TEACHING IN AN E-LEARNING AGE: 

Using a Virtual Environment to Facilitate Authentic, Interdisciplinary

Instruction of Home Assessment

Combined Sections Meeting 2010San Diego, CA Feb. 17-20, 2010

Carla Sabus, PT, PhDcsabus@kumc.edu

Patricia Kluding, PT, PhDpkluding@kumc.edu

 

Welcome to the University of Kansas Medical Center Virtual World

Theme ObjectivesRecognize available resources that can be utilized

to develop virtual environments.

Evaluate the educational utility of virtual environments in physical therapy education.

Appreciate levels of student involvement and participation using virtual environments.

Recognize the value of technology as vehicles for interdisciplinary collaboration and instructional technology research.

Technology is just a tool. In terms of getting the kids working together and motivating them, the teacher is the most important. Bill Gates

Learning ObjectivesStudents will formulate patient-centered

environmental recommendations through an interdisciplinary, collaborative effort.

Students will appreciate the influence of contextual factors including patient values, patient roles, and environmental barriers on optimal physical function.

Students will evaluate recommendations to appreciate unintended consequences of environmental modifications.

Students will develop a home-based physical therapy plan of care.

Instructional ChallengesKUMC PT & OT student curriculum includes

skills development in home evaluation and recommendations

Former learning experiences have not: Demonstrated before and after home modifications for a

specific home and client Allowed students to evaluate recommendations and

consider unintended consequences of changes Allowed interdisciplinary collaboration that is typical of

home assessment Reinforced a patient-centered approach

Instructional OpportunityVirtual environment under development by

the Teaching and Learning Technology (TLT) department at KUMC. TLT pursuing multiple applications for virtual environment. Parallel content coverage by 1st year OT and DPT students in Fall semester.

PTRS case-based curriculum approach

The ICF: A Conceptual Framework for Home Assessment

Activity limitation is problems in activity that occur as a result of an interaction between a health condition and the context in which the person exists.

Functioning & Disability Body Functions and Structures Activities Participation

Contextual Factors Environmental Personal

Appreciating Environment and Personal Factors

Why do they have two microwaves and which do they really use?

Microwave AOlderFewer ButtonsFewer FunctionsLower Wattage

Microwave BNewerMore FunctionsMore ButtonsGreater WattageReceived as a Gift

Microwave A

Microwave B

Why do they have two and which do they really use?

Family gave them the new oneOlder one is the one they really useLower watts doesn’t blow a fuse in the

mobile homeFewer buttons, less errorMostly used to heat up stuff made by a

caregiver

Patient Values

Home & Objects Have Meaning

Objects selected by the person create permanence in the intimate life

Objects make up the person’s identity Household objects reflect as well as shape

the pattern of the owner’s self

Physical ContextContext: “a variety of interrelated

conditions within and surrounding the client that influence performance”

Physical context Built environment Natural Environment

Lawton’s Ecological Model

Lawton & Nahemow, 1973

BackgroundSecond life Platform for 3-D Virtual reality Estimated 2 million users Used as a grounds for research and

education Mason, 2007; Martinez, Martinez, & Warkentin, 2007; Polvinen, 2007; Schmidt, Kinzer, & Greenbaum, 2007

Provides options to simulate real-world type experiencesDede, Clark, Ketelhut, Nelson, & Bowman, 2005

Second Life and Health Education

Allows consequences and evaluation of solutions/interventions

Allows simulation of clinical situations and patient/client interaction that cannot be feasibly created in the classroom setting

Multiple applications of KUMC Island in Second Life Nurse Anesthesia Nursing Health Informatics Physical Therapy and Occupational Therapy

Instructional DevelopmentPlanning KUMC Isle

Fit-to-build vs Build-to-fit Time

Resources Computer/Internet standards (systems requirements:

http://secondlife.com/support/system-requirements/?lang=en-US)

User training/tutorials

Instructional planning Interdisciplinary curriculum planning Structuring learning activity, assignment, and assessment

Development Process Spring 2008

Acquisition of KUMC Island within Second Life Development of KUMC virtual OR and retirement home Initial planning for PT/OT department use of Second Life

