**Preliminary Analysis of a Virtual Inter-University Game to Learn Radiology within the Second Life® Environment †**

#### **Alberto-Jimenez-Zayas \*,Shaghayegh Ravaei, Juan M. Alonso-Martinez and Francisco Sendra-Portero \***

Department of Radiology and Physical Medicine, School of Medicine, University of Málaga, 29071 Málaga, Spain; shaghayegh.ravaei@gmail.com (S.R.); martin17alonso@gmail.com (J.M.A.-M.)

**\*** Correspondence: albertojzayas@hotmail.es (A.J.-Z.); sendra@uma.es (F.S.-P.)

† Presented at the 3rd XoveTIC Conference, A Coruña, Spain, 8–9 October 2020.

Published: 19 August 2020

**Abstract:** A competition-based game, named League of Rays (LOR), designed to learn radiology within the multi-user virtual environment Second Life was adapted for the participation of teams of four students. The game ran from 20 February to 1 April 2020. Forty-one teams from 16 universities initially signed up and 28 teams from 14 universities finished the game. Participants found this activity fun, enjoyable and useful for their training. Some interesting proposals to be included in future editions of the game and interesting comments on the meaning of developing half of the game during the confinement caused by the Covid-19 pandemic were provided from participants.

**Keywords:** online learning; virtual worlds; gamification; game-based learning; medical students; undergraduate education; radiology

#### **1. Introduction**

In 2015, a virtual game called League of Rays (LOR) was designed to learn radiology in the multiuser immersive environment of Second Life® [1]. After several editions of individual participation, it was considered to replicate the game with students from different medical schools, taking advantage of the remote and free use of Second Life®, adding a "sense of belonging" and social comparison to the competition [2]. In 2019, the rules for participating in teams of four students were developed and in 2020 an edition with interuniversity teams was carried out, with the only requirement that participants were coursing a course on radiology this year. The goal of this study is to carry out a preliminary analysis of this last edition of LOR.

#### **2. Materials and Methods**

The game was organized in six weeks, the first three were dedicated to radiological anatomy and the latter three to radiological semiology. Participants had to register in Second Life, make an avatar and interact with the environment of the island, performing the actions required by the game (Figure 1). During the first four days of each week, participants had to view educational content presented in sets of three panels, as self-guided slide shows. On the last three days, the participants had to solve individual assessments (multiple choice test) and a team assessment related to the theme of the week. The score acquired for each team determined their position in the classification of participants. If one of the teams stopped participating for two consecutive weeks, it was disqualified. The organization of the game was in constant contact with participants by email. After the game, participants were asked to complete a questionnaire evaluating the project.

*Proceedings* **2020**, *54*, 17

(**c**) (**d**)

**Figure 1.** Several screenshots of the 2020 edition of the game League of Rays: (**a**) students watching educational content presented in sets of three panels; (**b**) a group of participants in front of the panel with the multiple-choice test corresponding to one of them. (**c**) Students doing an individual assessment on floating platforms in the sky; (**d**) several participants reviewing the assessment tasks by team.

#### **3. Results**

The game ran from 20 February to 1 April 2020, so the second half of it took place during confinement due to the Covid-19 pandemic. Forty-one teams from 16 universities initially signed up and 28 teams from 14 universities finished the game. The questionnaire was completed by 93 participants (83.0% of those who completed the game). The results are summarized in Figure 2. The students rated with average scores greater than or equal to 8.2 points out of 10, highlighting the organization of the project, the teacher, the usefulness of their information and interaction with peers (average scores greater than 9).

**Figure 2.** Bar graph depicting the mean rating of various aspects of the League of Rays game scored on a scale of 0 to 10. Error bars represent standard deviation. N or P means normal or pathological.

#### **4. Discussion**

The Second Life® virtual platform can be accessed free of charge and the learning opportunities it offers are almost endless, allowing communication, meeting and contact between different professionals in a synchronic and asynchronous way. LOR is intended as an asynchronous gamebased learning approach. Since its first edition in 2015, it has proven to be a well-accepted gamebased learning experience for students, which allows learning basic aspects of radiological anatomy and semiology in a very motivating way, providing a complementary tool to engage students in radiology learning [1]. The last 2020 edition also encourages teamwork and competitive pressure as a stimulus to establish radiology concepts and skills. The call can be considered very satisfactory, since 112 students from 14 different universities finally completed the activity.

