|Australasian Journal of Educational Technology
2012, 28(Special issue, 3), 480-503.
On the MUVE or in decline: Reflecting on the sustainability of the Virtual Birth Centre developed in Second Life
University of Canberra
Pressures in terms of the availability of quality, real-life clinical experiences for students have resulted in increased interest in the use of simulation in a variety of healthcare disciplines. Te wahi whanau: The birth place is a Virtual Birth Centre (VBC) that was created in Second Life in 2009 as part of the Second Life Education in New Zealand (SLENZ) initiative. It was introduced to midwifery students at two New Zealand polytechnics, with the aim of exposing the students to a birth centre environment and providing them with an opportunity to practise midwifery through immersion and engagement in a number of clinical scenarios. It has been just over two years since the development of the VBC, yet it is no longer used in the midwifery programs in which it was introduced. Using the VBC as a case study, we recount its development and critically reflect on the factors impacting on its ongoing utilisation. We believe our reflections offer useful insight into issues relating more broadly to the sustainability of MUVE-based teaching and learning projects and initiatives.
In 2009, we (both midwifery educators) submitted a proposal to the Second Life Education in New Zealand (SLENZ) group to be included as one of two pilot studies in a project funded by the New Zealand Tertiary Education Commission. We were successful in our application, and Te wahi whanau, the Virtual Birth Centre (VBC), was developed in Second Life, encompassing a range of teaching and learning strategies. The environment and strategies were trialled in undergraduate midwifery programs at two polytechnics located on the South Island of New Zealand. The development of the project was resource intensive, absorbing large quantities of funding, time and energy over a 12-month period. Two years later, the VBC gathers virtual cobwebs as it sits, relatively unused, on its original site within Second Life.
This article describes the development of the VBC, the pedagogical strategies employed and the learning outcomes developed for the project. Drawing on informal discussions with professional peers who have an interest in MUVEs and healthcare education, on the results of the project's formal evaluation, as well as on our own reflections on the experiences of developing the VBC, this article offers commentary and critical reflection on issues relating to the sustainability of MUVE-based teaching and learning innovations such as the VBC. Innovation in teaching and learning is often driven by educators who have limited e-learning and/or technical knowledge and experience, but are motivated to explore creative solutions to the pedagogical problems they encounter in their practice. This was the situation with the project reported here, in which excitement over the novelty and possibilities of a new technology obscured concern for longer-term issues like sustainability.
In this article, we explain, in retrospect, the importance of having a strategy in place for moving a successful MUVE-based teaching and learning innovation beyond experimental or pilot status to become an embedded component of the curriculum. While the VBC was developed specifically for use in the discipline of midwifery, the reflections offered here are likely to have broad applicability and be able to drawn upon to inform aspects of educational MUVE projects across the disciplines as they relate to innovation and sustainability. A case study such as this can sometimes be more illuminating than an article dealing abstractly with theories of innovation or sustainability.
A range of healthcare education resources ('builds') and teaching and learning strategies have been developed in MUVEs such as Second Life. Most of these focus on general health promotion and education for lay residents, and some also contribute to the education and training of health professionals, both pre-service and in-service (Beard, Wilson, Morra & Keelan, 2009). The US Centres for Disease Control and Prevention (CDC), for example, have a substantial presence in Second Life in the form of CDC Island (Boulos, Hetherington & Wheeler, 2007). This site contains informative displays and offers opportunities for users to interact with various virtual objects (e.g. microscopes to learn about bacteria) as well as to network with one another by joining discussions and focus groups. Another Second Life build that aims to raise awareness about a specific health issue can be seen in the University of California, Davis Medical Centre's Virtual Hallucinations simulation (Yellowlees & Cook, 2006). This build simulates the auditory and visual hallucinations that many patients suffering from schizophrenia experience, with the aim of promoting greater understanding and empathy for those with the condition as well as to disseminate related health information.