Summer 2008 Construction of virtual townhouses (original and solution house) Instructional planning Research proposal, grant funding, Human Subjects approval (exempt)

Fall 2008 Instructor-guided home assessment with interdisciplinary student groups

Summer 2009 Data analysis, review of outcomes, revision goals and instructional methods Introduction of optional virtual environment assignment for 3rd year students

Fall 2009 Student immersion in virtual environment for home assessment and sharing

group recommendations for 1st year students Home environment incorporated in course for 3rd year students

1st Year Student Instruction - 2008Week 1

Content coverage (lecture)Tour of virtual home environmentInterdisciplinary group completion of assignment

Identify environmental challenges and assetsWrite 3 patient goals related to home functionPrioritize 3 environment recommendations to support goal

Week 3Group presentation of goals and recommendationsTour of solution virtual home environmentInterdisciplinary group completion of follow-up assignment

Evaluate recommendations and any unintended consequencesRevise patient goals and reprioritize recommendations as needed Consider recommendations within a $500.00 budget constraint

Individual reflection statements

Week 5Final group assignment and individual reflections dueWeb-based survey invitation (open 4 weeks with reminders)

1st Year Student Instructional DevelopmentFall 2008

Instructors provided the virtual environment tour. Instructors also directed the tour of the home with modifications.

Fall 2009Each student accessed the virtual environment through

individual avatars. Students independently viewed the group recommendations and toured the home with modifications. Students met outside of scheduled class time to make revisions to recommendations within budgetary constraints.

Testing the Threshold of Technology Tolerance and Self-directed Interdisciplinary Learning

3rd Year Student InstructionEmbedded in final neurologic rehabilitation

course

Individual activityAssignment introduced in syllabus, with

links and instructions on course websiteAt student request, 1 hour of class time

used to review assignment: Technology liaison gave overview of procedures Brief tour of virtual world Q and A

Dee RiglesOlder, retired adult with

history of DM with retinopathy, nephropathy, and peripheral neuropathy

Afternoon caretaker for 2 school-aged grandchildren

Diminishing participation due to impairments

General health and wellness considerations

Home Tour

Anticipated OutcomesGreater value of

interdisciplinary collaboration

Expect differences in Second Life learning experiences between In class gr0up activity

Individual immersion activity

Assignment Quality(compared to home assessment of student’s own home environment with a paper patient)

Recommendations within the Virtual Environment were

• More Specific

• More Patient Centered

• More Individualized

• More Contextual

• More Creative

Capturing Educational OutcomesTechnological Aspects• 87.5% (n=28) enjoyed the virtual learning

environment

• 93.8% (n=30) found the virtual environment was NOT a distraction to learning

• 21.9% (n=7) report feeling dizzy

Capturing Education OutcomesInterdisciplinary Interaction• 84.4% (n=27) found the interdisciplinary

activity was helpful to learning  

• 84.4% (n=27) found the interdisciplinary interaction helped with decision making

Second Life use in the future• 90% (n=29) agreed they could apply

learning to actual home assessment

• 43.8% (n=14) thought they would like to use Second Life in another class

Student Feedback - 2008

Strongly disagree

Disagree Unsure Agree Strongly agree

0

5

10

15

20

The Second Life envi-ronment helped my de-

cision making

Strongly disagree

Disagree Unsure Agree Strongly agree

0

5

10

15

20

Interdiscplinary inter-action helped my deci-

sion making

0

20

I can apply my learning with the virtual envi-ronment to an actual home assessment.

Student Feedback - 2009

Strongly disagree

Disagree Unsure Agree Strongly agree

0

5

10

15

Interdiscplinary interaction helped my decision making

Strongly disagree

Disagree Unsure Agree Strongly agree

0

4

8

12

The Second Life envi-ronment helped my de-

cision making

Strongly disagree

Disagree Unsure Agree Strongly agree

0

10

20

I can apply my learning with the virtual environ-ment to an actual home

assessment.

Strongly disagree

Disagree Unsure Agree Strongly agree

0

4

8

12

Accessing Second Life was too time consuming.

