Procedia

Procedia Computer Science 3 (2011) 1454–1463 Computer

www.elsevier.com/locate/procedia
Procedia Computer Science 00 (2009) 000–000 Science
www.elsevier.com/locate/procedia

WCIT 2010

Health Course Module in Virtual World

Nik Siti Hanifah Nik Ahmad, Dr Tao Ruan Wan, Ping Jiang

Department of Informatics, University of Bradford

Bradford, BD7 1DP, UK

Abstract

Explorative learning in Virtual World concerns about student getting lost and without clear direction. More
time is wasted through wondering around places rather than go through learning and training directly. This project is
about how to design health course in Virtual World by using instructional design. On pilot study, episiotomy and
dementia module is created in Second Life. The result is gathered and used for further development.
⃝
c 2010 Published by Elsevier Ltd. Selection and/or peer-review under responsibility of the Guest Editor.
Keywords: Virtual World; Second Life; health course module; instructional design.

1. Introduction

Vozenilek (2004) said that the explosion of the number of technology tools for the last decade has enable
health and medical education in exploring web-based education, virtual reality and high-fidelity patient simulation.
Mead et al (1999) stated that there is exponential growth of internet health seeking information which uniformly
high. Healthcare and pharmaceutical industries used to brings everyday innovations which mean the difference
between life and death of the patients. Enspire is one of the organizations which bring solutions for medical
education. It brings unique experience, cutting edge innovation, and production values to the online healthcare
education space. Toyle (1998) stressed that changes of health services are the result of the vast changes in computers
and communication technology.

Since today, the Virtual World or online 3D Virtual Learning Environment has become the new comers in
education field, there is a lot of vacant space needs to be accessed to create firm learning environment for online
students. Teaching and learning practices should evolve and the university should be in the fore in implementing
changes, recognizing that it is academic objectives that should drive innovations and not the technology. Therefore,
a general methodology for the planning, application and evaluation of teaching and learning techniques and tools
should be developed in manipulating this new technology.

Sanchez (2007) had analyzed that Second Life that is one of Virtual World or metaverse program lack of
two important things which make it unsuccessful to attract student interest. The first was that student could not

1877-0509 ⃝c 2010 Published by Elsevier Ltd.

doi:10.1016/j.procs.2011.01.031
 N.S.H. Nik Ahmad et al. / Procedia Computer Science 3 (2011) 1454–1463 1455

Nik Siti Hanifah Nik Ahmad, Dr Tao Ruan Wan and Dr. Ping Jiang/ Procedia Computer Science 00 (2010) 000–000

realize and understand the purpose of their Second Life activity which how it was related to their course material.
Second, students felt that they weren’t given adequate instruction to complete the tasks assigned in second Life.
Second Life also lacks of Learning Management Systems which normally could provide a grade book, an
assignment drop box, asynchronous discussion tools, online surveys, and objective assessments (Kluge and Riley,
2008). This would make instructors has rigid control over lesson sequencing. The instructors need to get control of
lectures, power point presentations, essay and multiple choices exams as well as discussion boards in Second Life.

It can be seen throughout history that instructional design would changes through the changes of time and
technology. Reiser (2006) confirmed that the changes of media such as computers, media and other digital media
did have great effects towards the instructional practices. This would include instruction in Virtual World
environment, mobile phone technology and other gadgets.

Since intervention strategies could be done to enhance promotion of health and safety, instructional design in
metaverse could be used to give solutions. Mead et al (1999) suggested the application of cognitive theory to
training and design solutions for age related computer use. Feldman and Case (1999) had proved that instructional
design materials can improve health and safety through self learning. Through instructional design self-training,
people with low intellectual skills can improve their parenting skills with low cost, low technology and self
instructional materials. Further more J Sweller and P Chandler (1994) had compute the result of analysis of both
intrinsic and extraneous cognitive load that can lead to instructional designs generating spectacular gains in learning
efficiency.

2. Current Courseware in 2D

Both web-based courseware and Virtual World course module have similarities and difference in certain
design. There are four major parts of the course module. They are objective, tutorial, enhancement activities and
quiz or test.

x Navigation Design
Navigation in 2-dimensional course module normally use hyperlink. The titles of the lessons list can be
presented anywhere at the beginning of the module, for example appeared below on the left hand side of
Figure 1.