Strategies targeted towards the education of health professionals range from those that involve the running of in-world symposia or seminars (Kessler & Rowell, 1998) through to those that provide the opportunity engage in role-play with peers and/or with virtual patients and objects (e.g. X-rays) with the aim of improving communication, diagnosis and/or other generic and specialised clinical knowledge and skills (Hansen, 2008). One such build that is particularly relevant to the nursing and midwifery discipline is the postpartum haemorrhage clinical scenario developed by academics from the Boise State University in the US and The University of Auckland in New Zealand (Honey, Diener, Connor, Veltman & Bodily, 2009).
The body of available research literature on the use of MUVEs in the education of health professionals is in its early stages. Most of the papers and articles published to date in this area are descriptive (e.g. Skiba, 2007) or exploratory (e.g. Rogers, 2011), with those that are evaluative often reporting on pilot studies (e.g. Wiecha, Heyden, Sternthal & Merialdi, 2010) and/or studies with small sample sizes (e.g. Blyth, Loke & Swan, 2010; McCallum, Ness & Price, 2010). There is a dearth of empirical evidence comparing the outcomes of MUVE-based teaching and learning strategies with those of traditional methods. In our searches, the only significant study focussing on the education of health professionals we located that compared traditional teaching and learning methods with teaching and learning using virtual-reality environments was the one by Lok et al. (2006). That study, however, involved the projection of a life-sized virtual patient on a wall rather than the use of a MUVE.
Sustainability of any initiative is closely related to adoption. While it is beyond the scope of this article to address adoption of innovations in detail, it is noteworthy that a number of factors have been found to impact on adoption (and therefore sustainability) of e-learning innovations. These include perceived value to the user, accessibility, digital literacy and competence with the technology, motivation, and effectiveness of the innovation (Eley, Fallon, Soar, Buikstra & Hegney, 2008; Kelly, Coburn, Hegarty, Jeffrey & Penman, 2009; Stewart, 2006; Yu, Chen, Yang, Wang & Yen, 2007). Drawing on a survey of higher educators across Australia and New Zealand, Dalgarno, Lee, Carlson, Gregory and Tynan (2011b; see also Dalgarno et al. 2011a; Lee, Dalgarno, Gregory, Carlson & Tynan, 2011) discuss the technical and policy hurdles that teaching staff must negotiate to overcome barriers to the utilisation of MUVEs in universities. These include technological issues, support issues, funding and time, usability and familiarity, equity and ethical issues, inherent limitations of virtual worlds, acceptance of virtual worlds, and management and planning.
For some time now, educators have expressed concern about the need to improve the sustainability of e-learning innovations, identifying a variety of obstacles and potential solutions in this regard (Andrews, Smyth, Tynan, Vale & Caladine, 2008; Gunn, 2011; Holt & Segrave, 2003; Wiles & Littlejohn, 2003). Andrews et al. (2008) point to the inability of teaching staff to alter their pedagogical approaches to make the best use of available technologies, and the lack of infrastructure within institutions to support the integration of those technologies. Addressing the issue of media-rich technologies more broadly in the Australian context, they suggest that these factors contribute to a situation in which institutions have been largely unsuccessful in implementing the technologies in sustainable and scalable ways. Wiles and Littlejohn (2003) suggest that the major challenges standing in the way of sustainability of e-learning innovations relate to cultural and social rather than technical issues. They echo the sentiment that educators moving into e-learning need to rethink their pedagogical approach, reversing their usual processes by prioritising learning design over content development. They also emphasise the importance of sharing and reusing resources, suggesting that this can be best facilitated through the cultivation of communities of practice.
A comprehensive report by Attwell (2004) addresses the sustainability of e-learning from a variety of perspectives, including learning platforms and software, institutional responses, materials, pedagogical approaches, and teacher skills. The report concludes with a sustainability 'checklist' featuring items such as the sharing and reuse of materials, a planned approach to developing and reviewing strategies, frameworks for professional development, integration of services, embedding of e-learning within curricula, and developing partnerships and networks. Yet another valuable resource is the UK Joint Information Systems Committee (JISC) 'good practice guide' on sustaining and embedding innovations (Chatterton, 2011). This guide aims to support those involved in innovative projects to embed them into practice by providing useful information and resources in a number of areas: changing people and culture, influencing organisational change, embedding or aligning innovations, creating usable tools and resources, and commercial and open approaches to innovation.
