeon, a developer of educational virtual worlds. The company's most high-profile project is Whyville, a preteen- and child-targeted virtual world launched in 1999. Whyville's population is two-thirds female, with an average player age of 12.5 years. It focuses on science and math, but attracts its players on the strength of its social component and, as Bower puts it, because it is "a place where you're encouraged to be smart - unlike the real world." "We care about real issues in Whyville," said Bower. The world attempts to infuse its users with knowledge gained through a "pull" educational structure - the participants seeking out the knowledge themselves - rather than the "push" structure that is dominant in more traditional education, which Bower criticizes as being a holdover from the Middle Ages. As an example, Bower pointed to an in-game program to encourage healthy eating. Consuming poor foods plagues avatars with conditions such as scurvy and osteoporosis, which has a negative visual effect. Players are then able to read nutritional information and plan better eating habits. Interestingly, players attempted to contract scurvy as fast as possible - but doing so led them to be "more educational than the ways you planned." It led to 587,000 visits to the in-game dietitian, who offers recommendations rather than strict orders. A fictional disease called Y-Pox was released on Valentine's Day; afflicted girls are stricken with acne as well as a more debilitating chat-erasing sneeze. Affected players did not simply leave, Bower pointed out, they attempted to figure out how to return to health. This then led to 134,000 virtual flu shots. "After I got my grandmother virtually vaccinated, I bothered her every day to get really vaccinated," said Bower. The in-game epidemic even generated real-world scholarly papers. Attempts to make viruses as virulent as possible encouraged players to take matters into their own hands, resulting in the community setting up in-game vaccine research companies. "Twelve-year-olds know as much about biotech as doctors in universities," Bower said. Bower wrapped up his talk with his own list of benefits and potential pitfalls of using virtual worlds for health education. On the plus side is the integration of education into a real community - humans like learning socially, a fact that the gaming industry has proven over time. For a certain age group, such as tweens, such worlds can in many ways be their "first life." Finally, the virtual nature of these environments produces "metrics like you wouldn't believe," as he put it. On the other hand, virtual worlds are a significant investment of resources. Factors like community management and design are not trivial. "Just mapping what's done in the real world into the virtual world isn't going to get done what you want to get done," Bower cautioned. A clear mission, goal of what needs to be measured, and pre-existing knowledge and experience are also important, he stressed. To researchers, he advised not to go it alone first - rather, work with people who know the space. "You will be shocked at the consequences, as we have been," he said.

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