Birley Place: a virtual community for the delivery of health and social care education

Abstract

Virtual simulation can provide high-quality learning experiences through innovative and engaging activities while also overcoming some of the constraints associated with physical simulation. We developed a virtual community, called Birley Place, to facilitate simulation-based learning activities. Adopting a novel approach, we modelled the virtual community on the large metropolitan city in which our institution is based. Publicly available health and population data were used to ensure that the homes, businesses and services in the community were representative of distinct socioeconomic areas of our city. The residents of the virtual community were also matched with the real-world areas based on health and lifestyle data. Our virtual community is used to facilitate learning activities across our health and social care degree programmes. In this article, we summarise how we developed Birley Place, before providing one example of how it is used to facilitate the delivery of a large-scale interprofessional education project. Birley Place is an innovative tool for delivering online and virtual simulation. The use of this virtual community facilitates learners’ understanding of the connection between settings and health status.

Introduction

Simulation uses guided interactive learning activities to replicate real-world experiences, often in an immersive manner.¹ Simulation typically involves practical scenarios that replicate real-world professional or clinical experiences. Learners interact and make decisions as they would in real life, but in a safe and supportive environment without real-life consequences. Alongside physical simulation, virtual simulation is gaining popularity.^2–4 Virtual worlds enable multiple users to interact and collaborate in educational activities in real time. They can be effective for creating immersive, experiential simulation-based learning experiences that are transferable to real-world healthcare practice.⁵ Virtual and computer-based simulation can also overcome several barriers associated with providing physical simulation to large cohorts, where staff availability, equipment costs, timetabling and space constraints pose challenges to educators.⁶ Virtual simulation⁷ and virtual worlds^{4 7} enable learners to engage and interact synchronously and asynchronously from any location, using accessible technology. These technologies, therefore, have the potential to serve as an ideal forum for learners to collaborate in communities of practice.⁸ Communities of practice provide a space for both social support and the development of knowledge and skills over time. Such communities act as a space to pursue shared enterprise and engage in peer learning, development and reflection.

Development of a virtual community

Principles of simulation-based education and experiential learning were used to develop an online virtual community at our institution. Although persistent virtual worlds have been used effectively,⁵ these platforms are expensive and were not created specifically for educational purposes. Our virtual community, called Birley Place,^{9 10} is a web-based bespoke virtual world,⁴ specifically designed to facilitate health and social care education at our institution. Content for Birley Place, including scenarios and role profiles, is co-created by academic and e-learning development staff, often with input from service users and students and in collaboration with colleagues with relevant clinical experiences from different disciplines. This multidisciplinary approach enables learners to engage in experiential, interactive and realistic scenarios that enhance both their traditional learning and physical simulation. In its original form, Birley Place consisted of a series of interlinked simulated scenarios, featuring people living on a single street. To develop this concept, we expanded the community to model a larger area to create a more realistic context within which further simulated people or services could exist. Using an innovative approach, we modelled the virtual community on publicly available population and health data related to three distinct socioeconomic areas of our city. The fictional neighbourhoods are represented on a map (see figure 1A) and provide realistic representations of the housing, businesses, and health and social care services that exist in those real-world areas (figure 1C). For example, more affluent neighbourhoods contain bigger homes and premium shops and services, whereas less affluent neighbourhoods contain smaller multi-occupancy homes and a higher proportion of fast-food outlets. The healthcare services are also modelled to ensure their size and services offered are representative of the real-world areas of our city. Statistical data also informed the development of people who ‘live’ in Birley Place. This ensured that the people are representative of the populations on which the neighbourhoods are based, matched proportionally for age, sex, race, education, health and employment status. The data allow accurate representation for long-term health conditions and lifestyle habits relating to smoking, alcohol consumption, exercise and diet. The people also interconnect with others, enabling family groups and social networks to be represented. Finally, these data were used to create simulated neighbourhood profile documents containing statistical health and population data for each neighbourhood (figure 1B), further modelling the real-world areas of our city.

Figure 1.

The Birley Place community map (A), including examples of the neighbourhood profile documents (B), shops and services (C), resident role profiles (D) and interactive learning activities (E) that learners can access when interacting with the virtual community. NB: Personal details relating to all individuals shown in this figure are fictional and were created for the purpose of simulation-based learning activities.

The map can be used as a way for learners to engage with the community; learners click on the map to visit buildings to access information about the people who live or work there. Background information is provided for each person in the form of a role profile, containing details relating to their personality, age, occupation, hobbies and lifestyle (figure 1D). Narrative context related to their health status is provided through scenarios (figure 1E). These include text and/or audiovisual case-based interactive media that bring the people ‘to life’ by describing events from the person’s life or depicting interactions they had with health or social care services. Interactive scenarios with embedded reflection and decision-making also allow learners the opportunity to ‘stop and think’, act and react to the scenario presented to them. The virtual community differs from traditional online learning and computer-based simulation, as learners interact socially and academically to explore the outcomes of their decisions.

