AN ANALYSIS OF VIRTUAL SIMULATIONS FROM THE TPACK PERSPECTIVE
Un análisis de las simulaciones virtuales desde la óptica del modelo TPACK

ADRIÁN BAEZA GONZÁLEZ, MIREIA USART RODRÍGUEZ AND LUIS MARQUÉS MOLÍAS
Universidad Rovira i Virgili (España)

DOI: 10.13042/Bordon.2023.97585
Fecha de recepción: 19/12/2022 • Fecha de aceptación: 11/04/2023
Autor de contacto / Corresponding autor: Adrián Baeza González. E-mail: adrian.baeza@estudiants.urv.cat
Cómo citar este artículo: Baeza González, A., Usart Rodríguez, M. and Marqués Molías, L. (2023). An analysis of virtual simulations from the TPACK perspective. Bordón, Revista de Pedagogía, 75(4), 109-134. https://doi.org/10.13042/Bordon.2023.97585

INTRODUCTION. Virtual simulations (VS) have increased their presence in the higher education training actions during the last years and have been consolidated as a result of the COVID-19 pandemic as a powerful tool that allows us to overcome many of the limitations of the face to face simulation rooms, related to costs and replicability. However, there is a lack of studies about the use of theoretical models, such as the TPACK, for the analysis of VS. METHOD. In this article a systematic review of the literature is conducted with the main aim of analysing the characteristics of the VS used in higher education during the last decade (2012-2022) from the optic of the TPACK model. RESULTS. The main findings are the big use of VS in Health-related areas and especially in the American continent (Unite States and Canada); the screen-based and computer-based simulation played online as the most common technological features; and the Experiential learning, the Situated learning and the Problem-based learning as the most common theories for the pedagogical justification of VS in higher education. DISCUSSION. A series of relationships has been spotted among the technological, pedagogical and content features of the VS that help us to better understand this tool that has a growing use, especially in the health field. Conclusions show, on the one hand, the lack of articles that properly describe the use of VS according to the TPACK requirements and, on the other hand, the adequacy and viability of this model for the analysis and development of VS.

Keywords: Simulation, Virtuality, Higher education, Training, Systematic review.

Introduction

Simulation is defined by the Health care simulation dictionary as a situation or environment that allows the experimentation of real events’ representations with the purpose of practising, learning, understanding or evaluating some skills or knowledge (Lioce, 2020Lioce, L. (2020). Healthcare Simulation Dictionary –Second Edition. Rockville, MD: Agency for Healthcare Research and Quality. https://doi.org/10.23970/simulationv2). A Virtual Simulation (VS) is a simulation of a real-life situation, that takes place in a virtual environment that is accessible to the user through technological devices (Gordon & McGonigle, 2018Gordon, R. M. & McGonigle, D. (2018). Virtual Simulation in Nursing Education. Springer Publishing Company.). Although there is great variability among VS in higher education depending on their technological features, some shared characteristics are immersion, interactivity, illusion and perceptual aspects (Li et al., 2021Li, S., Huang, M., Chen, J., Wu, Z. & Liu, J. (2021). Application of Virtual Simulation Technology in Architectural Design. En V. Sugumaran, Z. Xu & H. Zhou (Eds.), Application of Intelligent Systems in Multi-modal Information Analytics (pp. 536-542). Springer International Publishing. https://doi.org/10.1007/978-3-030-74811-1_78). Apart from these core characteristics, VS are also defined by the way in which they are implemented, with a 3-step application protocol (prebriefing, enactment or playing, and debriefing) that is completely essential for this technological tool to become a didactic tool with a big impact in the learning process of students (INACSL Standards Committee et al., 2021INACSL Standards Committee, McDermott, D. S., Ludlow, J., Horsley, E. & Meakim, C. (2021). Healthcare Simulation Standards of Best PracticeTM Prebriefing: Preparation and Briefing. Clinical Simulation In Nursing, 58, 9-13. https://doi.org/10.1016/j.ecns.2021.08.008). These phases are designed to make the VS efficient in terms of learning. In particular, some authors state that the biggest educational potential of VS resides in the debriefing phase, that is the final stage of the simulation process, aimed to reflect and extract conclusions of the playing experience, and especially to support the transfer of knowledge and skills from the simulated experience to real life (Bradley et al., 2020Bradley, C. S., Johnson, B. K. & Dreifuerst, K. T. (2020). Debriefing: A Place for Enthusiastic Teaching and Learning at a Distance. Clinical Simulation In Nursing, 49, 16-18. https://doi.org/10.1016/j.ecns.2020.04.001; Zigmont et al., 2011Zigmont, J. J., Kappus, L. J. & Sudikoff, S. N. (2011). The 3D model of debriefing: Defusing, discovering, and deepening. Seminars in Perinatology, 35(2), 52-58. https://doi.org/10.1053/j.semperi.2011.01.003).

