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Jan 3, 2011 - 2Teaching and Academic Support Center (TASC), University of Kentucky, ... 3Curriculum Development Center, Dentistry Academic Affairs, ...
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A ‘‘Second Life’’ for Gross Anatomy: Applications for Multiuser Virtual Environments in Teaching the Anatomical Sciences April Richardson,1* Matthew Hazzard,2 Sandra D. Challman,3 Aaron M. Morgenstein,4 Jennifer K. Brueckner1,5 1 Department of Anatomy and Neurobiology, College of Medicine, University of Kentucky, Lexington, Kentucky 2 Teaching and Academic Support Center (TASC), University of Kentucky, Lexington, Kentucky 3 Curriculum Development Center, Dentistry Academic Affairs, College of Dentistry, University of Kentucky, Lexington, Kentucky 4 College of Medicine, University of Kentucky, Lexington, Kentucky 5 Department of Anatomical Sciences and Neurobiology, University of Louisville, School of Medicine, Louisville, Kentucky

This article describes the emerging role of educational multiuser virtual environments, specifically Second LifeTM, in anatomical sciences education. Virtual worlds promote inquiry-based learning and conceptual understanding, potentially making them applicable for teaching and learning gross anatomy. A short introduction to Second Life as an anatomical educational tool is provided, along with description of existing anatomy applications and future directions for this innovative teaching modality. Anat Sci Educ 4:39–43. © 2011 American Association of Anatomists.

Key words: anatomy education; Second Life; virtual technology; avatar; online learning; computer-assisted learning; gross anatomy; virtual anatomy laboratory; innovations

INTRODUCTION With the introduction and maturation of broadband internet, wireless computing, and advanced video and audio technologies, virtual immersive environments are becoming more practical and useable in higher education (Bers, 2008; Gronstedt, 2008; Trelease, 2008; Bell, 2009). A virtual world provides an experience set within a technological environment that gives the user a strong sense of being there (Warburton, 2009). Multiple virtual world environments exist, including OLIVETM (OLIVE, 2010), Croquet Consortium (Croquet The Teaching and Academic Support Center (TASC) is now referred to as UK Teaching and Learning. Matt Hazzard is specifically affiliated with the division of Graphics and Multimedia Production. *Correspondence to: Dr. April Richardson, Department of Anatomy and Neurobiology, MN212 Chandler Medical Center, 800 Rose Street, Lexington, KY 40536, USA. E-mail: [email protected] Received 18 May 2010; Revised 23 November 2010; Accepted 24 November 2010. Published online 3 January 2011 in Wiley (wileyonlinelibrary.com). DOI 10.1002/ase.195

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Consortium, 2010), Protosphere1 (Protosphere, 2010), and Second LifeTM (Second Life, 2010a). Currently, Second Life is the most mature and popular multiuser virtual world platform used in higher education, providing a three-dimensional (3D) environment that mimics real life (Second Life, 2010c).

WHAT IS SECOND LIFE? First launched by Linden LabTM in 2003, Second Life is a 3D social network in which participants can interact with one another and with existing objects in the virtual world, as well as collaboratively create and edit objects (Boulos et al., 2010). It consists of a flat earth simulation of nearly two billion square meters (Wiecha et al., 2010). Users enter Second Life (Second Life, 2010a) through a free client program called Second Life Viewer (Second Life, 2010b) and subsequently follow instructions for creating a customized avatar, or online persona, to represent themselves in the virtual world. New avatars are directed to navigate to Second Life’s Orientation Island, where they learn to modify their appearance, communicate with others, and transport themselves to desired locations by walking, running, flying, or teleporting. Communication between avatars occurs either via a chat interface (text Anat Sci Educ 4:39–43 (2011)

messaging) or using the voice features (Baker et al., 2009). After this basic training, avatars are ready to interact with one another and with their surroundings on plots of virtual land known as islands that can be designated as public or private, if a more secure environment is needed for a particular audience. Though creating an avatar and interacting in Second Life is free of charge, users can conduct business with the currency in Second Life (Linden dollars), purchasing virtual land (island) and consumer goods. Users may use the intrinsic building capabilities of Second Life to demonstrate their own imaginative work by creating simple geometric primitives (prims) to which various textures may be overlaid to achieve the desired detail. Importable textures (i.e., jpegs) may also be used to tailor the overall design of the in-world creation (i.e., the avatar with a muscle texture in Fig. 1) Once the object is created, additional Second Life programming using Linden Scripting Language may be used to activate these objects; these scripts are essential codes for movement or chat that may be applied to the avatars and/or inanimate objects to enhance interactive movements and communication among avatars and other objects within the virtual environment. Thus, the Second Life users may take an active role in creating their own virtual world.