In a report for the Australian Flexible Learning Framework, Callan and Bowman (2010a, p. 14) identify seven factors that influence the sustainability of e-learning innovations, which they describe as follows:
Concern for sustainability reflects a desire to maximise the gains achieved by innovations beyond the life of the project. Gunn (2011) gives an overview and synthesis of the literature addressing the challenges and proposed solutions for sustainability of e-learning initiatives, and in doing so makes an astute observation with regard to the extant literature (p. 509):
The challenges of turning funded projects from e-learning innovations into sustainable products and services have featured in the higher education literature for more than forty years. Various guidelines and strategies designed to facilitate the process have been developed and tested, key challenges are identified and critical success factors proposed, yet the problem persists in more or less original form, suggesting that most of the advice has been lacking in some respect.Another problem that Gunn points to is a lack of published evidence supporting strategies for sustainability. The literature is replete with 'good ideas' and 'works in progress' (see, for example, Lucas, 2006; Wiles & Littlejohn, 2003) but seriously lacking in hard evidence and systematic retrospective analysis. This is where our case study seeks to make a contribution. It presents an in-depth reflective analysis - a 'post-mortem', of sorts - of an e-learning innovation, focussing particularly on the issue of sustainability. As Gunn argues, the sustainability of e-learning innovations continues to be a problem despite published literature providing generic advice, strategies, guides and checklists. While there is something to be gained from the literature, this implies that sustainability may be significantly impacted upon by the situations and circumstances surrounding individual projects. Case studies (and a review of case studies, as Gunn proposes) offer an opportunity to examine the innovations within the bounds of their unique contexts. In the next section, we provide an overview and description of the VBC project before proceeding to critically reflect on the sustainability aspects of the project.
We have thus seen a gradual eroding of avenues for student midwives to learn and practise the skills that form the foundations of practice in the profession. The landscape of tertiary education is also changing as institutions embrace flexible modes of course delivery for a variety of reasons. Learning is no longer confined to the physical location of the classroom or to set 'office hours', as we are having to reach out to students who may be accessing courses from a variety of locations and at times more convenient to them. The midwifery programs at the two New Zealand institutions in which this project was implemented were moving towards flexible delivery modes in order to support students studying midwifery at a distance. This largely meant migrating existing courses to an Internet-based LMS, with the use of synchronous web conferencing for tutorial support.
This was the professional, clinical and educational context motivating the development of the VBC. Based in Second Life, Te wahi whanau: The birth place (http://www.slurl.com/secondlife/Kowhai/82/213/35) was designed to be a safe, risk-free environment in which for student midwives to hone their clinical problem-solving and decision-making skills through engagement with a variety of physiological birth scenarios, as well as for them to gain exposure to a birth centre environment, an experience that would otherwise not be available to them in real life. The VBC was also intended to provide a (virtual) venue where geographically dispersed students could come together to work collaboratively and form a community of learning with their peers.
The aim of this first phase of the project was to encourage midwifery students to think about the effect of the environment on the physiology of normal labour and to provide them with evidence-based information on practices that promote physiological birth (e.g. water immersion) in an applied, authentic context. A number of learning activities were developed to assist students in focussing on the birth environment and its features. These included an assignment requiring them to produce a written piece comparing and contrasting the birth environment of the VBC with other birth environments they had encountered in real life (e.g. the tertiary maternity hospital), and a tutorial conducted within the VBC where the design of birth units was discussed following a tour of the VBC. Specifications of these and other learning activities can be found on the project's WikiEducator site (http://www.wikieducator.org/The_virtual_birthing_unit_project#Learning_activities). These activities were voluntary and formative, and they did not contribute to the students' grades. They were, however, designed to complement the subjects undertaken by the students in the first year of their program, and to contribute to the existing objectives for the first-year clinical practice subject, in particular:
The student who plays the part of the midwife is required to assess, plan and act on the information provided and the behaviour exhibited by the 'mother'. At the end of each scenario, the 'midwife' receives feedback from the 'mother', and is able to self-assess his/her own performance against predefined criteria developed by the midwifery educators. The 'mother' is asked to focus on the following in her feedback to the 'midwife':
The scenario-based learning activities developed in the second phase are aimed at student midwives in the second and third years of their program and were voluntary, supplementing rather than replacing existing teaching and learning strategies and real-life clinical experiences. Again, they were designed to contribute to existing learning objectives:
The lack of integration of this project in the overall e-learning strategy of the participating institutions may also reflect the novelty of (and suspicion towards) virtual reality technologies in the educational setting. The focus of the institutional strategy, at least from our perspective as educators within one of those institutions, was on more mainstream e-learning technologies, including the use of web-based LMSs to serve as a replacement for face to face teaching. A number of authors (Attwell, 2004; Gunn, 2011) have stressed the importance of devising a high-level strategy for the implementation, integration and review of e-learning initiatives at institutions. While e-learning represents an array of teaching and learning strategies and technologies, innovations developed for MUVEs are often (though not always) considered niche, and thus tend not to be included as part of this broader e-learning strategy (Kirriemuir, 2010a).