Different studies justify the use of VS as tools for training in higher education, arguing that they enhance learners’ motivation, provide a better contextualization of the learning material and help students to develop higher technical abilities (McGrath et al., 2018McGrath, J. L., Taekman, J. M., Dev, P., Danforth, D. R., Mohan, D., Kman, N., Crichlow, A. & Bond, W. F. (2018). Using Virtual Reality Simulation Environments to Assess Competence for Emergency Medicine Learners. Academic Emergency Medicine, 25(2), 186-195. https://doi.org/10.1111/acem.13308). VS also increase the completion rates and reduce the time needed for learning the materials (Zhang, 2021Zhang, J. (2021). Analysis and Design of Teaching Experiment System Based on Virtual Simulation Technology. 2021 IEEE Asia-Pacific Conference on Image Processing, Electronics and Computers (IPEC), 595-598. https://doi.org/10.1109/IPEC51340.2021.9421328); provide a safe environment to train different skills without risk of hurting other people or damaging equipment (Koivisto et al., 2017Koivisto, J.-M., Niemi, H., Multisilta, J. & Eriksson, E. (2017). Nursing students’ experiential learning processes using an online 3D simulation game. Education and Information Technologies, 22(1), 383-398. https://doi.org/10.1007/s10639-015-9453-x); allow the reduction of huge costs (buying equipment and organizing rooms or laboratories for the training of students) (Verkuyl et al., 2017Verkuyl, M., Romaniuk, D., Atack, L. & Mastrilli, P. (2017). Virtual Gaming Simulation for Nursing Education: An Experiment. Clinical Simulation in Nursing, 13(5), 238-244. https://doi.org/10.1016/j.ecns.2017.02.004); allow the reproduction of processes and phenomena that cannot be observed in such detail, or that are difficult to experience based on their exceptionality or rarity (Šidjanin et al., 2020Šidjanin, P., Plavšić, J., Arsenić, I. & Krmar, M. (2020). Virtual reality (VR) simulation of a nuclear physics laboratory exercise. European Journal of Physics, 41(6). https://doi.org/10.1088/1361-6404/ab9c90); and have unlimited access and repeatability (MacKenna et al., 2021MacKenna, V., Díaz, D. A., Chase, S. K., Boden, C. J. & Loerzel, V. (2021). Self-Debriefing After Virtual Simulation: Measuring Depth of Reflection. Clinical Simulation in Nursing, 52, 59-67. https://doi.org/10.1016/j.ecns.2021.01.002).

In addition to these VS characteristics, a decisive event has contributed to spreading VS during the last years: The COVID-19 pandemic. This unexpected situation has forced higher education to change the traditional onsite simulation facilities to online learning contexts. In this situation, VS appear as an alternative to onsite training simulations (Liu, 2021Liu, W. (2021). The Effects of Virtual Simulation on Undergraduate Nursing Students’ Beliefs about Prognosis and Outcomes for People with Mental Disorders. Clinical Simulation in Nursing, 50, 1-9. https://doi.org/10.1016/j.ecns.2020.09.007).

Nonetheless, the spread use of VS in higher education claims for standardization regarding both the use and the research on the technological and pedagogical aspects of these tools (Verkuyl & Mastrilli, 2017Verkuyl, M. & Mastrilli, P. (2017). Virtual Simulations in Nursing Education: A Scoping Review. Journal of Nursing and Health Sciences, 3(2), 39-47. ), in order to make them a valid and reliable alternative to onsite simulations (Jiang-Bo & Jin, 2021). Up to authors’ knowledge, there is an absence of literature reviews and meta-analysis focused on the study of VS from a tecno-pedagogical standpoint; Ledger et al. (2022) claim that more research about the pedagogical role of technology is needed to fully take profit from the new developments of the educational technology in the future, as well as from the statements of others authors such us Jiang-Bo and Jin (2021Jiang-Bo, T. & Jin, Z. (2021). Research on Teaching Application Category Based on Virtual Simulation Technology, 408-411. Scopus. https://doi.org/10.1109/IEIT53597.2021.00097) who state that teachers are still confused about how to effectively apply VS.

Therefore, this study proposes a systematic literature review with the goal of taking a closer look to the application of VS in higher education under the framework of the TPACK model, which will allow us to see the big picture in the implementation of VS in higher education. The TPACK model was proposed by Koehler and Mishra (2009Koehler, M. & Mishra, P. (2009). What Is Technological Pedagogical Content Knowledge? Contemporary Issues in Technology and Teacher Education, 9(1), 60-70.) and allows the analysis of the technological characteristics of VS (Technology), the pedagogical theories used to justify the application of these tools (Pedagogy), the field of knowledge and their learning objectives (Content), as well as their relationships.

