A virtual world is a computer-based, simulated multi-media environment, usually running over the Web, and designed so that users can ‘inhabit’ and interact via their own graphical self representations known as avatars. Linden Lab's (http://lindenlab.com/) Second Life (http://slife.com/) is perhaps the most popular virtual world platform in use today, with an emphasis on social interaction (other platforms also exist, e.g. There—http://www.there.com/ and Active Worlds—http://activeworlds.com/).
The population of Second Life has more than doubled since January 2007, and, as at 2 May 2007, has reached more than six million virtual citizens or ‘Lifers’, all with their own fully textured high-resolution avatar that can be finely customized to the nth degree. Second Life also has a thriving economy that currently boasts millions of US dollars in monthly transactions via the in-world unit-of-trade, the Linden dollar, which can be converted to US dollars at a number of online Linden Dollar exchanges.1,2
The popularity of Second Life is well deserved thanks to its host of advanced technologies (e.g. a unique in-world weather system, with realistic day–night cycle support)3 which, combined, place it well above all other virtual world platforms on the market today.
Three-dimensional (3-D) virtual worlds like Second Life can be considered as 3-D social networks, where people can collaboratively create and edit objects in the virtual world (like a collaborative 3-D wiki space), besides meeting each other and interacting with existing objects. (The reader is referred to Kamel Boulos & Wheeler4 for a detailed discussion of conventional social networks and wikis.)
Compared with the conventional 2-D Web, virtual worlds offer novel, intuitive ways to:
- • navigate multi-media content (streaming audio/video/TV collections—see, for example, Second Life SONY BMG Music Entertainment on Media Island);5
- • browse information spaces/document collections in 3-D virtual libraries (see, for example, Second Life Medical and Consumer Health Libraries in Healthinfo Island6—described below);
- • relax, visit new places, and sample new cultures (virtual tourism, e.g. visit Virtual Morocco in Second Life7 or Egypt's pyramids and Sphinx in There.com);
- • play multi-player games in the virtual world, including educational, health related games;8
- • buy, sell and advertise virtual and real-life goods and services—many real-world, famous brand names have already established a presence in Second Life;9
- • develop social skills (and even clinical skills—see, for example, Second Life Heart Murmur Sim,10—described below)/socialize and interact with other people via customisable, realistic, 3-D, fully textured and animated avatars (3-D social networking);
- • attend and participate in live events like Second Life lectures, conferences, festivals, and concerts; and build communities, including learners’ communities and patient support groups, among many other things.
The latest Second Life client also supports advanced, realistic voice chat (in addition to text chat and instant messaging), featuring 3-D-mapped voice with ‘audio focusing’ capabilities and speech gestures.11 (As a user walks around someone who is speaking to them in Second Life, they will hear the voice move around in 3-D, based on where they are relative to that avatar. If the user turns toward someone who is speaking and moves closer, the voice will get louder. Also, as each speaker's volume is attenuated/boosted by their distance from the user's camera position in Second Life, the user can thus use the camera controls to create a momentary ‘audio focus’ on a given speaker. Speech gestures are customizable head, arm/hand and body movements that animate an avatar while speaking, and are triggered by different speech intensity levels.) A voice-changing Windows software driver [like Screaming Bee (http://www.screamingbee.com/)] can be optionally used to hide the speaker's identity, or just for some added fun!
The potential of such a rich and engaging experience in education must be great. In fact, real and virtual world conferences have been (and are being) organized to explore and discuss the educational potentials of Second Life,12–14 while a recent project, Sloodle (for Second Life (SL) + Moodle—http://sloodle.com/), developed a mashup between Second Life and the popular learning/course management system, Moodle (http://moodle.org/).
Furthermore, in April 2007, the New Media Consortium (NMC—http://www.nmc.org/), an international, US-based not-for-profit consortium of nearly 250 learning-focused organizations dedicated to the exploration and use of new media and new technologies, advertised the availability of low-cost Second Life educational sims (land parcels with pre-built educational facilities) for rental to educational institutions.15 Indeed, in a virtual world, educational institutions and educators can create online communities that students can log into and interact in. Within these educational virtual worlds, students can, among other things, use their avatar to learn about new assignments and to create projects that are viewable within the virtual world.16,17
In the next section, we describe some medical and health education examples from Second Life, including Second Life Medical and Consumer Health Libraries (Healthinfo Island), and VNEC (Virtual Neurological Education Centre). The pedagogical potentials of Second Life are then discussed, as well as some issues and challenges related to the use of virtual worlds. We have also compiled a companion resource page (http://healthcybermap.org/sl.htm), with additional up-to-date online material and pointers to support and extend this study.