Figure 1: Courseware navigation design in 2D

x Objectives design
1456 N.S.H. Nik Ahmad et al. / Procedia Computer Science 3 (2011) 1454–1463

Nik Siti Hanifah Nik Ahmad, Dr Tao Ruan Wan and Dr. Ping Jiang/ Procedia Computer Science 00 (2010) 000–000

Figure 2 shows the example of the objective part in web courseware, whereby the student would know the
missions that they should achieve at the end of the lesson.

Figure 2: Courseware objective design in 2D

x Body of knowledge or Tutorials Design

Tutorial contains the contents of the teaching in a lesson. Figure 3 shows the example of the tutorial part
where the student may learn the lesson of the subject in 2D.

Figure 3: Courseware tutorial design in 2D

x Enhancement Design
Figure 4 shows the example design of the enhancement part where the student can make activities of the
security lesson. The student can make matching the appropriate item by dragging it to the human body. If
it’s correct, it will stay; otherwise it will go back to the original place.
 N.S.H. Nik Ahmad et al. / Procedia Computer Science 3 (2011) 1454–1463 1457

Nik Siti Hanifah Nik Ahmad, Dr Tao Ruan Wan and Dr. Ping Jiang/ Procedia Computer Science 00 (2010) 000–000

Figure 4: Courseware activity design in 2D

x Quizzes Design
A quiz is the short test given to student after a lesson. Figure 5 shows the example of web based quizzes
design of the course module.

Figure 5: Courseware quizzes design in 2D

3. Virtual World Course Module

In this development, we had created three prototypes. They are in tooth decay, episiotomy and dementia.
Two of them (episiotomy and introduction of dementia) had been implemented and tested at the Malaysia Science of
University by 21 health students during the pilot study. Each of the programs consists of 5 parts. They are the 3D
hospital environment, introduction, tutorial, and quizzes. The test system was developed after the conduction of case
study and the health 3D simulator objects for enhancement would be developed in further research.

x Framework in VW
Developing health and medical module can be a hassle without the framework. Technically medical
subjects need a practical or clinical practice besides the theoretical. Figure 6 shows the simple framework
of the Virtual World course module design.
1458 N.S.H. Nik Ahmad et al. / Procedia Computer Science 3 (2011) 1454–1463

Nik Siti Hanifah Nik Ahmad, Dr Tao Ruan Wan and Dr. Ping Jiang/ Procedia Computer Science 00 (2010) 000–000

Module
Objectives in a
drop note card or
board
Knowledge
transfer: Learning
by experience

Exit

Enhancement:
Evaluation: Simulation, or
Quizzes or
Experience
Test in 3D

Figure 6: Virtual World Courseware Framework Design

x Navigation Design
Navigation in Virtual world can be made through teleporting, flying, walking and running from current
place to another place. The student just make point to where or which lesson they want to move, then they
would be transferred to that places. Figure 7 show navigation design in virtual world.

Figure 7: Navigation design in virtual world

 N.S.H. Nik Ahmad et al. / Procedia Computer Science 3 (2011) 1454–1463 1459

Nik Siti Hanifah Nik Ahmad, Dr Tao Ruan Wan and Dr. Ping Jiang/ Procedia Computer Science 00 (2010) 000–000

x Objectives design
Objectives can be given at the beginning of environment exploration whereby the student may know what
task that they should make throughout the lesson learning for examples, at the front door of the building, in
front of the gate of the prison or at any beginning stage of the exploration. Figure 8 show objective design
sample in Virtual World

Figure 8: Objective design sample in Virtual World

x Body of knowledge or Tutorials Design

Tutorial of the course can be offered through pictures, whiteboards, power points, web links, 3D
animations, video and experience learning environment. Figures 9 show tutorial sample design in Virtual
World.

Figures 9: Tutorial samples design in Virtual World

x Enhancement Design
For enhancement learning, simulated environment and simple game can be offered through this stage
whereby the student may practice and enhance their understanding from tutorial part. Figure 10 shows
simulated environment sample in Virtual World.
1460 N.S.H. Nik Ahmad et al. / Procedia Computer Science 3 (2011) 1454–1463

Nik Siti Hanifah Nik Ahmad, Dr Tao Ruan Wan and Dr. Ping Jiang/ Procedia Computer Science 00 (2010) 000–000

Figure 10: Simulated environment sample in Virtual World

x Quizzes Design
The student may answers short quiz after each lesson learned by clicking the multiple choice answer. The
correct and wrong answer would be told directly and the student can learn their mistake through this
practice. Figure 11 shows sample Quizzes design in Virtual world.