Figure 1. TPACK model [View full size] [Descargar tamaño completo]

Method

This literature review has been conducted following a three-phase process: Planning, conducting and reporting (Kitchenham, 2004). In the planning phase, a quick exploration of the literature, especially, of other systematic literature reviews or meta-analysis in the topic of VS in higher education helped us to set the goals:

• General objective: Describe the use of VS in higher education according to their technological, pedagogical and content features.
• Specific objectives:

– O1. Define the technological features of VS used in higher education (TK).

– O2. Identify the pedagogical theories that justify the use of VS in higher education (PK).

– O3. Identify the field of knowledge in which VS are used in higher education (CK).

– O4. Analyse the relationships between the technological features of VS and its content (TCK).

– O5. Analyse the relationship between the pedagogical justification of VS and its content (PCK).

– O6. Analyse the relationship between the pedagogical justification of VS and its technological features (TPK).

The research strategy started with the following search string: (“virtual simulation” OR “virtual reality simulation” OR “simulation game” OR “virtual gaming simulation” OR “online virtual simulation”) AND (“university” OR “higher education”). This was applied in different platforms such as Scopus, Web of science and Eric, all of them containing high quality journal articles, conference papers, books, etc. in educational technology. The search was restricted to study title, abstract and keywords. The selection and exclusion criteria for the articles included in the systematic literature review is shown in table 1. Criteria 9 to 12 are focused on the TPACK model. When a study met at least one exclusion criteria, it was removed from the review. The selection process is presented in detail.

During the Conducting phase, the literature review is carried out. The analysis of the references was conducted between December 2021 and September 2022. A total of 3906 articles emerged from the searches. A 90% of them came from the SCOPUS repository, an 8% from Web of science, and a 2% from the ERIC database. All of them published in these data bases from 2012 and 2022.

Publication selection process: The refinement of the articles in order to obtain the 19 articles from the 3906 found publications was divided into three steps (see figure 2):

1. Duplicated articles were deleted from the database (244).
2. Remaining articles were analysed taking into consideration their title and abstract in order to consider their adequacy to the inclusion criteria (2735).
3. 927 remaining publications were fully examined and applied all the inclusion and exclusion criteria, obtaining a final amount of 19 publications that met all the requirements.

Figure 2. Summary of the publication selection process [Descargar tamaño completo]

A total of 19 publications were selected for this literature review (0,5% of the initial publications). Several publications were removed in the steps 1, 2 and 3 following the exclusion criteria outlined in table 1. The most common exclusion criteria were those related to TPACK (EC 9- EC12). These criteria excluded a 40% of the remaining articles in step 3. Other relevant exclusion criteria were EC 4 (“The type of study is not empiric”) and EC5 (“The text is not fully available”), which excluded respectively 15% and 10% of the step 3 publications. In the next section the results of this review are presented in accordance with the objectives.

Results and discussion

Descriptive analysis of the selected articles shows that VS in higher education are mostly conducted in the American continent, and specifically in USA and Canada (see Fig. 3). Nonetheless, the use of VS is spreading in the last years in Europe and also Asiatic countries like Korea.

Figure 3. Countries where VS are applied [View full size] [Descargar tamaño completo]

The number of publications is increasing, mostly during the pandemic. This was expected, based on the validity of this training tool for online learning modalities of education. This trend is highly likely to continue because even in last months of 2021, when the collection of articles was conducted, there were already some publications for 2022 gathering the TPACK requirements of this review (see Fig. 4).

Figure 4. Years of publication [View full size] [Descargar tamaño completo]

There is a huge variability and inconsistency of terms regarding the terminology about virtual simulated environments. Researchers commonly do not provide with definitions for the terms they use (Cant et al., 2019Cant, R., Cooper, S., Sussex, R. & Bogossian, F. (2019). What’s in a Name? Clarifying the Nomenclature of Virtual Simulation. Clinical Simulation In Nursing, 27, 26-30. https://doi.org/10.1016/j.ecns.2018.11.003; Verkuyl & Mastrilli, 2017Verkuyl, M. & Mastrilli, P. (2017). Virtual Simulations in Nursing Education: A Scoping Review. Journal of Nursing and Health Sciences, 3(2), 39-47. ). Virtual Simulation (VS) is the most common term among the selected articles (see figure 5), followed by Virtual Reallity Simulation (VRS), which already implies some features of the simulation as it is the used of virtual reality features within the simulation, or simulation game, which also includes the presence of gaming elements into de conceptualization of the VS.