Medical and health education examples from Second Life
Second Life currently features a good number of medical and health education projects (see the ‘key presentation’ entitled ‘Second Life in Medical and Health Education: A Quick Visual Tour’ and the section entitled ‘Top educational locations in Second Life’, both at http://healthcybermap.org/sl.htm).
For example, at the Ohio University Sim in Second Life, visitors can play a ‘Nutrition Game’ to learn about the impact fast food has on health.8 This is achieved by allowing players to experiment with different eating styles in simulated fast-food restaurants to learn about the short- and long-term health impacts of their choices. The goal for an individual player is to make healthy choices that will result in a high score for the game and a positive effect on health.18
The Heart Murmur Sim in Second Life10,19 is another example. Conceived by Jeremy Kemp, an instructional designer at San José State University, CA, USA, it provides an educational virtual world for cardiac auscultation training that allows visitors (clinical students) to tour a virtual clinic and test their skills at identifying the sounds of different types of heart murmurs, based on sound files from McGill University's Virtual Stethoscope project (http://sprojects.mmi.mcgill.ca/mvs/mvsteth.htm).
Readers interested in genetics should visit the Gene Pool in Second Life.20,21 This is an interactive genetics lab/museum and learning area, featuring simulated lab experiments, tutorials and simple videos to enhance the learning experience. Visitors can learn about DNA and human chromosomes in great detail, explore a giant 3-D eukaryotic cell, and play the ‘Mating Game’ at a realistic mock-up of the Augustinian Abbey at Brno, where Mendel did his work about the laws of inheritance. The Gene Pool was conceived by Mary Anne Clark at Texas Wesleyan University in Fort Worth, USA.
At the University of California, Davis, USA, Peter Yellowlees and James Cook developed and evaluated a special place in Second Life to educate people about schizophrenic hallucinations22 and concluded in a paper they published in November 2006 that ‘the use of Internet-connected graphics environments holds promise for public education about mental illness’.23
The US Centers for Disease Control and Prevention (CDC—http://www.cdc.gov/) also have a pilot presence in Second Life, and are looking at ways social media can be used to reach out to more audiences and promote public health.24,25 Two other Second Life examples, Healthinfo Island and VNEC, are discussed in some detail below.
Healthinfo Island—Second Life Medical and Consumer Health Libraries
HealthInfo Island (http://infoisland.org/health_info)and reference6 is entirely funded by a $US40 000 grant from the US National Library of Medicine (NLM)/Greater Midwest Region of the National Network to provide consumer health information services in Second Life.26 The NLM-funded project is officially entitled ‘Providing Consumer Health Outreach and Library Programs to Virtual World Residents in Second Life’ (2006–2008). Project partners include the Alliance Library System (ALS), the University of Illinois Library of the Health Sciences-Peoria, the Central Medical Library, the University Medical Center Groningen (UMCG) in the Netherlands, and TAP Information Services.
The following description of HealthInfo Island is derived with permission from a personal e-mail communication (by the first author) that took place on 1 May 2007 with Carol Perryman, the Project Coordinator, and Guus van den Brekel from UMCG. Perryman is a medical and consumer health librarian with years of experience, and also a PhD student at the University of North Carolina at Chapel Hill, USA, with research interests in evidence-based library and information practice, and consumer health information behaviours.27 van den Brekel is Coordinator of Electronic Services at the Central Medical Library of the University Medical Center Groningen, the Netherlands.28
Purpose and audience
The project is dedicated to health information in various forms. It aims at providing training programmes, outreach to virtual medical communities, important consumer health resources, and one-on-one support to Second Life residents. The target populations for HealthInfo Island include Second Life residents participating in identified in-world medical groups (e.g. groups dealing with stroke support, cerebral palsy, mental health and autism), or interested in learning more about health and wellness, in addition to outside groups/professionals who might be interested in Second Life as a platform for providing services and outreach for health services.
Description and unique features
Healthinfo Island is run by a team of medical/consumer health librarians and information professionals, in collaboration with an epidemiologist, an internal medical physician, a retired pharmacist, an educator in nursing, some library para-professionals, and many others, to accomplish the grant objectives.