SECOND LIFE IN HIGHER EDUCATION Second Life has attracted the attention not only of individual users but also of nonprofit organizations, universities, corporations, and government agencies (Schmidt and Stewart, 2010). Many universities and colleges have used the tools provided in Second Life to build replicas of their campuses, which can be used as recruiting tools to showcase their institution to potential students and other important audiences such as donors (DeLucia et al., 2009). Live university events, including research seminars and international conferences are regular occurrences in Second Life (Leong et al., 2008). University faculty can hold virtual office hours in Second Life, eliminating the necessity for travel to campus for the student or professor (Rzewnicki, 2007). The body of research addressing Second Life as an educational environment is relatively small, but addresses its potential for both distance learning and on-campus instruction (Cobb et al., 2009; Schmidt and Stewart, 2009; Skiba, 2009). The immersive nature of Second Life allows students to explore and discover content, such that the role of the instructor is transformed from a ‘‘sage on the stage’’ to the role of a mentor or coach (Welch, 2008). Second Life can simulate expensive or potentially dangerous activities in an accessible and safe manner (Stott, 2007; Hewitt et al., 2008; Foss, 2009) and may help students overcome anxiety of making mistakes in real life groups (Broadribb and Carter, 2009).

SECOND LIFE IN ANATOMY EDUCATION Second Life has several features that make it is well suited for supplementing anatomical education, including the ability to build 3D models that avatars can examine from all perspectives and to promote discussion and interaction amongst avatars. Some universities have developed anatomical models in Second Life for use as ancillary teaching and learning tools 40

Figure 1. At each station, a note-card is issued to the student’s inventory upon clicking on the station heading; this note-card explains the orientation of the anatomical structure displayed, in addition to supplying basic information about this structure for their review. Station 1 in the virtual anatomy laboratory demonstrates atlas and cadaver images of the anterior compartment of the thigh. Questions are embedded in the note-card, so that the instructor can promote group discussion regarding the anatomy of this region. These questions range from basic anatomical understanding to more complicated correlations with clinical scenarios. Student avatars are pictured here as they gather to view these images and to answer a series of note-card questions facilitated by the instructor.

for undergraduate and health professions students. Northern Michigan University has constructed a Virtual Speech, Language and Hearing Clinic, which contains interactive larynx and middle ear models (Virtual Speech-Language & Hearing Clinic, 2010). The Ohio State University has built a 3D interactive testis in which students can take a virtual tour through sperm development (Virtual Sperm Tour, 2010). In 2007, the University of Kentucky established a presence in Second Life, and the College of Medicine is now utilizing this virtual environment to serve the student population in a variety of ways.

Virtual Anatomy Laboratory Because Second Life so effectively facilitates experimental learning, role-play, and collaboration in other educational settings (Berge, 2008; Jarmon et al., 2008; Hew and Cheung, 2010), we sought to incorporate this virtual technology into anatomical science education by developing a virtual laboratory experience for undergraduate and health professional students alike. The University of Kentucky College of Medicine has constructed a multipurpose, virtual anatomy laboratory (UKVAL, 2010) that contains a series of stations, including areas focusing on: (1) atlas/cadaver images (Fig. 1), (2) a guided tour through cross-sectional anatomy, (3) video tutorials of cadaveric anatomy (Fig. 2), and (4) group quizzes. At each station, a note-card (i.e. an electronic tablet that includes typed text) is issued to the student’s inventory upon clicking on the station heading (Fig. 3); this note-card explains the orientation of the anatomical structure displayed, in addition to supplying basic information about this strucRichardson et al.

ture for their review. Questions are embedded in the notecard, so that the instructor can promote group discussion regarding anatomical concepts. To simulate a professional environment, student participants are informed about the rules of the anatomy laboratory, including wearing appropriate attire (i.e., laboratory coat) at all times and demonstrating appropriate respect for the cadaver images, and for fellow classmates in the context of any group discussion. Thus far, pilot sessions regarding specific anatomy topics (i.e., anterior compartment of the thigh) have been conducted in this virtual environment to test the general student response to this potential educational tool. Future goals include the development of a virtual laboratory course that will be offered to undergraduates as a supplement to their anatomy education, consisting of weekly virtual sessions that integrate anatomical principles in clinical correlates. The curriculum associated with this course is being completed at this time. In addition to the monthly cost to sustain the island ($200 US dollars), expenses associated with the construction of the virtual anatomy laboratory to date total $45 US dollars, as the exchange rate for US dollars and Linden dollars is minimal ($1 US dollar is equivalent to L$270 Linden dollars). In addition, the number of manual hours expended to create this laboratory thus far totals 100 hours.