Figure 5. Terminology used to name the VS [View full size] [Descargar tamaño completo]

According to the first specific objective, the technological feature (TK) that outstands in the analized articles is that most of the VS are screen-based, what means that a computer or a smartphone’s screen is used as the support for the VS environment. Furthermore, most of VS are computer-based, meaning that the user can experience the situation through the common components of a computer such as screen, mouse, keyboard and speakers (Lioce, 2020Lioce, L. (2020). Healthcare Simulation Dictionary –Second Edition. Rockville, MD: Agency for Healthcare Research and Quality. https://doi.org/10.23970/simulationv2).

However, other technological features such as virtual reality glasses and haptic devices are also present in the literature review, which significantly contribute to the feeling of immersion during the simulation play (Dunleavy et al., 2009Dunleavy, M., Dede, C. & Mitchell, R. (2009). Affordances and Limitations of Immersive Participatory Augmented Reality Simulations for Teaching and Learning. Journal of Science Education and Technology, 18, 7-22. https://doi.org/10.1007/s10956-008-9119-1), but these are less common in the literature review (Hannans et al., 2021Hannans, J. A., Nevins, C. M. & Jordan, K. (2021). See it, hear it, feel it: Embodying a patient experience through immersive virtual reality. Information and Learning Sciences, 122(7/8), 565-583. https://doi.org/10.1108/ILS-10-2020-0233; Lanzieri et al., 2020Lanzieri, N., Samelson, H., McAlpin, E. & Shilane, D. (2020). Work-in-Progress-A 360 Virtual Reality Simulation to Prepare Social Work Students to Interact with Community Environments, 271-274. https://doi.org/10.23919/iLRN47897.2020.9155161; Smith et al., 2016Smith, S., Farra, S., Ulrich, D., Hodgson, E., Nicely, S. & Matcham, W. (2016). Learning and Retention Using Virtual Reality in a Decontamination Simulation. Nursing Education Perspectives, 37, 210-214. https://doi.org/10.1097/01.NEP.0000000000000035). Nonetheless, screen-based simulations also have some technological resources to immerse users into the experience, such as the creation of avatars that can be freely moved in a 3D environment, the presence of other users in the VS and the communication among them, or the first person view perspective, features also found in the analysed articles.

Another important technical aspect is that the vast majority of VS do not need downloading any specific software to play, but they are accessible online.

Table 2 describes the main technological features of each simulation.

Based on the aforementioned technological features, VS can be grouped in the following way:

• 3D multiplayer environments. In these VS a higher degree of immersion is achieved through avatars that can handle conversations and have movement freedom in the environment. These VS incorporate at a times virtual reality glasses to make the experience even more immersive.
• 2D single player environments. In these VS a higher degree of immersion is achieved in some cases by including a first view perspective and real actors playing different roles involved in the simulation, while others simply try to recreate a system with different parameters that the users can manipulate.

The second specific objective is related to pedagogical knowledge (PK). Every technological tool that is incorporated into an educational training program should be designed and / or implemented with pedagogical principles that support its use and set the educational goals. In table 2 the learning theories used to justify the VS analysed are shown. Authors use different theories to support the implementation of VS in higher education, but the more recurrent theories are Situated learning, with 5 authors (Aebersold, 2018Aebersold, M. (2018). Simulation-Based Learning: No Longer a Novelty in Undergraduate Education. Online Journal of Issues in Nursing, 23, 1-1. https://doi.org/10.3912/OJIN.Vol23No02PPT39; Falconer, 2013Falconer, L. (2013). Situated learning in virtual simulations: Researching the authentic dimension in virtual worlds. Journal of Interactive Learning Research, 24(3), 285-300. http://bit.ly/3Uq5MdG; Lanzieri et al., 2020Lanzieri, N., Samelson, H., McAlpin, E. & Shilane, D. (2020). Work-in-Progress-A 360 Virtual Reality Simulation to Prepare Social Work Students to Interact with Community Environments, 271-274. https://doi.org/10.23919/iLRN47897.2020.9155161; Sanborn et al., 2019Sanborn, H., Cole, J., Kennedy, T. & Saewert, K. J. (2019). Practicing interprofessional communication competencies with health profession learners in a palliative care virtual simulation: A curricular short report. Journal of Interprofessional Education & Practice, 15, 48-54. https://doi.org/10.1016/j.xjep.2019.01.010; Smith et al., 2016Smith, S., Farra, S., Ulrich, D., Hodgson, E., Nicely, S. & Matcham, W. (2016). Learning and Retention Using Virtual Reality in a Decontamination Simulation. Nursing Education Perspectives, 37, 210-214. https://doi.org/10.1097/01.NEP.0000000000000035), Experiencial learning with 4 authors (Hannans et al., 2021Hannans, J. A., Nevins, C. M. & Jordan, K. (2021). See it, hear it, feel it: Embodying a patient experience through immersive virtual reality. Information and Learning Sciences, 122(7/8), 565-583. https://doi.org/10.1108/ILS-10-2020-0233; Ranchhod et al., 2014Ranchhod, A., Gurǎu, C., Loukis, E. & Trivedi, R. (2014). Evaluating the educational effectiveness of simulation games: A value generation model. Information Sciences, 264, 75-90. https://doi.org/10.1016/j.ins.2013.09.008; Rim & Shin, 2022Rim, D. & Shin, H. (2022). Development and Assessment of a Multi-User Virtual Environment Nursing Simulation Program: A Mixed Methods Research Study. Clinical Simulation in Nursing, 62, 31-41. https://doi.org/10.1016/j.ecns.2021.10.004; Verkuyl et al., 2020Verkuyl, M., Lapum, J. L., St-Amant, O., Hughes, M., Romaniuk, D. & McCulloch, T. (2020). Exploring Debriefing Combinations After a Virtual Simulation. Clinical Simulation in Nursing, 40, 36-42. Scopus. https://doi.org/10.1016/j.ecns.2019.12.002), and Problem-based learning with 2 authors (Espitia et al., 2021Espitia, N., Zoran, D., Clendenin, A., Crosby, S., Dominguez, B., Ellis, C., Hilburn, A., Moyer, W. & Bissett, W. (2021). Direct Measurement of Veterinary Student Learning Outcomes for the NAVMEC Professional Competencies in a Multi-User Virtual Learning Environment. Journal of Veterinary Medical Education, 48(1), 33-47. https://doi.org/10.3138/jvme.0318-025r2; Legner et al., 2013Legner, C., Estier, T., Avdiji, H. & Boillat, T. (2013, diciembre 18). Designing Capstone Courses in Management Education: Knowledge Activation and Integration Using an ERP-based Simulation Game. ICIS.). The rest of them are mentioned by just one author.

