A general lack of familiarity with SL was detected at the commencement of this project, despite being a tool used by more than 300 colleges and universities (Oxford
], Carlos III
]) and institutions (Instituto Cervantes
]) for hosting regular events, seminars and workshops
With respect to the opinion expressed by healthcare professionals about the virtual environment, we coincide with that of Wiecha et al
], in which all the healthcare professionals surveyed consider SL to be superior to other distance learning methods (almost two thirds of the subjects in our study). However, we were surprised to find that in their study the majority also considered SL to be equal or superior to face-to-face methods, an opinion given by less than half of the subjects in our study. Although Wiecha’s study did not refer to acceptance, this is a possible explanation for the difference. It took a great deal of effort to have SL accepted as a useful teaching tool in our setting, despite the fact that the individuals involved were healthcare professionals under the age of 50 who had all had previous exposure to technology. This contrasts with the situation experienced by Holzinger
], where lack of acceptance was related to lack of previous exposure to technology.
Nonetheless, our results do coincide with those presented by Wiecha in that the subjects liked it as a tool and were willing to repeat the experience.
One advantage observed was that when one health centre was connected through a single avatar (the one projected on the screen of the health centre library/seminar room), it did not cause the problems that occur when too many people are online at the same moment in real time with a single Internet access. However, some of the participants considered this to be a negative point, as it hindered the interaction that might have existed had they been given the use of individual computers.
The clinical sessions always began with theory, wherever this was applicable to the topic, followed by the presentation. Previous studies on simulations, such as that by Holzinger
] showed that the successful use of simulations requires students to have a certain level of prior theoretical knowledge.
The advantages offered by SL according to all the participants was the opportunity it afforded them to interact with other health centres and with teachers, and that of facilitating the exchange of medical information between healthcare professionals. On the contrary, there was considered to be little interaction with other healthcare professionals, despite the possibility for this. This could be explained by the way the sessions were set up; in order to provide access to all health centre personnel, individual access could not be provided. One person entered SL from a single computer and image and sound were projected for the other participants. The results were not compared to those of other non-interactive training methods, such as platforms for simulating patient cases
Most of the limitations of SL as a platform were found to be of a technical nature. In fact, technical problems were considered to be the main weakness of SL. One significant problem was that of continuous updates (as many as three in one month), with the consequence that SL could not be accessed if the updates had not been downloaded and installed. This was in addition to the problems caused by firewalls and anti-virus protection on health centre computers that prevent the downloading and installation of computer programs of unknown origin. When presented with an update, those health centres affected had to contact the IT service to update the version of SL in order to have access to the corresponding clinical session. Other technical problems related to sound and image that had caused major disruption during the trial sessions were completely resolved or minimized by the time the official programme began as a result of the experience gained by the participants.
Incidents were experienced involving the appearance of intruders in the virtual open-air auditorium during the course of some sessions. These included a professor of architecture from Madrid who was interested in incorporating this resource in his lectures, and general practitioners from other regions of Spain who were interested in using SL in teaching or incorporating SL into the accident and emergency services of a number of different hospitals. All of these intruders shared a teaching role and the space where the sessions were held.
A limitation of this study could be the way the questions in the survey were answered. As responses were given orally in SL, we feel this may have led to a number of responses differing from what they might have been if they had been obtained individually, anonymously or in writing. 10 of the questions were answered by only 42% of those present, fewer than half of the subjects surveyed, which may limit their inference.
Training in and use of SL currently covers 75% of urban health centres, 33% of rural health centres and the primary care pharmacy service in the zone. All junior doctors serving in the zone are currently receiving training in the use of SL. This will allow them to attend clinical sessions without the need to travel during their rotations with tutors in health centres and hospitals. Medical students on placements at health centres also participate in the clinical sessions in SL.
A third edition of the project will provide training for the remaining health centres in order to achieve 100% coverage, and for health professionals at the zone’s referral hospital.