ArticlePDF Available

Second Life in higher education, medicine and health.

August 2008
He lth Information on the Internet

DOI:10.1258/rsmhii.64.1.6

Authors:

Silversprite

The Second Life ‘worlds’ consist of islands and larger areas of ‘virtual land’. Linden Labs make much of their income by renting out land to people and organisations. Once you are renting some land, you can develop buildings and other structures. Some laws of physics can be ignored; for example, you can build rooms or floors high in the sky. Structures can incorporate an increasing selection of media, connecting Second Life to websites and ‘Web 2.0’ applications such as YouTube and Twitter. Streaming video feeds from ‘real world’ conferences – and sending back comments and questions from avatars to the conference – is increasingly popular, as it means attendees do not have to travel to the event, saving time, money and carbon emissions.

Content uploaded by John Kirriemuir

Content may be subject to copyright.

An introduction to Second Life

Second Life (SL) <www.secondlife.com/>

is an internet-based ‘virtual world’,

launched in 2003 by Linden Research,

otherwise known as Linden Labs (LL).

Around 13 million accounts have

been set up in SL, though the average

number of people ‘in world’ at any

one time is around 40,000.

The SL ‘worlds’ consist of islands

and larger areas of ‘virtual land’. LL

make much of their income by rent-

ing out land to people and organisa-

tions. Once you are renting some

land, you can develop buildings and

other structures. Some laws of

physics can be ignored; for example,

you can build rooms or floors high in

the sky. Structures can incorporate

an increasing selection of media, con-

necting Second Life to websites and

‘Web 2.0’ applications such as

YouTube and Twitter. Streaming

video feeds from ‘real world’ confer-

ences – and sending back comments

and questions from avatars to the

conference – is increasingly popular,

as it means attendees do not have to

travel to the event, saving time,

money and carbon emissions.

People (residents) who register for

SL are given a default, human-

shaped avatar. This can be easily cus-

tomised at any point in a large

variety of human and non-human

ways, for example by changing its

clothing. It is not uncommon to

attend an event in SL and find your-

self amid a crowd of human, semi-

human and non-human avatars.

Avatars move around the world

by walking or flying or by ‘teleport-

ing’ instantly to locations. Forms of

communication include instant mes-

saging, text chat, movement (e.g.

waving to or pointing at another

avatar) or, more recently, using voice

(which has received a mixed

response).

Underpinning SL is a currency sys-

tem (the Linden Dollar) and an econ-

omy. People can create virtual items,

such as clothing, shoes, new body

shapes and other ephemera that exist

in SL only. These can then be traded

or sold, which has led to a market-

based economy. A small proportion

of people make a living from SL,

while more make enough income to

offset their in-world expenses. The

complex economy, and issues such

as the exchange rate with the US dol-

lar and the taxation of income gener-

ated within SL, has led to interest

from economists, academics and

Inland Revenue services.

Teen Second Life is a self-con-

tained version of SL for 13–17-year-

olds. Age verification is required for

people to enter the Teen Grid. Teen

Second Life users are transferred to

the main SL grid once they turn 18

years, taking all content and private

islands with them.

Though there are many articles

and books on SL and the many other

emerging virtual environments and

worlds, there is no replacement for

actually experimenting with and

experiencing SL itself. It is highly

He@lth Information on the Internet

6NUMBER 64 AUGUST 2008

The Second Life ‘worlds’ consist of islands and larger areas of ‘virtual land’. Linden Labs make

much of their income by renting out land to people and organisations. Once you are renting

some land, you can develop buildings and other structures. Some laws of physics can be

ignored; for example, you can build rooms or floors high in the sky. Structures can incorporate an

increasing selection of media, connecting Second Life to websites and ‘Web 2.0’ applications such

as YouTube and Twitter. Streaming video feeds from ‘real world’ conferences – and sending back

comments and questions from avatars to the conference – is increasingly popular, as it means

attendees do not have to travel to the event, saving time, money and carbon emissions.

Second Life in higher education,

medicine and health

John Kirriemuir john@silversprite.com

Researcher and consultant

in the application of digital games and virtual environments <www.silversprite.com>

Health and medical islands, installations and services within Second Life have been developed by

a variety of medical, educational, research and private organisations.

… there is no replacement for actually experimenting with and experiencing SL

itself. It is highly recommended to download the software (called the ‘viewer’)

He@lth Information on the Internet

NUMBER 64 AUGUST 2008 7

recommended to download the soft-

ware (called the ‘viewer’), set up a

free avatar, follow the orientation

exercises, find and explore areas of

interest, and communicate with

other people within SL.