In table 3, and brief explanation of the most used theories is provided.

In the common ground of these theories there are some shared features. First, students and teacher must change their traditional roles; while students become active, researching and solving problems, teachers become facilitators, guiding students in the process. Second, reflection periods are seen as a key element in order to refine and consolidate knowledge. Third, the engagement with the learning activity is achieved by involving students in a realistic and authentic environment in which they have to solve a situation that is meaningful to them. Therefore, all these theories relate to the constructivist paradigm of learning, sharing the central statement that knowledge is actively constructed by the individuals rather than received or conveyed from a mentor.

Finally, it can also be noted that Situated learning and Problem-based learning pay a closer attention to the social character of the learning process, considering the exchange and discussion among pairs as key elements of a complete learning experience.

The third specific objective is focused on content knowledge (CK). Based on GTIWEB’s (2021) classification, the field of knowledge in which VS has major use is Medical sciences (including nursing, medicine, pharmacy and other related degrees). Twelve out of the nineteen articles come from this health-realted sector of science which clearly dominate the production and use of VS nowadays. Nonetheless, the use of VS in higher education is also beginning to spread to others fields of knowledge such as Economic sciences in which 4 articles has been identified (see table 3). Other fields such as Physics, Agricultural sciences, Sociology or Earth and space sciences are also found.

Figure 6. Fields of knowledge in which VS are applied [View full size] [Descargar tamaño completo]

Related to content knowledge, it is also relevant to take into consideration the VS learning objectives. Table 4 outlines these pedagogical objectives grouped by the field of knowledge in which simulations are used, where three different cathegories of goals emerge:

1. Technical learning goals: specific objectives for the field of knowledge and speciality of the subject that the VS is inserted in.
2. Transversal learning goals: more general objectives aimed at trainning transversal soft skills that are also highly important for their professional practice.
3. A mixture between the technical and transversal side of the objectives.

Some of the VS cover a lot of learning objectives, from transversal skills to hard skills such as Tiffany and Hoglund (2014Tiffany, J. M. & Hoglund, B. A. (2014). Facilitating Learning Through Virtual Reality Simulation: Welcome to Nightingale Isle. En M. Ma, L. C. Jain & P. Anderson (Eds.), Virtual, Augmented Reality and Serious Games for Healthcare 1 (pp. 159-174). Springer. https://doi.org/10.1007/978-3-642-54816-1_9) or Legner et al. (2013Legner, C., Estier, T., Avdiji, H. & Boillat, T. (2013, diciembre 18). Designing Capstone Courses in Management Education: Knowledge Activation and Integration Using an ERP-based Simulation Game. ICIS.). These simulations include technical learning objectives such as Integrating an understanding of population-focused principles, family theory, disaster planning/emergency preparedness, or defining a company business strategy, which are mixed with other more transversal learning goals such as demonstrating effective verbal, electronic, and written communication skills, or developing goal setting skills.