Students increase their engagement and participation in their education through game-based learning and virtual worlds [3,4]. Current medical students, belonging to Generation Z, may find game-based learning activities, such as LOR, particularly attractive for learning because they are active problem solvers, independent learners and appreciate healthy competition [5]. This activity, developed as a multi-user online game, has been fun, enjoyable and useful for their training. Participants provided interesting proposals to be included in future editions of the game and interesting comments on the meaning of developing half of the game during the confinement by the Covid-19 pandemic.

**Supplementary Materials:** A PDF with information about the LOR 2020 prior to the start of the game is available online at http://www.biznaga.org/LOR2020/LOR2020.pdf. The last qualification of the game is available online at http://www.biznaga.org/LOR2020/LOR2020-37-SEXTA-calcificacion-general-ord.pdf.

**Author Contributions:** Conceptualization, F.S.-P.; methodology, A.J-Z., S.R., J.M.A.-M. and F.S.-P.; software, F.S.-P.; validation, A.J.-Z. and F.S.-P.; formal analysis, A.J.-Z. and F.S.-P.; investigation, A.J.-Z., S.R., J.M.A.-M. and F.S.-P.; resources, F.S.-P.; data curation, A.J.-Z.; writing—original draft preparation, A.J.-Z.; writing—review and editing, A.J.-Z. and F.S.-P.; visualization, A.J.-Z., S.R., J.M.A.-M and F.S.-P.; supervision, F.S.-P.; project administration, F.S.-P.; funding acquisition, F.S.-P. All authors have read and agreed to the published version of the manuscript.

**Funding:** The Innovative Education Project #PIE19-217 of the University of Málaga partially supported this study. The maintenance cost of the Medical Master Island during this project was supported by the Andalusian Society of Radiology (Asociación de Radiólogos del Sur), a subsidiary of the Spanish Society of Medical Radiology (SERAM).

**Acknowledgments:** We want to thank all the students who have participated in this game-based learning experience, as well as their teachers, who have encouraged them to do so.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**


© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

### *Proceedings*  **Introduction to Second Life® As a Virtual Training Environment: Perception of University Teachers †**

**Teodoro Rudolphi-Solero 1,\*, Alberto Jimenez-Zayas 2 and Francisco Sendra-Portero 2,\*** 


Published: 20 August 2020

**Abstract:** In January 2020, two three-hour workshops on an introduction to Second Life® as an online educational platform were held inside a virtual world. The workshops were dedicated to medical university teachers with the main objective being to let them get to know Second Life® and its formative possibilities. The format of this experience was well received by the participants. Everyone who answered the questionnaire agreed that the environment was useful and interesting and that they would repeat a similar experience again. Ten out of 23 participants (43.5%) declared that they were willing to carry out a teaching activity in Second Life®. This kind of action allows for the promotion of other future in-world actions directed to the training of trainers.

**Keywords:** online learning; virtual worlds; training of trainers; undergraduate education; radiology

#### **1. Introduction**

Second Life® is one of the most well-known multiuser virtual worlds for higher education [1,2]. Since 2011, different teaching activities have been developed in the Medical Master Island, a place inside Second Life® dedicated to medical education [3,4] that, by the end of 2019, involved more than 1800 undergraduate and postgraduate students. In parallel to the Second Life® teaching expansion among medical students [5–7], it is also important to promote the knowledge of Second Life® among other medical teachers. The objective of this study was to evaluate the perceptions of medical teachers about Second Life® after an introductory session to the 3D virtual world and its educational possibilities in medicine.

#### **2. Materials and Methods**

Two three-hour-length sessions were held in The Medical Master Island on January 23rd and 30th 2020. The sessions consisted of: (1) a basic training in the main functions of the avatar (walking, flying, speaking, listening, chatting, sending note cards and controlling the settings to see the virtual world); (2) a guided visit to the island and its facilities; (3) a conference about the activities held at the Medical Master Island since 2011; (4) a practical presentation about the technical possibilities of Second Life®, useful resources and other previous experiences in this 3D environment (Figure 1). An invitation was sent in December 2019, along with the program of the sessions, through the academic mailing lists of the Medical School of Málaga and the Association of University Professors of Radiology and Physical Medicine (APURF). A PDF with a basic guide to Second Life® was provided to the attendees before the workshop (see Supplementary Materials).