SL in UK higher education

The key advantage of SL in teaching

and learning is that there are many

activities in which the student must

be more than a passive learner in

order to progress. The student has to

develop ‘stuff’, collaborate and par-

ticipate. Before these can occur, he or

she has to master a new and transfer-

able skill set, meaning that, in SL,

learning is done more by participat-

ing and doing than by listening and

absorbing.

A growing body of research points

to virtual worlds being increasingly

used in teaching and learning over

the next few years. For example, a

key 2007 report predicted that ‘vir-

tual learning spaces’ will be adopted

on a wide-scale basis in education

within the next 2–3 years.1

After a slow take-up during previ-

ous academic years, the number of

higher education staff in the UK who

are developing or operating teaching

and learning resources in SL has

grown rapidly in the last year. While

an accurate figure is difficult to

determine (partially due to the non-

public nature of some develop-

ments), a report by the Eduserv

Foundation2estimated that some

three-quarters of UK universities are

actively developing or using SL at an

institutional, departmental, or individ-

ual academic level. Of these, many

institutions support several ongoing SL

developments, often involving groups

of people or collaborations across

departments or institutions rather

than lone individuals.

Many of these developments are

funded internally, with staff often

donating significant amounts of their

own time. An increasing body of aca-

demics are reporting substantial use

of their SL developments and suc-

cesses in teaching and learning activ-

ities. Measuring the usage of these

developments tends to be through

raw visitor statistics or informal feed-

back, though a few academics teaching

in SL use more rigorous evaluation

techniques.

Academics who have successfully

developed in SL report that their host

institution and technical services are

largely supportive, though with the

latter there are often problems with

firewalls, PC capability and enabling

voice functionality. Academics

report a wide variation in reactions

to SL from colleagues, ranging from

interest and curiosity to suspicion

and ‘hatred’.

The Eduserv Foundation survey

showed that academics developed a

wide range of SL activities spanning

teaching, learning, research, perfor-

mance, construction and student

presentation and demonstration.

However, though use of SL in UK

higher education (and, to a lesser

extent, further education) is growing,

many academics are not committed

to it in the long term, being aware of

its deficiencies and open to moving

to alternative virtual environments,

especially open source and more

localised versions, in the next acade-

mic year or two.

SL in medicine and health

The ALS (Alliance Library System)

received a grant of US$40,000 from

the National Library of Medicine to

provide consumer health informa-

tion services within SL. The resulting

HealthInfo Island <http://slurl.com/

secondlife/Healthinfo%20Island/128/

128/0> contains a variety of displays,

information boards, surveys and

other informative material from

many health and medical organisa-

tions. A recent collaborative event on

the island discussed the research evi-

dence in stroke rehabilitation and

survivor perspectives. The final pro-

ject report3details many of the fea-

tures, and collaborative partners, of

the island.

In Spain, teenagers can ‘speak’ to a

doctor within SL, using the advan-

tage of anonymity to discuss embar-

rassing conditions.4This particular

application of SL is not without its

critics, who argue, for example, that

the root cause of teenagers not

attending surgery should be

addressed, and that the doctor often

cannot give an accurate diagnosis of

a patient he or she cannot see.

The SL Institute for Clinical

Education <http://slurl.com/secondlife/

Aido%20Wedo/228/83/39> is being

developed by the Department of

Medical Education at the University

of Illinois at Chicago. This SL area is

used to train medical students and

physicians, and explore the educa-

tional applications of virtual envi-

ronments. Meanwhile, in a

password-protected area of SL, Dr

Peter Yellowlees, Professor of

Psychiatry at the University of

California has created a simulation5

of schizophrenia so non-sufferers can

experience (to a certain extent) the

condition.

The Medical Ethics Park

<http://slurl.com/secondlife/Odaesan/24/

224/0> contains information on med-

ical ethics around the world, and a

meeting place for ethics committee

members. Meanwhile, the London

Oncology Clinic Island <http://slurl.com/

secondlife/Cancer%20Innovation/137/65/

29> is a recreation of a real-world

clinic. People can walk in, look

around, and read various informa-

tion on the ‘latest cancer treatments’,

for example.

… in SL, learning is done more by participating and doing than

by listening and absorbing.

the London Oncology Clinic Island

<http://slurl.com/secondlife/Cancer%20Innovation/137/65/29>

is a recreation of a real-world clinic.

The key advantage of SL in teaching and learning is that there are many

activities in which the student must be more than a

passive learner in order to progress

He@lth Information on the Internet

8NUMBER 64 AUGUST 2008

SL can be used to engage with older

people and people with physical dis-

abilities, and help them combat social

isolation and loneliness. A recent video

interview of a SL user with cerebral

palsy, describes how he runs a dance

club in Second Life called Wheelies

<http://jeremylundberg.blogspot.com/

2006/11/second-life-excellent-review-

from-cbc.html>. The technology also

exists (though not yet in mass-market

form) for paralysed people to use SL to

meet avatars, communicate, explore

and carry out other functions without

the need of a carer or other person

<http://news.sky.com/skynews/article/

0,,30200-1294720,00.html>.As more

internet-based services are connected

to or made accessible from within SL,

so this technology may give back

some independence and control to

severely disabled people.