On the other hand, other simulations just focus on specific and technical skills related with the problem to be solved in the simulation such as Aebersold et al. (2018Aebersold, M. (2018). Simulation-Based Learning: No Longer a Novelty in Undergraduate Education. Online Journal of Issues in Nursing, 23, 1-1. https://doi.org/10.3912/OJIN.Vol23No02PPT39), Smith et al. (2016Smith, S., Farra, S., Ulrich, D., Hodgson, E., Nicely, S. & Matcham, W. (2016). Learning and Retention Using Virtual Reality in a Decontamination Simulation. Nursing Education Perspectives, 37, 210-214. https://doi.org/10.1097/01.NEP.0000000000000035), Holthaus and Longhi (2022Holthaus, A. M. & Longhi, J. A. (2022). Transforming National League for Nursing Advancing Care Excellence for Seniors Unfolding Cases into Virtual Simulations: An Innovative Approach for Interactive Learning. Clinical Simulation in Nursing, 72, 37-42. https://doi.org/10.1016/j.ecns.2021.09.003) or Savadatti and Johnsen (2017Savadatti, S. & Johnsen, K. (2017, junio 1). Exploring a Virtual Reality Simulation to Aid Inductive Learning of Fluid Pressure Characteristics. https://doi.org/10.18260/1-2--28325). These simulations include objectives like training clinical psychomotor skills to place a nasogastric tube, preparing to respond and safely perform when a disaster occurs, developing chronic care knowledge, and learning fluid mechanic concepts, goals that are much more technical.

