FACULTY OF HEALTH ETHICS COMMITTEE
APPLICATION FORM
Title of the research: Evaluating the impact of virtual world learning on communication and team working behaviour during high fidelity simulations.Chief Investigator:Nigel Wynne
Staff
!Before you start to complete this form please take a few minutes to answer the following questions to make certain that you are applying to the right committee at the right time.
1. Have you completed your application for sponsorship?
(as appropriate)
Yes / / Go to question 2No / See sponsorship page on Ethics Committee website for advice.
2. Are you researching outside the NHS, or in the voluntary sector or some other setting in which there is no Research Ethics Committee?
(as appropriate)
Yes / Apply to Faculty of Health Ethics CommitteeNo / / See questions 3-6
3. Are you researching students or staff within the Faculty of Health andenrolled in the Faculty of Health?
(as appropriate)
Yes / / Apply to Faculty of Health Ethics CommitteeNo / See questions 3 -6
4. Are you undertaking your research to meet the requirements of a course in another BCU Faculty?
(as appropriate)
Yes / Apply to the ethics committee in that Faculty.No / / See questions 3 – 6
5. Are youan external researcher who has not obtained ethical review elsewhere?
(as appropriate)
Yes / Apply to Faculty of Health Ethics CommitteeNo / / See questions 3 -6
6. Does your research involve patients, staff, relatives or anyone else in the NHS?
(as appropriate)
Yes / Apply to the National Research Ethics Service website at .No / / See questions 3-6
!If you are still not sure which committee you should apply to please emailPaula McGeeorNicky Stockfor advice.
FACULTY ETHICS COMMITTEE APPLICATION FORM
Applicant’s checklist
Title of the research: Evaluating the impact of virtual world learning on communication and team working behaviour during high fidelity simulations.Chief Investigator/supervisor: Nigel Wynne
Associate investigator/supervisor: Emma Winterman
Please complete this checklist and send it with your application. Failure to include relevant documents as listed below may invalidate your application.
Answer yes/no as appropriate
Documents / Have you Included? / Office useCompleted application form /
Yes
Declaration signed by chief investigator /Yes
Signature of supervisor (student research only) /NA
Research proposal / YesLetter from sponsor / No – to be sent on Monday
Summary C.V. for Chief Investigator/supervisor (if from outside BCUBirmingham) using the NRES guidelines) / NA
Letter of invitation for research participants (on headed notepaper and based on the NRES guidelines) / Yes –appendix 1
Participant information sheet (on headed notepaperand based on the NRES guidelines) / Yes
Participant consent form (on headed notepaper and based on the NRES guidelines) / Yes
Details of any medical device being tested and the appropriate permissions and licenses / NA
Written evidence of consultation/partnership arrangements with research participants/other bodies where applicable / Yes
Letters from managers/consultants/other persons giving permission for access to patients/staff/students etc. / NA
Letters from any persons or organisations that have agreed to provide support for participants or to help the researcher e.g. interpreters, counsellors etc. / NA
Letter and other relevant documents from funding organisation / Yes
Letter from statistician / Yes – e mail
Peer review / No
Interview schedule / Yes
Validated questionnaire / No
Non-validated questionnaire / Yes
Details of any other research tools / Yes – observation rubric
Written permissions for the use of research tools / NA
Copies of advertisements or any other materials used to recruit participants / No
Other relevant documents? (please list and specify and continue on a separate sheet if necessary) / NA
!Question-specific guidance is included in this form.If you are unsure about how to answer any of the questions please email Paula McGee orNicky Stockfor advice
1a
1b
1c
1d /
Title of the research
Evaluating the impact of 3D Virtual World learning on student nurse ability to work and communicate effectively within teams during high fidelity simulation activities.Name: Nigel Wynne
Chief investigator:
Name Nigel WynneTel: 0121 331 7172
Fax:
Email:
Proposed start date:
June 2010 /Proposed completion date:
October 2010 (inc. time to write up)2a / What is the primary purpose of the research?(please as appropriate)
Commercial product development/licensing
Clinical product development/licensing
Funded investigation /
Educational qualification
Establishing a database
A CETL project
Other:
2b / Does the research involve (please as appropriate)
Testing a medical device?
Using radiation?
Using stored samples of human biological material, e.g. blood, skin
Taking new samples of human biological material?
Staff/student records?
Prisoners or others in custodial care?
Adults unable to consent for themselves?
Members of staff? / as researchers
Identifiable samples/data? /
Settings within the defence forces?
Quantitative data analysis?
Qualitative data analysis?
Both qualitative and quantitative data analysis? /
Audit?
Evaluation? /
More than one research site?
3a / Other members of the research team
Name
Emma Winterman
Senior Lecturer
Faculty of Health
Timothy Marquis
Learning Technologist
Faculty of Health.
Two members of staff, yet to be confirmed, drawn from local Trusts to act as blind reviewers during the observation phase of the study.