#### *Proceedings* **2020**, *54*, 18

**Figure 1.** Two screenshots of the workshop for medical teachers held in the virtual place "The Medical Master Island": (**a**) A guided visit by boat around the island; (**b**) A session about technical possibilities of Second Life, rendering objects and sculpted figures, and explaining the activity of the former "Isla de la Salud" owned by the Spanish Association of Family and Community Medicine (SAMFYC).

Attendees were asked to send a notecard to the organizer at the beginning of the session, evaluating the cognitive load involved in handling Second Life, using the 9-point cognitive load scale, developed by Paas and van Merriënboer [8] and explaining in brief their first impressions about the experience. After the session, they were asked for a second notecard with four 1- to 5-point Likert scale questions about their perception of Second Life and their willingness to participate in the 3D world as teachers, with a space for "any additional comments" in open format.

#### **3. Results**

Twenty-three teachers from seven different universities (Málaga, Córdoba, Granada, Sevilla, Autónoma of Barcelona, Salamanca and La Coruña) participated in the workshops. All were mainly Radiology and Physical Medicine teachers (16), although teachers from other knowledge areas, such as Anatomy (1), Pathological Anatomy (1), Biochemistry (1), Pharmacology (2), Otorhinolaryngology (1) and Pediatrics (1) also participated. Regarding cognitive load, on a scale of 1 to 9, one participant indicated that administering Second Life® implied a very, very high mental effort (9 points), eight indicated somewhat high effort (6 points), three indicated neutral effort (5 points), five indicated low or very low effort (2–3 points) and the remaining six did not answer that question. The answers to the questions about Second Life® in a 1–5-point Likert scale are shown in Table 1.


**Table 1.** Answers of the teachers attending the workshop on the questions about Second Life.

1 Likert scales values were: 1—strongly disagree, 2—disagree, 3—neutral (nor disagree neither agree), 4—agree, 5—strongly agree. NA: not answered.

#### **4. Discussion**

The format of this experience was well received by the participants. Everyone who answered the questionnaire agreed that the environment was useful and interesting and that they would repeat similar experiences again. Ten out of 23 participants (43.5%) declared that they were willing to carry out a teaching activity in Second Life®.

The workshop provided a first contact with Second Life® and its formative possibilities to medical teachers who attended. As it is designed, it is a 3-h activity, so it is easy to include into university teachers' and specialist doctors' busy schedule. Although the situation supervened by the Covid-19 home confinement limited the available time to organize new similar workshops (mainly because of the increase in clinical workload), in the future we intend to spread the educational potential of Second Life® among a greater number of teachers of medicine and other health-related sciences. This kind of action allow promote other future in-world actions directed to training of trainers: (i) fostering collaborative work in the Second Life® virtual world; (ii) familiarizing teachers with the educational possibilities of virtual worlds and the basic technology applicable to them; (iii) sharing teaching experiences carried out in Second Life® to achieve new interdisciplinary collaborative projects; (iv) using Second Life® as a means of meeting, gathering and having virtual debates; (v) promoting the development of multidisciplinary and inter-university collaborative educational projects.

**Supplementary Materials:** The workshop program brochure is available online at http://www.biznaga.org/Programa-IntroSL1.pdf, and the basic guide to Second Life is available online at http://www.biznaga.org/guia-basica-secondlife.pdf.

**Author Contributions:** Conceptualization, F.S.-P. and T.R.-S.; methodology, F.S.-P. and T.R.-S.; software, F.S.-P. and T.R.-S.; validation, T.R.-S., A.J.-Z. and F.S.-P.; formal analysis, T.R.-S., A.J.-Z. and F.S.-P.; investigation, T.R.- S., A.J.-Z. and F.S.-P.; resources, F.S.-P.; data curation, T.R.-S.; writing—original draft preparation, T.R.-S.; writing—review and editing, T.R.-S., A.J.-Z. and F.S.-P.; visualization, T.R.-S., A.J.-Z. and F.S.-P.; supervision, F.S.-P.; project administration, F.S.-P.; funding acquisition, F.S.-P. All authors have read and agreed to the published version of the manuscript.

**Funding:** The Innovative Education Project #PIE19-217 of the University of Málaga partially supported this study. The maintenance cost of the Medical Master Island during this project was supported by the Andalusian Society of Radiology (Asociación de Radiólogos del Sur), a subsidiary of the Spanish Society of Medical Radiology (SERAM).

**Acknowledgments:** We want to thank José Pavia-Molina and Félix del Ojo for their participation and help in the two days of the Second Life introductory workshop for teachers.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**


*Proceedings* **2020**, *54*, 18


© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