In examining the educational pos-

sibilities of user-created virtual

worlds,6David Antonacci and Nellie

Modaress from the University of

Kansas Medical Center introduce

some of the educational potential of

simulations such as SL. The paper

includes a reference to their use of SL

role play to provide medical students

with practice in physician/patient

encounters together with a sample

video in which they use text chat to

simulate the dialogue between the

healthcare team and a patient and

spouse.

Several health and medical islands

and buildings were developed by the

UK education and health sectors. For

example, the University of Plymouth

Sexual Health SIM <http://slurl.com/

secondlife/Education%20UK/18/36/22>

is a public education and outreach

project, with a variety of interactive

displays and tools.

Meanwhile, the Faculty of

Medicine at Imperial College

London have developed a ‘virtual

hospital’ <http://slurl.com/secondlife/

Imperial%20College%20London/150/

86/27> in SL which will provide expe-

riential, diagnostic and role-play

learning activities supporting the

teaching of patient diagnosis, investi-

gation and treatment. A ‘virtual

patient’ has being implemented in

this virtual hospital;7a randomised

controlled trial is currently taking

place, aiming to compare the learn-

ing gains of participants in two

groups given the same respiratory

emergency case, one in an interactive

e-module and the other using game-

based activities in the respiratory

ward in SL.

There are many other medical and

health information services within

SL. Again, descriptions of these are a

poor substitute for visiting, explor-

ing and interacting with them. The

number of health and medical devel-

opments (and teaching and learning)

within SL will probably increase

over the next few years. Factors in

this rise include the proliferation of

broadband, improvements in PC and

virtual world capabilities, the costs

of formal education, and more ‘real

world’ issues such as the rising cost

of large numbers of people collec-

tively travelling to a centralised

teaching location and the resulting

carbon footprint.

However, some of the long-stand-

ing issues concerning health and

medical information, services and

advice are also applicable to virtual

environments. How does the person

behind the visiting avatar know the

health or medical information is

accurate? Who, or what, is providing

the information? Is it up to date? Is it

more suited to a visiting patient or

doctor? These issues, long-grappled

with by web-based services such as

OMNI (now part of Intute:

<www.intute.ac.uk>) are yet to be seri-

ously considered and addressed by

virtual environments such as SL.

While SL provides a smorgasbord of

information and communication

opportunities, the caveat ‘reader,

beware’ still holds true for visitors to

this virtual world.

References

[All accessed 29 May 2008]

1. 2007 Horizon Report. The New Media

Consortium, EDU CAUSE Learning

Initiative, 2007 <www.nmc.org/pdf/

2007_Horizon_Report.pdf>.

2. Kirriemuir J. A spring 2008 ‘snapshot’ of

UK Higher and Further Education

Developments in Second Life. Eduserv

Foundation, 2008

<www.eduserv.org.uk/foundation/sl/

uksnapshot052008>.

3. HealthInfo Island Final Report. Alliance

Library System, 2008

<www.alliancelibrarysystem.com/pdf08/

healthinfoislandfinalreport08.pdf>.

4. Keeley G. Teenagers to take embarrassing

ailments to doctors. Guardian online, 2008

<www.guardian.co.uk/technology/2008/

may/10/secondlife.spain>.

5. Elliott J. What it’s like to have

schizophrenia. BBC News Website, 2007

<http://news.bbc.co.uk/1/hi/health/

6453241.stm>.

6. Antonacci DM, Modress N. Envisioning

the educational possibilities of user-

created virtual worlds. AACE J 2008; 16:

115–126.

7. Games-based learning for virtual patients

in SL, Imperial College London.

<www.elearningimperial.com/

index.php?option=com_content&task=

view&id=37&Itemid=58>.

Jakob Nielsen’s Alertbox,

June 9, 2008

<www.useit.com/alertbox/print-

vs-online-content.html>

Writing for print as compared

to the web requires a different

style which can be summarised

as: ‘Linear vs non-linear.

Author-driven vs reader-driven.

Storytelling vs ruthless pursuit

of actionable content. Anec-

dotal examples vs compre-

hensive data. Sentences vs

fragments’.

Writing Style for Print vs

web

Professor of Psychiatry at the University of California has created

a simulation5of schizophrenia so non-sufferers can experience

(to a certain extent) the condition.

… a SL user with cerebral palsy, describes how he runs a dance club

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The New Media Consortium, EDU CAUSE Learning Initiative