Qualifications see 3C
Address see 3C
Telephone
0121 331 6185 / Email
3b / Are you planning to undertake this research in partnership or collaboration with any of the following? Please state
YES / NO
Another BCU Faculty?
Local NHS Trust? /
Local voluntary organisation?
Elsewhere in UK?
Other EU state?
Other country in the European
Economic area?
Other country outside Europe?
3c / If you have answered YES to any of the questions in 3b please provide the names and contact details of the organisation/BCU personnel involved and include written evidence that they have agreed to participate with you.
Two staff based Sandwell and West Birmingham NHS Trust who have been involved in the scenario design, stakeholder analysis and user testing phases of the COMLIVE project will act as observers who are blind to the intervention and control status of students groups engaging in the high fidelity simulation experience. An e-mail confirming their involvement is attached to this form.
3d /
Students only
Who is your supervisor? NAFor which qualification are you studying? NA
Have you discussed and agreed your application with your supervisor? NA
Yes / No
Supervisor’s signature NA
Date NA
4a / What is the principal research question?
Does student engagement with 3D virtual world scenarios that aim to promote communication skills development lead to enhanced communication skills performance during high fidelity simulation activities?
Null Hypothesis
Student engagement with 3D virtual world communication skills learning activities has no impact on student communication skills performance during high fidelity simulation activities.
4b / What are the aim(s) of the research?
- To explore whether a 3D virtual world communication and teamwork scenario promotes a student experience that is conducive to deep learning?
- To ascertain whether learning about communication and team working within a 3D virtual world enhances team working and communication behaviour during high fidelity simulation activities.
4c / What is the justification for this research?
The drivers for this research can be described in terms of its topic or skills focus and in terms of the learning technology the research is seeking to evaluate.
The need for more effective approaches to communication and team working skills development.
Inadequate communication and team working skills are rated as one of the leading contributors to unanticipated patient deaths and illness within the UK (NPSA, 2007, NAO, 2005). As well as the significant personal cost associated with this skills deficit there is also a crippling financial cost to the NHS. The NHS pays out around £400 million a year in settlements of clinical negligence claims, and has a potential liability of around £2.4 billion for existing and expected claims (DOHEG, 2007). Of the 28,000 written complaints made about aspects of hospital treatment each year many could have been alleviated by more effective written and verbal communication(DOHEG, 2007). The impact of inadequate communication on unintended morbidity and mortality across health care systems in the USA is even more pronounced and has been well documented in the publication To Err is Human(Kohn et al., 2000).
There is therefore a strong social imperative for teachers to develop more creative and effective approaches to teaching communication skills.
Ours and others’ response to this has been investment in and application of full context mannequin and standardised patient simulation scenarios, occasional role play and multimedia resource development and reliance on more traditional didactic approaches to teaching.
Indeed the potential role that simulation may play in enhancing skills development within nursing was explored by the Nursing and Midwifery Council for England and Wales (NMC). In 2006 the NMC conducted a large scale study involving 13 universities that sought to explore whether different approaches to simulation learning could safely and effectively develop clinical skills in pre-registration nursing students. The study concluded that simulation encompassing a range of modalities could provide valuable and safe opportunities for skills development (NMC, 2007b). This report led to the NMC modifying their standards of proficiency by allowing full time undergraduate and diploma pre-registration nursing programme providers to use up to 300 hours of the practice component of their courses to provide clinical training within a simulated practice learning environment (NMC, 2007a) This ruling has led to increased interest in the use of simulation within nurse education in the UK and suggests that further investigations into the role that simulation may play within nursing are well merited.
For different reasons however both onlinemultimedia and higher fidelity simulation approaches have significant limitations in developing communications skills amongst large populations of students. Multimedia,we argue, suffers from limited fidelity, artificially structures communication learning and often places the learner in a passive role. Mannequin and actor based simulation offers higher fidelity, but are resource intensive, geographically fixed, and as a consequence are difficult to scale and difficult to apply in support of iterative skills development.
One potential solution to communication and team working skills development may be found in the application of 3D virtual worlds technologies.
The specific attributes of the Open Wonderland VW platform that we have used to develop communication training scenarios may provide a transformative solution to communication skills development.
3D virtual worlds are often used for constructivist learning because of the opportunities they present for learners to explore, collaborate and be immersed within an environment (Neeley, 2009)
One of the explicit features of 3D virtual world learning is the strong emphasis on visual and spatial stimuli that accompanies this type of learning environment. Learning within the 3D virtual environment created for this studywill require learners to navigate within virtual buildings, assess 3D virtual patients and interact with elements within this space. For example, where students access patient charts these charts are located at a patient’s bed space, urine outputs are assessed by exploring catheter bag drainage and heart rate and rhythm can be viewed through a monitor above a patients’ bed. Students are required to draw curtains to maintain patient privacy and dignity and to simulate handwashing when appropriate.
