title: Cardiopulmonary Resuscitation Training by Avatars: A Qualitative Study of Medical Students' Experiences Using a Multiplayer Virtual World.
abstract: BACKGROUND
  Emergency medical practices are often team efforts. Training for various tasks and collaborations may be carried out in virtual environments. Although promising results exist from studies of serious games, little is known about the subjective reactions of learners when using multiplayer virtual world (MVW) training in medicine.
  
  
  OBJECTIVE
  The objective of this study was to reach a better understanding of the learners' reactions and experiences when using an MVW for team training of cardiopulmonary resuscitation (CPR).
  
  
  METHODS
  Twelve Swedish medical students participated in semistructured focus group discussions after CPR training in an MVW with partially preset options. The students' perceptions and feelings related to use of this educational tool were investigated. Using qualitative methodology, discussions were analyzed by a phenomenological data-driven approach. Quality measures included negotiations, back-and-forth reading, triangulation, and validation with the informants.
  
  
  RESULTS
  Four categories characterizing the students' experiences could be defined: (1) Focused Mental Training, (2) Interface Diverting Focus From Training, (3) Benefits of Practicing in a Group, and (4) Easy Loss of Focus When Passive. We interpreted the results, compared them to findings of others, and propose advantages and risks of using virtual worlds for learning.
  
  
  CONCLUSIONS
  Beneficial aspects of learning CPR in a virtual world were confirmed. To achieve high participant engagement and create good conditions for training, well-established procedures should be practiced. Furthermore, students should be kept in an active mode and frequent feedback should be utilized. It cannot be completely ruled out that the use of virtual training may contribute to erroneous self-beliefs that can affect later clinical performance.
authors.affiliation: Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.|Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Johan
authors.identifier: http://orcid.org/0000-0001-9406-8484
authors.initials: J
authors.lastname: Creutzfeldt
authors.affiliation: Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.|Department of Psychology, Umeå University, Umeå, Sweden.
authors.forename: Leif
authors.identifier: http://orcid.org/0000-0003-4004-2275
authors.initials: L
authors.lastname: Hedman
authors.affiliation: Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.|Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Li
authors.identifier: http://orcid.org/0000-0003-0693-6080
authors.initials: L
authors.lastname: Felländer-Tsai
keywords: avatars; cardiopulmonary resuscitation; educational technology; experiences; medical students; multiplayer virtual worlds; patient simulation; virtual learning environments