Once developed, the complex teaching and learning strategies in the MUVE require maintenance and updating, and without ongoing funding or commitment, may quickly become obsolete or inoperative. The ability of innovations to become sustainable after project funding has been depleted is a common, recurring concern (Gunn, 2011; Tynan & Lee, 2009). Along with unrealistic timeframes or expectations of funders, this contributes to a situation whereby, according to Gunn (2011, p. 509), "many projects with strong educational potential fail to find the means to continue beyond the funding phase, and a low return on investiment is achieved". In our project, there was no ongoing funding provided to maintain or further develop the VBC on its original Second Life site, though the open-access arrangements and Creative Commons licensing used provided a means for others to obtain a copy of the VBC for reuse and/or further development on their own sites.
Unfortunately, we have not formally tracked the number of copies that have been made of the VBC to date, though we are advised by our developer that it is in the vicinity of 30. We have no way of knowing for what purposes the copies were made, and some may have perfomed the copying in order to obtain particular artefacts rather than to use the VBC environment in its entirety for the purposes it was originally intended. We are aware of one educator in the USA who copied the VBC some time ago, and has since developed and repurposed it into an aged care facility for training nurses. Another aspect of the open-access philosophy of the project involved storing all of our planning, curriculum, teaching and learning documents on WikiEducator. A midwife educator in the UK who has built another birth facility in Second Life reports that she used our planning framework to guide the development of her build (Bailey, 2012). Two midwifery educators in the UK and USA have expressed intentions to integrate the VBC into their teaching, but at the time of writing of this article have yet to actually do so. They have told us that this is because they have not had the time to develop their skills to a point where they are confident enough to support students in Second Life. They also do not have access to adequate time and funding to customise the VBC to fit their own context. Open source, open access and the development of shared learning repositories is a key feature of the works addressing sustainability of e-learning innovations (Attwell, 2004; Chatterton, 2011; Holt & Segrave, 2003). Attwell (2004) points out that a shared approach to resources, especially across a variety of institutions and disciplines, calls for a major change in academic culture. Open access has the potential to aid others in resourcing their projects and to contribute to sustainability, but resources are not the only barrier to developing and sustaining innovations in the MUVE.
These sorts of innovations are often driven heavily by the energies and commitments of individuals who are, in effect, the leaders and local champions for the innovation. Often, the work involved in developing teaching and learning projects in MUVEs is taken on by those involved on top of their regular, day-to-day responsibilities, and is sustained by their enthusiasm for the project (Dalgarno et al., 2011b; Kirriemuir, 2010b; Lee et al., 2011). The risk to an institution with this approach is that the project or strategy is not sustainable beyond the commitment of the individuals, and the expertise they have developed may not have been shared with colleagues within the institution by the time they are ready to move on. E-champions are often early adopters, and their role in innovation is well recognised in the literature (Tynan & Lee, 2009). However, many share concern for the sustainability of these innovations once their enthusiasm for a project has waned or they have gone on to other projects and roles (Gunn, 2011; Holtham, 2005; Tynan & Lee, 2009). When an innovation relies heavily on local champions and is not otherwise integrated or supported at the institutional level, the innovation (and the relevant expertise) is lost to the institution upon the departure of the champions. This was a significant factor in the case of the VBC.