The ‘Medical Library’ is one of three main buildings on HealthInfo Island. It has three floors intended to highlight health displays both inside and on the roof. In its current incarnation at the time of writing (May 2007), the ground floor serves as a showcase of different ways to offer medical information as content in Second Life. Education and research on medically related subjects in Second Life will be displayed in the Medical Research Room, while another room houses a ‘Breast Cancer Awareness’ centre. The second floor is used by contractors employed by the US National Institutes of Health (NIH) to explore potential applications of the virtual environment. Plans for further development of the Medical Library include displays of historical medical images.
The second main building on HealthInfo Island, the ‘Consumer Health Library’, looks like a home. This design choice was made on purpose, to encourage comfort and create a warm environment where Second Life residents can feel ‘at home’. The design of the library, the landscaping, and all displays are intended to be accessible, interactive, and to encourage a collaborative, friendly atmosphere. Like the Medical Library, the Consumer Health Library showcases innovative information objects whose primary intent is to engage the viewer interactively. Some of these objects lead the participant through a decision tree by using questions, eventually providing a tailored response in the form of a Flash tutorial, a PDF document, links to in-depth information, or even teleport links to other landmarks within Second Life.
The third building, the ‘Health and Wellness Center’, was developed to bring patient advocacy to Second Life. To achieve its objectives, the centre intends to collaborate with non-profit groups and organizations, and to host special in-world meetings and events. The centre uses skyboxes, so that support groups or smaller consultations are ensured privacy.29
Besides the three main building described above, a ‘Health Information Outreach Research Lab’ building was created by the Specialized Information Services (SIS—http://sis.nlm.nih.gov/) Division of the US National Library of Medicine (Fig. 1). SIS is exploring Second Life as a venue to provide health information to special populations, and as a platform for testing new information delivery technologies. Their building on HealthInfo Island currently hosts an interface to Tox Town (http://toxtown.nlm.nih.gov/), an environmental health portal, as well as links to other well-known NLM information products. SIS is working to bring more health information products to Second Life, and to host a number of outreach activities in Second Life in the future.
A focal feature of the new HealthInfo Island is the landscaping. The ‘Gardens and Mountains’ of Healthinfo Island provide excellent meeting spaces for large and small groups, and for collaborative events and activities. For example, the island hosted a Second Life Diabetes Support Group event, in which an internal medicine physician with a strong interest in patient education participated in a casual question-and-answer session that was held in the beautiful mountain gardens.
Other services piloted by the project include:
- • Trial access to Ebsco's Consumer Health Database and to Reuters Consumer Health News, accompanied with workshops on the Consumer Health Database and the evaluation of health information on the Internet.
- • Collecting and presenting quality consumer health resources about illness, drugs, allied/alternative and complementary medicine using US, European and other resources. This includes also presenting information about freely available scientific medical research (in e-books, e-journals, and online databases and repositories), as well as podcast modules for on-demand listening to themed audio sessions.
- • Providing in-world medical and health related RSS (Really Simple Syndication) feeds.
- • An in-world PubMed search has also been made available in the Medical Library building.
- • Infostations: These offer an in-world search interface to PubMed and consumer health and patient information, trying to bridge the gap between the conventional Web and Second Life. Infostations can also be monitored from Internet web pages, and interaction with live avatars from the ‘real world’ is possible using chat.
- • Automated tours of the island to give visitors information about specific services and events, especially at times when there is no in-world human librarian coverage.
- • An artificial intelligence chat experiment dubbed ‘Healthy’ is being piloted that enables patrons to ask health related questions in Second Life, even when there is nobody around. Healthy always has an answer—and sometimes, even a relevant one. Chatbots are able to provide information in the form of a web address or Second Life teleport link, results from a Google ‘define’ search, or even images on demand.
VNEC—virtual neurological education centre
Purpose and audience. The Virtual Neurological Education Centre (VNEC—http://www.vnec.co.uk/) was developed by Lee Hetherington at the University of Plymouth, Devon, UK.30 It demonstrates a virtual simulated online experience, where people are able to actively expose themselves to the most common symptoms that a person suffering from a neurological disability may encounter. It also provides related information, events, and facilities through the virtual world of Second Life.