Also, it has been highlighted that the VS found usually recreate situations that although are important for the student to understand and know how to proceed, it is difficult or even dangerous to have access to them for several reasons such as the complexity or impossibility of that situation to happen in real life (Falconer, 2013Falconer, L. (2013). Situated learning in virtual simulations: Researching the authentic dimension in virtual worlds. Journal of Interactive Learning Research, 24(3), 285-300. http://bit.ly/3Uq5MdG; Hannans et al., 2021Hannans, J. A., Nevins, C. M. & Jordan, K. (2021). See it, hear it, feel it: Embodying a patient experience through immersive virtual reality. Information and Learning Sciences, 122(7/8), 565-583. https://doi.org/10.1108/ILS-10-2020-0233; Menzel et al., 2014Menzel, N., Willson, L. & Doolen, J. (2014). Effectiveness of a Poverty Simulation in Second Life®: Changing Nursing Student Attitudes toward Poor People. International Journal of Nursing Education Scholarship, 11(1). https://doi.org/10.1515/ijnes-2013-0076; Smith et al., 2016Smith, S., Farra, S., Ulrich, D., Hodgson, E., Nicely, S. & Matcham, W. (2016). Learning and Retention Using Virtual Reality in a Decontamination Simulation. Nursing Education Perspectives, 37, 210-214. https://doi.org/10.1097/01.NEP.0000000000000035), the high risk for the subjects (patients, populations, etc) or even the own students (Aebersold, 2018Aebersold, M. (2018). Simulation-Based Learning: No Longer a Novelty in Undergraduate Education. Online Journal of Issues in Nursing, 23, 1-1. https://doi.org/10.3912/OJIN.Vol23No02PPT39; Keys et al., 2021Keys, E., Luctkar-Flude, M., Tyerman, J., Sears, K. & Woo, K. (2021). The Integration of Virtual Simulation Gaming Into Undergraduate Nursing Resuscitation Education: A Pilot Randomised Controlled Trial. Clinical Simulation in Nursing, 54, 54-61. https://doi.org/10.1016/j.ecns.2021.01.013; Rim & Shin, 2022Rim, D. & Shin, H. (2022). Development and Assessment of a Multi-User Virtual Environment Nursing Simulation Program: A Mixed Methods Research Study. Clinical Simulation in Nursing, 62, 31-41. https://doi.org/10.1016/j.ecns.2021.10.004), the huge responsibility that will imply for the learners (Buil et al., 2018Buil, I., Catalán, S. & Martínez, E. (2018). Exploring students’ flow experiences in business simulation games. Journal of Computer Assisted Learning, 34(2), 183-192. https://doi.org/10.1111/jcal.12237; Holthaus & Longhi, 2022Holthaus, A. M. & Longhi, J. A. (2022). Transforming National League for Nursing Advancing Care Excellence for Seniors Unfolding Cases into Virtual Simulations: An Innovative Approach for Interactive Learning. Clinical Simulation in Nursing, 72, 37-42. https://doi.org/10.1016/j.ecns.2021.09.003; Keys et al., 2021Keys, E., Luctkar-Flude, M., Tyerman, J., Sears, K. & Woo, K. (2021). The Integration of Virtual Simulation Gaming Into Undergraduate Nursing Resuscitation Education: A Pilot Randomised Controlled Trial. Clinical Simulation in Nursing, 54, 54-61. https://doi.org/10.1016/j.ecns.2021.01.013; Legner et al., 2013Legner, C., Estier, T., Avdiji, H. & Boillat, T. (2013, diciembre 18). Designing Capstone Courses in Management Education: Knowledge Activation and Integration Using an ERP-based Simulation Game. ICIS.; Riivari et al., 2021Riivari, E., Kivijärvi, M. & Lämsä, A.-M. (2021). Learning teamwork through a computer game: For the sake of performance or collaborative learning? Educational Technology Research and Development, 69(3), 1753-1771. https://doi.org/10.1007/s11423-021-10009-4; Rim & Shin, 2022Rim, D. & Shin, H. (2022). Development and Assessment of a Multi-User Virtual Environment Nursing Simulation Program: A Mixed Methods Research Study. Clinical Simulation in Nursing, 62, 31-41. https://doi.org/10.1016/j.ecns.2021.10.004; Tiffany & Hoglund, 2014; Verkuyl et al., 2020Verkuyl, M., Lapum, J. L., St-Amant, O., Hughes, M., Romaniuk, D. & McCulloch, T. (2020). Exploring Debriefing Combinations After a Virtual Simulation. Clinical Simulation in Nursing, 40, 36-42. Scopus. https://doi.org/10.1016/j.ecns.2019.12.002), or the need of other professionals or patients to be present to work interprofessional skills, leadership, teamwork, etc. (Espitia et al., 2021Espitia, N., Zoran, D., Clendenin, A., Crosby, S., Dominguez, B., Ellis, C., Hilburn, A., Moyer, W. & Bissett, W. (2021). Direct Measurement of Veterinary Student Learning Outcomes for the NAVMEC Professional Competencies in a Multi-User Virtual Learning Environment. Journal of Veterinary Medical Education, 48(1), 33-47. https://doi.org/10.3138/jvme.0318-025r2; Falconer, 2013Falconer, L. (2013). Situated learning in virtual simulations: Researching the authentic dimension in virtual worlds. Journal of Interactive Learning Research, 24(3), 285-300. http://bit.ly/3Uq5MdG; Lanzieri et al., 2020Lanzieri, N., Samelson, H., McAlpin, E. & Shilane, D. (2020). Work-in-Progress-A 360 Virtual Reality Simulation to Prepare Social Work Students to Interact with Community Environments, 271-274. https://doi.org/10.23919/iLRN47897.2020.9155161; Riivari et al., 2021Riivari, E., Kivijärvi, M. & Lämsä, A.-M. (2021). Learning teamwork through a computer game: For the sake of performance or collaborative learning? Educational Technology Research and Development, 69(3), 1753-1771. https://doi.org/10.1007/s11423-021-10009-4; Rose et al., 2020Rose, K. A., Jenkins, S. D., Astroth, K. S., Woith, W. & Jarvill, M. (2020). Testing a Web-Based Intervention to Improve Awareness of Civility and Incivility in Baccalaureate Nursing Students. Clinical Simulation In Nursing, 48, 46-54. https://doi.org/10.1016/j.ecns.2020.08.011; Sanborn et al., 2019Sanborn, H., Cole, J., Kennedy, T. & Saewert, K. J. (2019). Practicing interprofessional communication competencies with health profession learners in a palliative care virtual simulation: A curricular short report. Journal of Interprofessional Education & Practice, 15, 48-54. https://doi.org/10.1016/j.xjep.2019.01.010).

The fourth specific objective analyses the relationships between the technological features of VS and its content (TCK). Cant et al. (2019Cant, R., Cooper, S., Sussex, R. & Bogossian, F. (2019). What’s in a Name? Clarifying the Nomenclature of Virtual Simulation. Clinical Simulation In Nursing, 27, 26-30. https://doi.org/10.1016/j.ecns.2018.11.003) established that the level of immersion is one of the key features to take into account to properly describe and understand a VS. Immersion is described in the context of virtual environments as a psychological reaction that makes the participants feel enveloped by the virtual space, what will also increase the feeling of presence in the environment (Witmer & Singer, 1998Witmer, B. G. & Singer, M. J. (1998). Measuring presence in virtual environments: A presence questionnaire. Presence: Teleoperators and Virtual Environments, 7(3), 225-240. https://doi.org/10.1162/105474698565686). Therefore, immersive elements are VS features that help users to feel “inside” of the simulated scenario; thus, allow them to have a closer connection with the situation that is going on.

From this review, features that contribute to the immersion of the user in a VS are: VR glasses and Haptic devices, Avatars, Free of movement, Communication and First-person view. The 19 VS are ordered by their level of immersion, which ranges from 0 in case that the simulations do not have any of the previous features, to 5 in case it has them all- This immersion level is related with the kind of learning objectives of the simulations in terms of technical learning goals, transversal learning goals, or both.