The VBC project was not part of an integrated approach to e-learning in the institutions where it was piloted. A team consisting of members with particular expertise was formed specifically for the purposes of the project, and through this team e-champions (the midwifery educators) were supported to interface directly with students and other teaching staff. These e-champions were also responsible for designing the teaching and learning strategies for use in the MUVE. This aligns somewhat with Callan and Bowman's third model (partnering model with external expertise linked to e-champions). One of the challenges with this model as we experienced it was in the communication between the e-champions who possessed considerable course content and professional knowledge (of midwifery in this case) but limited technical knowledge, and those who had the opposite - in other words, strong technical knowledge but limited content or curriculum design knowledge. For the discipline of midwifery and the MUVE learning environment it is unusual to find content, curriculum and technical knowledge in the one individual. This means that developers, designers and educators must be able to work together successfully to achieve a favourable outcome; good communication and strong leadership are crucial to this. Our project may well have severely faltered if it were not for the strong leadership, as we seemed to be communicating across a cavernous gap in understanding at times!
A major barrier to making a strong business case for the inclusion of teaching and learning strategies in MUVEs is the dearth of solid empirical evidence demonstrating the effectiveness of this environment for learning when compared with traditional methods. In the absence of such evidence, it is very difficult to secure funding to develop or build on the work undertaken in the VBC.
Developing strategies for teaching and learning in a MUVE requires substantial effort on the part of both educators and students, who must acquire new skill sets specific to this environment. This does not simply involve mastering the particular tools or technology; it often also calls for drastically altering the pedagogical approach to a given subject area (Wiles & Littlejohn, 2003). Staff, in particular, may be reluctant to put in the time and effort to develop these skills and invest in these strategies without seeing compelling evidence of their effectiveness. Without robust evidence it is also difficult to make a business case or argue that such strategies should be embedded into a program. It is unlikely that the drivers for the use of MUVEs in education outlined above will subside in the foreseeable future, and it is important that we do not miss important opportunities for enhancing the learning experiences of our students - hence, investment in the necessary research is critical to generate the needed empirical support and to come up with evidence-based guidelines for MUVE-based teaching and learning.
This is complex and easier said than done, since teaching and learning strategies developed in this environment are as diverse and heterogeneous as they are in real-life environments. Salmon (2005) and others (e.g. Wiles & Littlejohn 2003; Andrews et al., 2008) are critical of e-learning in the form it exists in many higher education institutions, suggesting that rather than reflecting true innovation, they tend to simply entail application of existing pedagogy to new media. Salmon argues that e-learning should instead be viewed in terms of the prospects it offers for radically rethinking education. MUVEs provide an opportunity for such pedagogical innovation, and research may need to extend beyond simplistic comparisons between MUVE-based and traditional methods of teaching and learning (Oliver, 2010). More and better consideration needs to be given to the new possibilities MUVEs open up that were not previously available through other means, including pre-existing technologies (Dalgarno & Lee, 2010).
OERs were identified in the 2009 Australia-New Zealand Horizon Report (Johnson, Levine, Smith, Smythe & Stone, 2009) as being likely to have a significant impact on higher education within two to three years after the time of writing of the report. Rising costs associated with developing teaching and learning resources, together with pressures on educators' time, make OER an attractive option for promoting sustainability (Organisation for Economic Co-operation and Development [OECD], 2007). The development of teaching and learning strategies in MUVEs can be expensive and time consuming, and significant efficiencies can be achieved through the sharing of resources. However, analysis has shown that while educators are motivated to create their own OERs, they are less likely to reuse OERs that have been developed by others. When Duncan (2009) examined the Connexions OER repository (http://www.cnx.org/) at Rice University in the USA, for example, he found that only about 25% of the material in the repository was being reused. This reluctance to reuse others' resources is often attributed to the fact that it is too expensive and time consuming to appropriate or adapt materials developed for a different context, as well as to concerns about the quality of the materials (De Liddo, 2010). The sharing and reuse of resources is a feature of much of the work addressing sustainability of e-learning, particularly in the UK (Attwell, 2004; Chatterton, 2011), and large-scale initiatives such as national learning object repositories have been developed (Attwell, 2004).
