This paper presents the development of aComponent-Based System structured as a distributed threetierarchitecture, enabling monitoring and informationvisualisation of application activity as well as presentation offeedback to learners via a Heads-Up-Display (HUD) in thevirtual world of Second Life®. The activities follow a gamebasedlearning approach and take place in a RespiratoryWard in Second Life®, where learners interact with virtualpatients receiving intrinsic feedback about their diagnosis,investigations and treatments. The proposed architecturedeveloped by the authors, consists of different virtualpatient components that provide the relevant personal andclinical data to the clinical scenario; a data availabilitymodel that enables the sequencing and progressivedisclosure of a virtual patient identifying triggers andscaffolding information, and an activity model whichencodes the activities available and how the learner will beable to engage with the virtual patients.

In the field of medicine, various representative simulations have been developed to support the decreasing number of learning opportunities with real patients; the use of virtual patients is among them. Virtual patients are real-life clinical scenarios used for the purpose of medical education. They usually follow a linear or branching approach and they are usually accessed via a computer browser or as part of a computer programme. The purpose of this thesis was to design, and develop a platform for the delivery of virtual patients following a game-based approach in the virtual world of Second Life®, investigating attitudes and gender differences among medical students at Imperial College London. Virtual worlds, such as Second Life®, are 3D spaces in which users meet and interact and in which learning opportunities can take place. Second Life® was selected for this study due to its popularity among UK Higher Education Institutions at the time of the development. The virtual patients’ activities were designed following game-based learning and pedagogic principles. The technical infrastructure was designed following a Component-Based System (CBS) structure as a distributed three tier architecture presenting information via a Heads-Up-Display (HUD). The first study carried out concentrated on the survey “My feelings when playing games” developed by Bonnano and Kommers (2008). The survey was comprised of 21 statements. Six statements related to the affective component, five statements are about perceived usefulness, six statements about perceived control and four statements about behavioral components. Two groups were involved, one accessing a virtual patient via Second Life® and the other via an e-module. This study involved 42 Year 3 undergraduate medical students (21 years old). The gender distribution of the respondents was 42.85% female (n = 18) and 57.14% male (n = 24). The tendency encountered in each group towards the different attitudinal components was analysed as well as gender-related attitudes. Both groups showed very similar results in relation to the Attitudinal Components. In general, females demonstrated a more positive attitude overall for the perceived usefulness component. Other studies looked at and contrasted, provided interesting thoughts and reflections on gender tendencies and game play. It was concluded that more inclusive and holistic studies in this area ought to be carried out in order to identify game play tendencies in professional-level simulation with adults at university level, which may counteract outdated perceptions about age and gender differences in game play. The second study described the use of the Nominal Group Technique (NGT) to assess students’ attitudes again. Two groups of undergraduate medical students (Yr 3, n=14) were invited to participate. The research question posed was: “In your opinion what are the advantages and disadvantages of learning in Second Life® compared with other methods?” The results provide a different perspective to the ones highlighted in the first study. Results from the first group focused on the learning experience highlighting its importance for clinical diagnosis as a structure for learning. The second group focused on the clinical exposure although they were ambivalent about the advantages of this type of delivery mode. In general, learners did not find the virtual patient activities challenging enough. The results of this thesis show that although a game-based learning approach was followed in the design of the virtual patient activities and interfaces, the repetitive linear presentation of the cases did not motivate the students enough, targeting only low-end Cognitive skills which may be more suitable for students in Year 1 and 2. The use of more challenging branching learning experiences, such as the ones developed by the PIVOTE authoring system are suggested for the delivery of virtual patients in clinical years. All the programming code used in the CBS has been released as open source, licensed under a Creative Commons Attribution-Non Commercial 3.0 License, in order to stimulate other interested parties in the development of similar applications in the virtual world of Second Life®.

This chapter will present game-based learning activities developed forvirtual patients based on the four-dimensional framework developed by De Freitasand Martin, as well as other design considerations that look at emergent narrativesand modes of representation. This chapter will also present the interaction and callmanagementstructure implemented between the Second LifeTM (SL) virtual worldenvironment and the world wide web environment. This chapter also represents anoverview of the finding of a recent trial aimed to explore attitude towards two elearningdelivery methods including the delivery of game-based learning for virtualpatients in SL.

In view of the current interest taking place in the area of education and virtual worlds, such as Second Life®, many educationalists have began to explore the benefits of applying game-based learning in these environments. In this chapter, the authors attempt to explore the elements associated with game-based learning in virtual worlds, focusing on the design process and how effective game-based learning activities can be achieved following pedagogic frameworks. The authors view learning in games as a form of driving learners’ motivations and this is reflected in the design and development of the virtual respiratory ward at Imperial College virtual hospital explained in this chapter.

New learning technologies have changed the way teaching and learning is delivered. One of the technologies that offers great potential in helping to motivate and engage students is game-based learning. Social virtual worlds offer rich interactive three-dimensional collaborative spaces where users can meet and interact. One example of such an environment is Second Life (http://www.secondlife.com; henceforth ‘Second Life'). This article provides an overview of a recent trial carried out at Imperial College London aimed to explore gender-related attitudes towards game-based learning in Second Life. This article also draws on three recent studies to furthermore explore gender-related issues in computer and video game play. We here argue that the gender gap in gaming and learning is becoming less analytically significant, and in conjunction with this that game experiences have to be viewed from a more inclusive perspective in regard to game genre, gender and age

Opportunities for building learning activities around real patients have decreased. Therefore, various forms of representative simulation have become an increasingly common alternative. The use of virtual patients is one such simulation developed to support the delivery of clinical teaching. Virtual patient scenarios offer opportunities for 'game-informed learning'. This is due to their experiential and problem-based learning approaches as prime pedagogic drivers. A region has been developed in Second Life that aims to deliver game-based learning activities for delivery of virtual patients that can drive experiential, diagnostic, and role-play learning activities concerning diagnoses, and selection of, investigations and treatment. The game-based learning activities for virtual patients were designed based on the four-dimensional framework developed by De Freitas and Martin, as well as other design considerations that look at emergent narratives and modes of representation. This paper will present the three-component architecture for the delivery of Virtual Patients following game-based learning activities in a multi-user virtual environment (MUVE), such as Second Life. The proposed architecture consists of different virtual patient components that provides the personal and clinical data relevant to the clinical scenario, a data availability model that enables the sequencing and progressive disclosure of a virtual patient identifying triggers and scaffolding information, and an activity model which encodes the activities available and how the learner will be able to engage with the virtual patient. It is anticipated that this three-component architecture will accommodate many different deployment and delivery options for virtual patients in a MUVE. An overview of recent trials is also provided. The trials aim to explore the experience of computer and videogame play among medical students, and to identify any gender-related differences and social propensities that might exist between high gamers (frequently play computer games) and low gamers (rarely play computer games) in their approaches to game-based learning in Second Life.