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C2C Digital Magazine (Spring / Summer 2015)

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Simulation-based Learning: Health 101

By Susan Stockton1 and Terry McNeeley2
1Department of Nutrition & Kinesiology, University of Central Missouri
2Office of Technology, University of Central Missouri

Transitioning a 100% face-to-face personal health course within the General Education domain to a 100% online platform created some challenges.  The face-to-face course included multiple physical activities to enhance and engage the students in course content, e.g., stress reduction techniques, physical fitness exercises, age-related impairment simulations, environmental and sustainability practices, and personal self-care scavenger hunts, etc.  To provide the same type of experiences and activities afforded the face-to-face students, we worked with professional staff in our Technology Enhanced Instructional Design department to discover ways to provide similar learning environments for the online student.  

The Directional Function of Hearing

One of the first simulations used was the sensory directional function of hearing. A YouTube audio clip that mimics binaural hearing was found and incorporated into the online unit on aging.  To experience the effect, visit the Virtual Barber Shop (use of headphones will be required).

Age-Related Mobility and Vision Issues

We also used the virtual world known as Second Life to obtain this objective.

Virtual Medical Clinic:  Originally created in support of a rural disease outbreak simulation, the clinic now serves multiple virtual scenarios.


Medical Clinic’s Waiting Room:  Students access a virtual wheelchair as well as the items used to simulate various age-related vision impairments.

A virtual city for other academic programs (nursing, aviation, construction management) on campus was already well developed within Second Life (SL), so adapting this location to address our activities was the next step. 

Our SL engineer programmed various age-related mobility and vision impairments as part of the unit on aging.  He created an activity where students would arrive in the virtual city and were given directions to the medical clinic to “pick up” their wheelchairs.  After loading the wheelchair into SL, they were given specific tasks to accomplish, e.g., navigate along a sidewalk, cross a street that did not have wheelchair-accessible curbs, enter a fast food restaurant and order an item from the menu, and go to a residence and climb stairs to enter the house.  This last activity was meant to convey that in “real” life, an individual would never be able to steer a wheelchair up a staircase, and neither is it possible in this simulation. 

Students’ comments about the use of a wheelchair generally supported the intent of this activity which was to deepen their empathy with individuals required to use this mechanism for transportation.  It also proved frustrating to those that assumed they should be able to direct a wheelchair up the flight of stairs. In addition, it reinforced pedestrian safety awareness as we had students commenting about almost getting hit by a bus.
Mobility Impairment Exercise:  A student attempts to navigate three stairs while using a virtual wheelchair. 
Protecting Vision

The next activity directed students on experimentation with various vision changes that can occur with aging, i.e., macular degeneration, cataracts, and various retinopathies.  A serendipitous discovery appeared for us (developers of personal health activities within SL) with this exercise in that having students perform physical actions while using vision impairments could be potentially very dangerous in “real” life but could be performed safely within SL and yet yield the outcome intended that is to make appropriate behavior changes early in life to safeguard vision and health as much as possible.
Simulated Normal Vision:  This shows an avatar's view from the exterior of the Medical Clinic. 


Simulated Vision with Cataracts:  Students commented that they wanted to clean their computer screens after "wearing" the cataract simulator.

Simulated Vision with Detached Retina:  Note the city bus emerging from the obscured vision, right side.  This proved startling to students who unknowingly moved their avatar into oncoming virtual traffic.

Avoiding Empty Calories

After arriving at the store, we used the concept of calories instead of currency for items purchased so that when a student was asked to select three items from products on the shelves and checking out, they were given the total number of calories provided from those three items.  This helped reinforce the concept of empty calories from typical items purchased at these locations.  The ‘Stop-n-Shop’ calorie app is based on original work developed at the University of Kansas Medical Center (KUMC), and is used with permission.
Virtual Convenience Store:  Originally built in support of an aircraft accident scene investigation, the "Stop-n-Shop" convenience store now serves multiple roles.


Interior of Convenience Store:  Note the "Stop-n-Shop" calorie counting app on the right side of the image above.


Interior of Convenience Store:  When the cash register is clicked, the "Stop-n-Shop" app calculates the amount of calories based on the food selected, displays the total calories to the user and emails the data to the facilitator.

Assessing Locations for Health Parameters

A segue from this course developed when designing the curriculum for an upper level health course.  This course used the same SL city and asked students to assess the location for positive and negative health parameters.  Once students surveyed the environment and elected a topic for their health program, they created posters providing a synopsis of their choice.  The health program posters were then displayed in the SL art gallery.  This means of posting/sharing student ideas, allowing all students to simultaneously compare and contrast each student’s work on health program planning, was well-received and had the desired result of anonymity, creativity, and purpose.

Gallery of Art & Design:  In the past, some real-life exhibits have been mirrored within the virtual gallery.  Currently the Student Health Program Posters are on display.

Using Second Life for Simulation-Based Learning

Overall the creation of activities within SL has increased the degree to which students can experience and realize meaningful health objectives in a safe and educational environment.

About the Co-authors

Susan Stockton: 
Currently an Assistant Professor at the University of Central Missouri (UCM), Susan Stockton spent her early professional career as a Food Service Director for the Warrensburg R-VI School District.  She spent nine years in private chiropractic practice and the past 15 years teaching health related courses at UCM.  Her emphasis is in experiential learning environments and bio-communication technology for optimal human health evaluation, function, improvement, and performance.​ Her email is  

Terry McNeeley:  An Instructional Designer at the University of Central Missouri with over 20 years of experience in the field, Terry McNeeley began his career creating instructional training material at a community college.  He has been fascinated with 3D modeling and virtual worlds for years and enjoys realizing the power of simulation-based learning. His email is 
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