The VNEC offers an immersive, interactive experience with a unique feeling of ‘presence’31 with synthetic sensations that make the user feel like they are in another reality. Through the VNEC building, users are able to select a range of neurological symptoms—motor, sensory, and balance—that animate their avatar, resulting in an effective method of limiting and restricting their independence, movement and coordination.
The purpose of the project is to make more people aware of neurological disabilities and allow people suffering from a disability a place to further their knowledge and understanding, offering them support, information and rehabilitation training. The VNEC in Second Life aims to allow people with a neurological disability a second identify, without any reality restrictions, a place for socializing and to be involved with activities that may not be possible in the real world.
The VNEC has already attracted a wide range of audiences from around the world, but specifically would be appealing to neurological doctors, researchers, physiotherapists, occupation therapists, caregivers and patients, and can provide educational material for family members and friends.
Description and unique features. The VNEC has been built in the form of an L-Shape, two-story building (Fig. 2), with five main areas—reception, office, theatre, lecture and information point. All of the five areas have individual features, assisting the user with information blocks describing the location they are in and the options that are available to them.
At the entrance to the VNEC, the user enters the reception area that holds information regarding a range of neurological disabilities in three formats—web-based (URLs), uploaded podcasts, and viewable videos about neurological disabilities, rehabilitation techniques and comments from people who have visited the VNEC.
The office area entices the user to experience neurological symptoms: by selecting a chosen disability, the user is presented with information about the disability and a wearable badge that once worn will affect the performance of their avatar (cf. Yellowlees and Cook's Virtual Hallucinations project).23 The office has three areas of interest and usage—conference, desk and seating for social interaction—where the possibility to talk to real-life doctors or other sufferers of a neurological disability in a safe and non-restricting environment could occur.
The upstairs of the VNEC represents the design of a reality theatre (Fig. 3). Within the theatre, users are able to navigate around and explore machines and operating equipment that can be found in the neurological department of a hospital. The theatre can be used for medical training and staff awareness; this primarily is an information area with detailed descriptions of equipment for people in the medical profession.
The VNEC also includes a fully functional lecture theatre for online lectures, meetings and conferences. The lecture theatre is situated outside, with views looking on to the VNEC. The area has potential to stream live video, presentations and images through a virtual plasma screen, which is set up prior to the event.
The final and perhaps most important area of the VNEC is the information point. The information point advertises companies that offer support, help and advice for people suffering from a neurological disorder. The advertisement links the user directly through to the chosen company's website, which the user can then use to contact the company personally or to find out more about what the company can offer to them in their individual cases.
The ‘VNEC Member’ group, found in Second Life, offers members regular newscasts about the VNEC, including events, new features and visitor experiences. The group has full access to the VNEC building, including all of its facilities, with frequent meetings to discuss future development plans and suggestions to improve the overall experience.
The future development of the VNEC will allow the opportunity for medical professionals in reality a chance to enter the digital world, and be involved in online consultations, advice, and medical care in individual private rooms within Second Life. Furthermore, by making it possible to have a second, virtual life, the VNEC considers the prospect of people who possibly in reality have neurological restrictions; Second Life offers a new way of living in an extensive virtual environment.
Challenges and limitations. People suffering from a neurological disorder may present with individual forms of disabilities, which in some cases are felt as personal to the patient. Many people diagnosed with a neurological disability absorb it into part of their lifestyle, not seeing it as an impingement to their way of life. The VNEC only demonstrates a selection of symptoms of a neurological disorder, because of the wide variety of possible symptoms and the range of intensity, extent and effect variations that these symptoms may show at different disease stages.
On the technical side of things, the VNEC building has been built within Second Life, but also using additional 3-D software that has the capability of outputting and importing in to Second Life, at a cost. Objects imported or built into Second Life are made up of individual shapes called ‘prims’ (primitives).32 Prims can be manipulated in many ways to create objects of the designer's choice.
Individual islands in Second Life have limitations on the amount of prims that can be placed within the purchased land. In mid-design of the VNEC, the project encountered the issue of using all of the prims that were available. As a result of this, the purchase of another island in the same region was necessary that had the same amount of prims, which would be transferred and included in an overall amount, allowing further development to continue (another partial workaround could have been to use some prim-saving script to ‘rez’ or resolve objects on demand when an avatar enters the immediate area, thus allowing prims to be used only when needed).