Figure 3. This illustration depicts an example of a note-card that is transferred to the student’s inventory at each station when the heading above the station is clicked. Questions are embedded in the text to facilitate group discussion of anatomical principles.

Outreach for Prospective Medical Professional Students The virtual anatomy laboratory may be used for dual purposes on UK’s island. For example, in addition to utilizing this unique space for anatomy instruction, it may be used as a meeting place for prospective medical professional students who are being actively recruited to the UK College of Medicine. While visiting campus, students are introduced to the Second Life and its application in the classroom, and then

proceed to obtain their own avatar to explore the laboratory. These students may easily keep in touch with each other following their actual visit to UK, and in the future, administrators may also use this for subsequent follow-up sessions with groups of students that may be separated by large physical distances.

A 3D Construction of the Pterygopalatine Fossa The University of Kentucky is using the 3D capabilities of Second Life to teach conceptually difficult anatomical regions to medical and dental professional students. A 3D replica of the pterygopalatine fossa (PPF) was constructed on the roof of the virtual anatomy laboratory on UK’s island (UKVAL, 2010). This model includes an illustration of the relevant divisions of the maxillary nerve (V2) that course through the fossa and its associated communications between the orbit, cranial, nasal, and oral cavities. A second nearby anatomical model illustrates the relative placement of the PPF and its related nerves within the skull. This Second Life virtual tour can be used in conjunction with lecture to more thoroughly illustrate the various openings through which nerves traverse the PPF, as the avatar can essentially ‘‘fly’’ or maneuver in and out of the boundaries of the fossa to follow the course of the nerves to their destination.

Figure 2.

DISCUSSION

Stations 2 and 3 are located in the same area of the laboratory, and different videos may be loaded as needed for the class discussion. The video displayed in this image includes a voice-guided tutorial through the anterior compartment of the thigh of a cadaver. This station illustrates the potential to incorporate multimedia presentations into the virtual anatomy environment, allowing all users to see and respond to the same stimulus.

Second Life technology has introduced a venue for an innovative pedagogical style that may be adapted for various disciplines (Bente et al., 2008). Here, we describe and demonstrate various uses for Second Life in the evolving curriculum of the anatomy department at the University of Kentucky. This virtual environment not only provides a novel platform

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that enhances opportunities for online anatomy education but also it provides a way to construct difficult anatomical models so that the students or avatars can experience them in a 3D environment. This has tremendous potential for conceptualizing the intricacies of the human body. According to cursory qualitative feedback from students who have sampled the virtual anatomy environment in pilot sessions, several features of Second Life appeal to the millennial students. To begin, students report that the ‘‘pseudoanonymity" afforded by the avatars enables them to feel more comfortable answering questions in group discussion. This is consistent with previous work on Second Life in medical education (Wiecha et al., 2010). We have observed that students more readily answer questions asked by the instructors, often times polling their fellow peers for second opinions on the subject matter. This enhanced interaction, in part due to the avatar image, is in agreement with other studies in which the online environments facilitate a positive, even counter-intuitive, barricade between the student and instructor, so that students feel less inhibited to speak their mind (Hansen, 2008). A second theme emerging from this qualitative feedback is that students particularly enjoy the instantaneous feedback provided by their instructors, which is consistent with findings reported by Schmidt and Stewart (2009). Students also report that the group discussion in Second Life provides a more personal interaction with their instructors that would not be typically experienced in the traditional classroom. This may be in part due to the small group format of Second Life itself. These initial findings appear positive; however, future studies must be administered to quantifiably demonstrate the effectiveness of Second Life in anatomy education. A virtual laboratory in Second Life affords many advantages as an educational tool for anatomy. One of these advantages includes the accessibility of the laboratory, which correlates well with the preferences of the millennial students that populate our classrooms (Howe and Strauss, 2000). Although the virtual laboratory will not serve as a substitute for future experiences in cadaver-based anatomy, Second Life does provide a valuable experience that may prepare students for the content and peer learning/discussion skills they need for their future studies. Moreover, Second Life introduces a unique extension to online learning, as students are not only able to view the content but also interact virtually with one another as they view the same material in the same virtual room, despite the real physical distance between them. This concept allows students to participate to a greater extent than that afforded by typical lecture broadcasts through distance learning. Thus, our vision for the use of Second Life in undergraduate education is to serve as a transition between the college environment and the medical professional programs that follow. Second Life may be used to sharpen discussion skills and to expose students to a simulated anatomy laboratory environment that will be reflective of the level of detail and professionalism they will encounter in their professional programs. In addition, we plan to continue to build 3D anatomical models to supplement lectures in medical professional courses.