Figure 11: Sample Quizzes design in Virtual world

x Test Design
Test Design is normally done after the couple of lessons. Here is the example of the test design. When the
student click test paper of the module’s given, the questionnaires appeared on the screen and the student
can answer it by clicking the multiple choice answers. Figure 12 shows sample test design in Virtual
World. After the students answer all the questions, the lecturer can receive the student’s answer through his
email. This can make the lecturer track student performance. Figure 13 shows sample output result of test
of Virtual World in email.

Figure 12: Sample test design in Virtual World

 N.S.H. Nik Ahmad et al. / Procedia Computer Science 3 (2011) 1454–1463 1461

Nik Siti Hanifah Nik Ahmad, Dr Tao Ruan Wan and Dr. Ping Jiang/ Procedia Computer Science 00 (2010) 000–000

Figure 13: Sample output result of test of Virtual World in gmail.

4. 2D vs VW Courseware

2Ds and Virtual World courseware or course module have several similarities and differences. Here are several
points that can be declared about 2d and VW course module differences.

2D Virtual World
Different lessons in different frames Different lessons in different land space
Navigation by frames hyperlink Navigation by teleporting and flying
Simple activities like drag and drops with low High simulation activities like gaming can be
simulated activities. done in one activity
Table 1: Courseware different in 2D and Virtual World

5. Limitation

There are three important limitations of this pilot studies. They are connections speed, time and cost.
Connections speed is vital which we can’t develop, access, connect and do practice with low internet connection
speed. Time is relatively consuming in developing 3D objects and gaming or simulating styles in Second Life. It’s
good to have lots of 3D library objects to make developing faster. Cost is relatively high in developing course
module in second Life. There are monthly subscription needed and space or land buying required. Lots of lessons
means lots of space/land required. To develop 5 simple lessons means we have to buy 5 different lands, space or
location.

6. Further Development

From the results of pilot study, further design development and enhancement would continue to expand on
several aspects. They are:

x 3D instructional architecture design on building environment for navigation

The real map, signs and more instructions should be added. Adding real 3D environment could give more
real learning experience. Merrill (2002) has identified that learners should engaged in solving real-world
problems as first principle of instruction. Real situation and environment would resemble real world
problem and situation and the program would be more real and straight forward. Then, it would reach the
objectives faster.
1462 N.S.H. Nik Ahmad et al. / Procedia Computer Science 3 (2011) 1454–1463

Nik Siti Hanifah Nik Ahmad, Dr Tao Ruan Wan and Dr. Ping Jiang/ Procedia Computer Science 00 (2010) 000–000

x Quizzes result computation

Result of quizzes can be cumulated at the end of test. Dick and Carey (1990) and Andrews and Goodson
(1980) suggest test as one of the several activities that instructional designers need to created.

x Parental lesson modules

Courseware in virtual world could follow the good instructional principles by George M.piskurich (2000),
where the subject should only be given to the student of the subject itself, so they may have interest on it,
not for random users.

x Experiments would be launch in higher speed Internet connection region.

Further experiments would be launch in UK for better results and findings. From the pilot study and
previous research by Thompson , Vivian and Raye (1997) internet connection or access speed is highly
rated as very important by the users in case at Malaysia and Singapore. The system should only be
implemented at the fast speed region, so the virtual reality environment could be express in real time, and
fast. Thus, it would avoid the lack of interruption and slow movement which cause low concentration and
give up.

x Multimedia for more interactive learning

The program should be more interactive by adding sounds and more animations. Frick et al, (2002)
suggested that the modules need to be more interactive and with more multimedia, and making them more
difficult or challenging.

x Simulators on learning activities

The simulator or 3D simulations object should be created for learning understanding enhancement.
The plan of health simulators is already in future development plan. Salter (2003) had made some
suggestion on importance of multiple representation of content for instructors to be prepared and students
to be encouraged.

x Technology and specific instructions guidance before learning sessions

The specific guidance or User’s Guide would be prepared on next experiment for all participants as
guidelines in doing the learning of the program so they may well acknowledge before and during the
learning process.