The resource-intensive nature of developing and maintaining educational resources in MUVEs lends itself to inter-institutional cooperation and resource sharing. Salmon (2005) recognises collaborations and consortia as useful ways to explore innovations that are relatively low-risk for the institutions concerned. The development of resources such as the VBC may be beyond the capacity of a single institution, and better shared by several. This may be especially true for institutions that do not have an existing MUVE presence. In an ideal world, we would like to see the VBC supported by a number of institutions that share in the use of the resource and the costs associated with continuing maintenance and development. Cooperation and collaboration within and between institutions is seen as vital to sustainability, especially in the OER and open-source movements (OECD, 2007). This having been said, competition for market share, research or innovation kudos and academic rivalries often stand in the way of institutions working together (Littlejohn, 2003). While inter-institutional collaboration is not without its challenges, in small programs such as midwifery that tend to be more boutique than large scale, there is much to recommend such an approach (see Tynan, Dunne & Smyth, 2007).
While innovations such as the VBC are often dependent on external funding for their development, sources and factors from within the institution will be responsible for their sustenance. These include organisational leadership, the provision of ongoing practical support, motivation and commitment of staff, and integration of the innovation within existing processes or strategies. While individual champions may be critical to an innovation's success, we can and should anticipate that such individuals will move on from their current positions, and we need to consider how the initiative can be sustained beyond the stewardship of those individuals.
Frameworks like Callan and Bowman's (2010a) may be useful to developers in the planning phases of a project in the way of assisting and prompting them to consider relevant issues impacting on sustainability. In order to maximise gains from scant resources, it may be wise for funding bodies to focus more intently on issues of sustainability, incorporating these into the criteria that they use to assess applications they receive for funding.
For projects such as these, seed or innovation funding is important, yet in the absence of continued commitment from the institutions involved they are unlikely to be amply maintained or developed on an ongoing basis. Projects like the VBC often bring together unlikely partners (midwives and IT specialists, for example), and successful collaboration between those partners necessitates a degree of generosity along with open and effective lines of communication, because each party needs to understand elements of the other's expertise. The paucity of empirical evidence supporting claims about the effectiveness of MUVEs for teaching and learning is a persistent barrier to the sustainability of innovations in this area, since educators are limited in their ability to build a strong business case without such evidence. While the open sharing of resources associated with this project have contributed in a small way to the MUVE endeavours of other educators, this seems like a small return for the relatively sizeable investment that was expended on the development of the VBC.
There are a number of key issues for practice, policy and future research arising from our critical reflection on the sustainability of the VBC. First is the need for empirical studies to inform our understanding of teaching and learning strategies in MUVEs. Secondly, the importance and benefits of resource sharing and inter-institutional collaboration on MUVE-based teaching and learning initiatives (at both a national and international level) should not be overlooked. Thirdly and lastly, our experiences with the VBC have underscored the fact that a strategy for ensuring sustainability should be established in the planning stages of any MUVE-based education initiative; it cannot and must not be dealt with as an afterthought, or worse still, left to chance.
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|Authors: Sarah Stewart, Educational Developer|
Educational Development Centre, Otago Polytechnic
Forth Street, Private Bag 1910, Dunedin 9054, New Zealand
Email: firstname.lastname@example.org Website: http://sarah-stewart.blogspot.com/
Professor Deborah Davis, Clinical Chair in Midwifery
Faculty of Health, University of Canberra, ACT 2601, Australia
Please cite as: Stewart, S. & Davis, D. (2012). On the MUVE or in decline: Reflecting on the sustainability of the Virtual Birth Centre developed in Second Life. In M. J. W. Lee, B. Dalgarno & H. Farley (Eds), Virtual worlds in tertiary education: An Australasian perspective. Australasian Journal of Educational Technology, 28(Special issue, 3), 480-503. http://www.ascilite.org.au/ajet/ajet28/stewart.html