Although there has been a growing increase in the reported use of 3D virtual world technologies to support health care education and training (Danforth et al., 2009)relatively little evidence has been reported as to the effect of 3D Virtual World Learning on communication and team working skills development. Two studies identified to-date are summarised below.
(Heinrichs et al., 2008) conducted a comparative study that explored the relative effectiveness of 3D virtual world learning and higher fidelity mannequin simulation (HFS) learning to promote team work and crisis management skills. Working in pairs with 16 interns engaging in virtual world scenarios and 14 in HFS scenarios the study found that both groups led to significant increases across the same communication and team working parameters (p=0.01) between pre and post test scores. Moreover the study found that there were no significant differences between the two groups in the gain scores that each group achieved. This suggests that 3D virtual world training maybe as effective as HFS learning.
Wiecha et al. (2010) used the Virtual World Second Life to deliver post graduate medical education on the topic of type 2 diabetes. 14 primary care physicians took part on an hour long highly interactive learning activity. Evaluation involved rating the course experience and pre and post self confidence ratings in addition to pre and post case study based questions exploring understanding of type 2 diabetes. This study found significant differences in pre and post test confidence ratings related to a number of type 2 diabetes practice components. However despite increases in pre and post case study assessments no significant differences where found across these mean scores.
There is therefore considerable scope to increase our understanding of how these technologies can be leveraged by academic staff to promote effective learning.
Through this research we hope to understand more fully understand the role that our virtual world scenario may have on communication skills development. Findings will inform our understanding of scenario design, the value of this particular technology to our course requirements, our methodological considerations in future virtual world research and whether there is a case for more strategic deployment of virtual worlds across courses within the Faculty.
From a national perspective the study findings are anticipated by JISC the project’s funding body and will contribute to a series of national dissemination events during the remainder of the year.
5. / Outline the proposed methodology.
Theoretical Framework
The theoretical basis of this study is rooted within the broad school of learning theory known as social constructivism. Constructivism holds the ontological perspective that meaning or knowledge is always a human construction. Therefore the only reality that humans can know is that which is represented by human thought (Crotty, 1998). Social constructivism purports that it is the active involvement of learners with each other, teachers and their environment that promotes the most effective and transferable learning. For educators the key implication here is that education needs to place emphasis on the active learner and their construction of meaning as opposed to placing emphasis on a subject topic, its associated content and that content’s explication. The most significant base for social constructivism comes from the work of Vygotsky and his theory of the zone of proximal development (ZPD) (Vygotsky, 1978).
ZPD is the distance between a student’s ability to perform a task under guidance and/or with peer collaboration and the student’s ability when solving a problem independently. According to Vygotsky learning occurs when learners are set goals that encourage them to work within their zone of proximal development and are supported in this activity. Vygotsky emphasises that the connections between people and the socio-cultural context in which they act and interact in shared experience is pivotal to effective learning (Crawford, 1996).
More recent theories emerging from the social constructivist tradition and collectively called Practice Learning theories have also informed this study.
One practice learning theory known as Situated Learning Theory(Lave and Wenger, 1991) suggests that learning is a function of the context, activity and culture in which it occurs. Knowledge acquisition is best achieved through student focused activities with strong social components that occur within authentic domains. Heavily influenced by this work is the theory of situated cognition (Brown et al., 1989).
Situated cognition argues that traditional didactic education assumes a separation between knowing and doing, treating knowledge as a self sufficient substance that is theoretically independent of the situations in which it is learnt and used (Brown et al., 1989). Situated cognition describes how situations themselves can be said to co-produce knowledge through activity. That is, cognition and learning are fundamentally situated.
A particularly useful construct for this study is the concept of deep and surface learning. A surface approach to learning comes from the intention of students to get a task out of the way with minimum trouble while appearing to meet course requirements(Biggs, 2003) In contrast a deep approach comes from a felt need to engage the task appropriately and meaningfully, so the student tries to use the most appropriate cognitive activities for handling it. (Biggs, 2003). Using a deep approach students make a real effort to connect with and understand what they are learning as they seek both detailed information and try to understand the bigger picture.
Link to 3D Virtual World technology
The affordances provided by our virtual world technology (described in 9a) and our approach to scenario design suggest a tight fit with the conditions that the above theories suggest are needed for optimal learning. The 3D learning activities that we have created aim to place learners in a learning context that more closely resembles the practice context that these learners are preparing to apply their knowledge within. That is the virtual world setting has been designed to resemble a hospital ward within which learners are required to collaborate and communicate in teams in order to achieve certain goals.
By creating situated 3D immersive learning experiences in which students are challenged to work collaboratively within their zones of proximal development we hope to provide optimal learning conditions and encourage deep approaches to learning that may result in enhancements to students communication and team working behavior in the real world.
The Intervention
The intervention evaluated in this study will be the learning that takes place within a virtual world environment designed to depict a hospital ward.
In addition the virtual world also contains an orientation space which aims to support the students to use the tools and techniques required to interact with the virtual world. This space will also encourage the students to practice certain communication techniques and team working strategies.