7. Conclusion

We could see, that the slow internet connection become the highest limitation and the 3D environment and
instructions became the second important factor of system design, followed by module and sound. Animation and
simulator also need an attention in the future development.

Overall, most of the student agreed that, studying with virtual reality program is safe rather than make
experiment on real patient, interactive, less boring, easy to remember and alternative studying choice for distance
health student. On the other hand, the health students should be internet savvy and need proper guideline to start the
virtual environment learning and training. Otherwise, it would be wasting time and lack of focus. Thus, instructions
need to be more specific and elaborative. Further development is being done in alternative medicine, nutrition and
women health modules.

This Instructional Health Virtual World design framework can be applied in other field than health such as
engineering, pure sciences and arts. This learning program would be beneficial for understanding complicated health
modules and can be assessed worldwide. Thus this type of learning and training is safer, economical, faster, increase
student performance and profitable to educational institution, which would attract more people in learning health.
 N.S.H. Nik Ahmad et al. / Procedia Computer Science 3 (2011) 1454–1463 1463

Nik Siti Hanifah Nik Ahmad, Dr Tao Ruan Wan and Dr. Ping Jiang/ Procedia Computer Science 00 (2010) 000–000

This framework and strategy can still be enhanced either in macro or micro aspects.

Acknowledgements

Thanks and gratitude to those who had contributed either directly or indirectly in ensuring the success of this
research. They are USM health students, USM K.Kerian technicians and managements, Mark K Tympalski as
Bradford Informatics technician, 3D online VLE Dementia educational project coordinator Dr Clive Baldwin, and
finally A. Yoosoh , N. A Azzam and N.A. Aziz A.Y as motivational and strong supporters.

References
1. M.A. Feldman & L. Case, (March 1999). Teaching childcare and safety skills to parents with intellectual disabilities through self
learning. Journal of Intellectual & Development Disability, Vol 24 (1), pp 27-44.
2. Frick et al, (2002).5-Star Instructional Design: Evaluation of Web-Based Instruction in Medical Science.
http://www.indiana.edu/~tedfrick/aect2002/frickwatsoncullenhan.pdf.
3. George M.piskurich (2000) Rapid Instructional Design. John Wiley& Sons, CA.
4. J. Sweller & P. Chandler (1994). Why Some Material Is Difficult to Learn. Cognition and Instruction, JSTOR , 2 (3),185-233 .
Taylor & Francis, Ltd.
5. S. Kluge, & L. Riley, (2008). Teaching in virtual worlds: Opportunities and challenges. Issues in InformingScience and Information
Technology. Informing Science Institute, 5, 127-135. Retrieved June 12, 2009, from
http://proceedings.informingscience.org/InSITE2008/IISITv5p127-135Kluge459.pdf
6. S.E. Mead et al, (1999). Application of cognitive theory to training and design solutions for age-realted computer use. International
Journal of Behavioral development, 23 (3), 553-573.
7. D.M. Merrill (2002). First principles of instruction. Educational Technology Research and Development, 50 (3), 43-59.
8. R.A. Reiser (2006). A history of instructional design and technology: Part I: A history of instructional media. Educational Technology
Research and Development Journal, 49 (1), 53-64.
9. D. Salter et al ( Jan 2004). The" T5" Design Model: An Instructional Model and Learning Environment to Support the Integration of
Online and Campus-Based Courses. Educational Media International, - eric.ed.gov, 41(3), 207-218; Taylor & Francis Group.
10. J. Sanchez (2007). Second Life: An Interactive Qualitative Analysis. In C. Crawford et al. (Eds.), Proceedings of Society for
Information Technology and Teacher Education International Conference 2007, 1240-1243.
11. T.S.H. Teo et al (October 1997). Users and uses of the internet: The case of Singapore. International Journal of Information
Management, Volume 17, Number 5, 325-336 (12): Elsevier Science Ltd.
12. A. Toyle (1998). Continuing medical education. Changes in health care and continuing medical education for the 21st century: BMJ;
316:301-304.
13. J. Vozenilek et al (2004). See one, do one, teach one: advanced technology in medical education. Acad Emerg Med, 11:1149–54.