Reflection Themes - 2008Reflect on the learning process

Divergent viewpoints between disciplines Novelty of the experience Patient-centered approach

Identify knowledge gaps Expense/Reimbursement Practical aspects – feasibility, contractors Considerations of patient values when making recommendations

Reflect on your role in the group process Interdisciplinary role: professional identity, expertise of discipline Unique perspectives on the interaction of home environment on

patient function Understanding perception of self and viewpoints by others

3rd year Student AssignmentModifications to assignment

Detail on balance assessment in case description Prioritized problem list and plan for home-based PT

Reflection Did this assignment help you 1) develop a patient-

focused intervention, 2) understand home assessment for safety and function, 3) develop a home program of exercise that considers the home environment as a factor

Recommendations for this assignment in future?

3rd year Student Assignment[Recommended home modifications]

Problem list and plan for PT

Reflection comments

Unique Treatment Strategies Balance activities:

Using environment kitchen island carpet/tile surfaces seated reach on couch/bed open doors

Reach for household items cupboards move magnets on fridge objects on floor books in living room

Head turn while walk in kitchen/hallway Obstacle course with dog toys

Unique Treatment Strategies

Endurance training Walk pathway from kitchen to living room Use inside/outside stairs for exercise Play fetch with dog Play with grandkids

Simon Says Wii Play with legos or make bead necklace

Unique Treatment Strategies

Safety education: Kitchen – stove / coffee pot Rearrange items to within reach (kitchen / bathroom) Practice getting into/out of tub

Food prep: List of healthy, inexpensive, easy to prepare items /

cookbook Practice in therapy to assess deficits Include daughter/grandkids

Social: Host pot luck for family / friends with a cello concert!

Student Reflection: Positives

“It was nice to see the equipment/objects in her home for exercises”“Good to touch on the idea of home evals again after our first year in PT school”“This assignment helped me to think as a home health PT and use a critical, detail-oriented eye to find potential problems in the home”“I had to modify several of my initial treatment ideas once I saw the actual home environment”“I am new to Second Life and I was pleasantly surprised at how user-friendly it was”

Student Reflection: Negatives

“I don’t think many real homes look like this – on my home health rotation many homes were split level, crammed full of 40 years worth of stuff, wobbly handrails, etc” “A lot of work to install the program, create an avatar, and getting access to the isle for the project”“Challenging to upload to my home computer”; “Would prefer to have software more available on campus computers”“It would be better to see a depiction of the patient and how she moves in her home”; “A more complex patient or including a follow up component would improve this assignment”“This assignment would be improved by doing it in an actual home”

Both Positive and Negative …

“Second Life is an amazing program that can do a lot! … but it can be so involved that it distracted me from the actual assignment”

Take Home MessageStudents enjoyed using Second Life.

Students felt they benefited from interdisciplinary interaction.

Educational programs can use similar technology in building new curriculum.

Capture student outcomes when introducing an novel instructional strategy.

Future plansEmbedded information/prompts

Integration of clinical simulations with electronic health record

Expand interdisciplinary collaboration

Observation of patient’s interaction with environment

http://secondlife.com/

Questions, Ideas, and Discussion

Referenceswww.secondlife.com

Antonacci. D. M., & Modaress, N. (2005). Second life: The educational possibilities of a massively multiplayer virtual world (MMVW). Paper presented at the EDUCAUSE Southwest Regional Conference, Austin, Texas. Conklin, M. S. (2005). 101 uses for second life in the college classroom. Retrieved Jan. 3, 2010.

Dede, C., Clarke, J., Ketelhut, D., Nelson, B., & Bowman, C. (2005). Fostering motivation, learning, and transfer in multi-user virtual environments. Paper presented at the Annual Conference of American Educational Research Association (AERA), Montreal, Canada Lawton MP.

Competence, environmental press, and the adaptation of older people. In: Lawton MT, Windley PG, Byerts TO, ed. Aging and the Environment. New York, NY: Springer, 1982: 33-59.

Tomey KM, Sowers MR. Assessment of physical functioning; a conceptual model encompassing environmental factors and individual compensation strategies. Physical Therapy. 2009; 89:705-714.

AcknowledgementsAging in Place

Dory Sabata, OTD, OTR/L, SCEM

KUMC Teaching and Learning Technology Department

Tennille Fincham Stephanie Gerald Dave Antonacci