Using authentic data to create and populate a virtual community enables learners to construct a realistic picture of the people who live there. As our simulation activities are based on real-world areas, learners develop an understanding of their local setting and its inhabitants. As the virtual community represents realistic people, learners gain an implicit appreciation of the factors that influence the health and social status of the service users for whom they provide care, both on placement and in their future careers. The consideration of these issues early during their education encourages them to place the service user at the forefront of their decision-making when providing care. In addition, the virtual community affords a flexible and safe option while maintaining authenticity; there is no requirement to visit communities physically to understand the concepts, which can be challenging logistically and present ethical and health and safety barriers. However, it is possible for the residents to be introduced as simulated patients in physical simulation activities, allowing the characters to exist both virtually and physically.

The cost of Birley Place is approximated to be £10 000 for initial set-up (including web development and software licenses) and £3500 to maintain annually (for web domain, hosting and maintenance). In addition, the faculty employs an e-learning developer to manage and develop the platform, and this accounts for ~50% of their workload. Costs associated with academic staff time for planning and developing the learning activities used within Birley Place, as well as funded projects with specific remit for developing Birley Place, are not included within this calculation.

Use of the virtual community to facilitate health and social care education

Birley Place facilitates virtual simulation across our degree programmes related to health and social care. In this section, we provide one example of how we have used Birley Place to facilitate a large-scale interprofessional education (IPE) project. IPE involves learners from a minimum of two different professions learning together and from each other, with the aim of improving collaboration and care provision.¹¹ Inclusion of IPE within health and social care education has benefits, including the development of learners’ communication and teamwork skills, perceptions of other professions and knowledge of the roles of professionals from other disciplines.^{12 13} Despite these benefits, requirements for large groups to learn together at the same place and time present logistical challenges to scheduling IPE. Virtual delivery of IPE can alleviate these constraints while providing a quality learning experience.⁶ Importantly, the more flexible approach afforded by virtual simulation-based IPE can achieve similar learning outcomes to traditional IPE activities. For example, virtual simulation has been effective in helping learners understand the importance of interprofessional collaboration in improving care outcomes and raising their awareness of the roles of other professionals.⁶

Our IPE provision, led by the third author, comprises a mandatory 7-week programme, integrated into the timetable of first year undergraduate students studying Adult Nursing, Mental Health Nursing, Physiotherapy, Speech and Language Therapy, Social Work, and Integrated Health and Social Care (800 students in total). The purpose of the IPE provision is to support the development of skilled graduates with an enhanced understanding of the health and social care landscape and the interactive team approach that is required to become effective health and social care practitioners. To achieve these aims, learners are assigned to interprofessional teams of 10 students and collaborate in communities of practice in either face-to-face or remote tutor-facilitated sessions. The interprofessional groups are assigned a neighbourhood, directed to meet the residents and explore the local amenities and services. They also visit the virtual Town Hall to review the statistical information contained within the neighbourhood profile documents (see figure 1B), which enables the groups to develop a community profile. Accessing and scrutinising the data within the context of the virtual community help learners to visualise and interpret these data in a meaningful way. This encourages learners to develop an understanding of how the settings in which people live and wider determinants of health and social well-being interplay to influence health and social status. Learners discuss this information in their interprofessional groups to produce the community profile, before identifying a health and social care issue affecting their neighbourhood and developing an interprofessional strategy to address that issue, in a similar manner to Ching and Amidi-Nouri.¹⁴ Learners collaborate and share opinions on scenarios from the perspective of their own profession. Academic staff are involved in the interprofessional discussion which contributes to the sharing of perspectives, although leadership is shared across the group. This encourages interprofessional teamwork and communication¹² and promotes the belief that all perspectives are equally valuable. Through this process, learners begin to develop an understanding of how professionals from other disciplines may approach a care-related issue, which facilitates a deeper awareness of the roles and values of other professionals involved in care provision.⁶ Initial student evaluation data from the IPE programme indicate that learners perceived their interactions with Birley Place positively, as they reported that ‘the virtual community was well established and really easy to use’ and they ‘enjoyed analysing the profiles’. In addition, most learners responded in agreement to a statement that the Birley Place website and resources aided their learning, with free-text responses indicating that ‘learning from other professions’ and ‘sharing our understanding of roles, values and goals’ were among the most enjoyable aspects of the IPE programme.

Conclusion

We developed a virtual community, containing people, housing and services representative of real-world health and population data relating to our city. Birley Place provides an innovative and novel tool for delivering online and virtual simulation. The use of Birley Place allows us to overcome many of the constraints associated with the delivery of simulation activities and IPE on a large scale while providing a platform for learners to collaborate as a community of practice and develop teamworking skills. The use of real-world statistical information, detailed narrative to enhance role profiles and realistic scenarios helps to foster an engaging virtual community. This innovative approach challenges learners to explore the wider factors that contribute to health and social wellbeing, and encourages them to develop an enhanced awareness of the importance of interprofessional collaboration for effective care provision. A full research evaluation of student and staff experiences of the use of Birley Place to facilitate the delivery of IPE is currently ongoing and the findings will be communicated in due course.

Data availability statement

Data sharing is not applicable as no data sets are generated and/or analysed for this article.

Ethics statements

Patient consent for publication

Not required.