Avatar : saving lives in virtual worlds

In medicine, education and recurrent training is fundamental for efficient and safe care. In emergency situations one has to rely on robust protocols that reduce the risk for errors. However, today there is plenty of evidence that the professional level of knowledge, manual, cognitive and teamwork skills as well as suitable attitudes needs to be raised. By using new and promising educational technology it has been proposed that one can address several problems in today’s education and training. So far, in medicine there haven’t been many results on whether gaming technology supports learning although findings from several authors are encouraging. One area of particular interest is that of cardiopulmonary resuscitation (CPR), since all health care professionals are assumed to possess competence in this field. To disseminate the knowledge and skills, with the goal of reaching better outcome after out-of-hospital sudden cardiac arrests, CPR is also trained at schools.

With the rapid development in information and communications technology (ICT) and the increase in computer access and skills in a digital native generation, the stage is set for “serious games”. By using cardiopulmonary resuscitation as a model, the aim of this thesis project has been to understand if a virtual world is suitable for training medical and high school students to assist in emergency medical situations.

A virtual world with capabilities to train teamwork CPR was developed. Short scenario based training sessions using a virtual school environment was carried out in teams. In study I and II user experiences and reactions were assessed from a social cognitive and games research perspective. The findings in terms of strengthened self-efficacy beliefs and positive ratings on dimensions of “flow” experience indicated that this tool could engage the subjects and carried properties important for learning and execution. Results from Swedish and US high schools were comparable. Study III was a transfer study in which virtual world pre-trained groups were assessed and compared to control subjects in a full-scale high fidelity patient simulator, 6 and 18 months after virtual world CPR team training. Main findings in this study indicated that subjects trained 6 months before simulator assessment delivered higher quality CPR in terms of chest compressions, and followed the CPR protocol better than the other groups. In study IV the aim was to get a more complete picture of how the virtual world CPR team training was perceived by the participants and compare the findings with theories on learning and serious games. Using a qualitative approach, four categories evolved as end result. The findings support many of the proposed benefits of serious games, such as high levels of enjoyment and engagement. Further, learning in teams is beneficial for several reasons. However, there are areas that call for some caution. It can be questioned if a sense of mastery created in a virtual world easily transfers to the real world. Also, not all students are enchanted by computers and computer games – when establishing training in virtual worlds one has to consider the level of computer interest among the users. To evoke the proposed positive effects of virtual world training, one has to meet the demands this game derived method poses in terms of high levels of challenge, proximal goal-setting, affective involvement and rich feed-back.

Although being exploratory to its nature, the results from this project demonstrate possibilities within virtual worlds for training in teams. Being accessible, relatively inexpensive to run and rich in variations, virtual worlds based training can be motivated in a variety of settings within medicine.

List of scientific papers

I. Creutzfeldt J, Hedman L, Medin C, Heinrichs WL, Felländer-Tsai L. Exploring virtual worlds for scenario-based repeated team training of cardiopulmonary resuscitation in medical students. J Med Internet Res. 2010, vol.12, e38.
https://doi.org/10.2196/jmir.1426

II. Creutzfeldt J, Hedman L, Youngblood P, Heinrichs WL, Felländer-Tsai L. Cardiopulmonary resuscitation training in high school using avatars in virtual worlds: An international feasibility study. J Med Internet Res. 2013, vol.15, e9.
https://doi.org/10.2196/jmir.1715

III. Creutzfeldt J, Hedman L, Felländer-Tsai L. Effects of pre-training using serious game technology on CPR performance – an exploratory quasi-experimental transfer study. Scand J Trauma Resusc Emerg Med. 2012, vol.20, 79.
https://doi.org/10.1186/1757-7241-20-79

IV. Creutzfeldt J, Hedman L, Felländer-Tsai L. Training CPR by avatars: A qualitative study of medical students’ experiences of a multiplayer virtual world. [Manuscript]