NOTES ON CONTRIBUTORS APRIL RICHARDSON, Ph.D., is an assistant professor in the Department of Anatomy and Neurobiology at the University of Kentucky, Lexington, Kentucky. She teaches undergraduate anatomy courses and gross anatomy to medical, 42

physician assistant, and physical therapy students. Her research interests include the use of Second LifeTM for anatomy education. MATT HAZZARD, B.A., is a medical illustrator in the Teaching and Academic Support Center (TASC) at the University of Kentucky, Lexington, Kentucky. He designs threedimensional structures and spaces in the virtual anatomy laboratory on the University of Kentucky Island in Second LifeTM. SANDRA D. CHALLMAN, M.S., is the Curriculum Development Director in the Dentistry Academic Affairs Department at the University of Kentucky, Lexington, Kentucky. She focuses on incorporating innovative technologies into the dental curriculum. AARON M. MORGENSTEIN, M.S., is a fourth-year medical student at the University of Kentucky, Lexington, KY. In addition to his studies, he contributes to the curricular content for the virtual anatomy laboratory. JENNIFER K. BRUECKNER, Ph.D., is a professor of anatomical sciences and neurobiology at the University of Louisville School of Medicine, where she teaches medical/dental gross anatomy and medical embryology. In July 2010, she moved to University of Louisville School of Medicine from the University of Kentucky, where she had taught in the Anatomy and Neurobiology Department for 10 years. Her scholarly work focuses on the development and evaluation of innovative approaches in anatomy education. LITERATURE CITED Baker S, Wentz R, Woods M. 2009. Using virtual worlds in education: Second Life as an educational tool. Teach Psychol 36:59–64. Bell D. 2009. Learning from Second Life. Br J Educ Technol 40:515–525. Bente G, Ruggenberg S, Kramer NC, Eschenburg F. 2008. Avatar-mediated networking: Increasing social presence and interpersonal trust in net-based collaborations. Hum Commun Res 34:287–318. Berge ZL. 2008. Multi-user virtual environments for education and training? A critical review of ‘‘Second Life.’’ Educ Tech 48:27–31. Bers MU. 2008. Virtual worlds as digital playgrounds. Educause Rev 43:80– 81. Boulos MN, Hetherington L, Wheeler S. 2007. Second Life: An overview of the potential of 3-D virtual worlds in medical and health education. Health Info Libr J 24:233–245. Broadribb S, Carter C. 2009. Using Second Life in human resource management. Br J Educ Tech 40:547–550. Cobb S, Heaney R, Corcoran O, Henderson-Begg S. 2009. The learning gains and student perceptions of a Second Life virtual lab. Biosci Educ 13:1–9. Croquet Consortium. 2010. Open Cobalt Project, Durham, NC. URL: http:// www.opencroquet.org/index.php/Main_Page [accessed 20 August 2010]. DeLucia A, Francese R, Passero I, Tortora G. 2009. Development and evaluation of a virtual campus on Second Life: The case of Second DMI. Comput Educ 52:220–223. Foss J. 2009. Lessons from learning in virtual environments. Br J Educ Tech 40:556–560. Gronstedt A. 2008. Be first in Second Life. Training 2008:29–30. Hansen MM. 2008. Versatile, immersive, creative and dynamic virtual 3-D healthcare learning environments: A review of the literature. J Med Internet Res 10:e26. Hew KF, Cheung WS. 2010. Use of three-dimensional (3-D) immersive virtual worlds in K-12 and higher education settings: A review of the research. Br J Educ Tech 41:33–55. Hewitt AM, Spencer SS, Ramloll R, Trotta H. 2008. Expanding CERC beyond public health: Sharing best practices with healthcare managers via virtual learning. Health Promot Pract 9:S83–S87. Howe N, Strauss W. 2000. Millennials Rising: The Next Great Generation. 1st Ed. New York, NY: Random House, Inc. 368 p. Jarmon L, Traphagan T, Mayrath M. 2008. Understanding project-based learning in Second Life with a pedagogy, training, and assessment trio. Educ Media Int 45:157–176. Leong JJ, Kinross J, Taylor D, Purkayastha S. 2008. Surgeons have held conferences in Second Life. BMJ 337:a683. OLIVE. 2010. On-Line Interactive Virtual Environment. Science Applications International Corporation (SAIC), McLean, VA. URL: http://www.saic.com/ products/simulation/olive/ [accessed 20 August 2010].

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