Table 5 shows that all the VS with 3 or more immersive elements include transversal skills in their learning objectives, and 8 from the 10 most immersive simulations include a combination of technical and transversal skills, offering a wider training for the user. However, from the 10 VS with 2 or less immersive elements, just 4 include transversal skills into their learning goals, and the remaining 6 just focus on technical skills of the field of knowledge.

As an example one can see how more immersive simulations such as Hannans et al. (2021Hannans, J. A., Nevins, C. M. & Jordan, K. (2021). See it, hear it, feel it: Embodying a patient experience through immersive virtual reality. Information and Learning Sciences, 122(7/8), 565-583. https://doi.org/10.1108/ILS-10-2020-0233) that tries to completely introduce the learners into a different situation through the use of a headset and glasses so that users can experience the life of a person with hearing and visions impediments; or Tiffany and Hoglund (2014Tiffany, J. M. & Hoglund, B. A. (2014). Facilitating Learning Through Virtual Reality Simulation: Welcome to Nightingale Isle. En M. Ma, L. C. Jain & P. Anderson (Eds.), Virtual, Augmented Reality and Serious Games for Healthcare 1 (pp. 159-174). Springer. https://doi.org/10.1007/978-3-642-54816-1_9), that recreate a whole 3D virtual world in which users can freely move and interact with their pairs, usually include a wide range of learning objectives that go from more transversal skills to more technical ones. On the other hand, less immersive simulations such as Savadatti and Johnsen (2017Savadatti, S. & Johnsen, K. (2017, junio 1). Exploring a Virtual Reality Simulation to Aid Inductive Learning of Fluid Pressure Characteristics. https://doi.org/10.18260/1-2--28325), Keys et al. (2021Keys, E., Luctkar-Flude, M., Tyerman, J., Sears, K. & Woo, K. (2021). The Integration of Virtual Simulation Gaming Into Undergraduate Nursing Resuscitation Education: A Pilot Randomised Controlled Trial. Clinical Simulation in Nursing, 54, 54-61. https://doi.org/10.1016/j.ecns.2021.01.013), or Holthaus and Longhi (2022Holthaus, A. M. & Longhi, J. A. (2022). Transforming National League for Nursing Advancing Care Excellence for Seniors Unfolding Cases into Virtual Simulations: An Innovative Approach for Interactive Learning. Clinical Simulation in Nursing, 72, 37-42. https://doi.org/10.1016/j.ecns.2021.09.003), just mention technical learning objectives of their fields such as learning fluid mechanic concepts, receiving education on cardiac resuscitation, or developing chronic care knowledge.

In the fifth objective, pedagogical content Knowledge (PCK) aims to explore the relationship between the pedagogical theories used to justify the use of a VS and the content of that simulation. Table 5 highlights the VS based on the pedagogical theory that support them and the kind of learning objectives that they aim to achieve.

Authors who use theories like Experiential learning, Situated learning, Constructivism, or Problem-based learning, tend to include learning objectives that focus on the improvement of transversal and technical skills. This is because those theories pay attention not only to the specific task or problem to be solved, but also to the general situation that englobes the problem. However, more partial theories such as Concept based learning, Theory of deliberate practice or Inductive learning, which pay a closer attention to the task to be done over the situation in which this task need to be done, commonly are used by authors whose VS aim to achieve technical and specific learning objectives of their field of knowledge.

Finally, the sixth specific objective of this study aims to explore the relationship between the technological features of VS and the pedagogy that supports them (TPK). In table 5 both categories of the TPACK are related.

Although the relationship is not as clear as the previous ones, the same pattern can be seen. In this case, the more complete pedagogical theories about the learning experience (Experiential learning, Situated learning and Problem-based learning) are also more frequent in more immersive simulations. 10 out of the 13 VS that include two or more immersive elements use these kinds of theories for the justification of the VS.

On the other hand, VS with less immersive features tend to be justified with more partial and specific pedagogical theories such as Inductive learning, Theory of deliberate practice or Concept based learning. Almost half (3 out of 7) of the simulations with one or less immersive elements use these kinds of theories for the justification.

Conclusions

Description provided in this literature review shows that VS are complex tools that present wide variations in terms of their technological features, their learning goals and, therefore, their pedagogical foundations. Results of these systematic literature review, regarding the first specific objective, agree with previous findings with a domain of screen-based simulations, and a classification of VS in two big groups: 3D multiplayer environments and 2D single player environments. These categories correspond respectively with the Virtual worlds and Virtual patients categories used by authors like Chang et al. (2016Chang, T., Gerard, J. & Pusic, M. (2016). Screen-Based Simulation, Virtual Reality, and Haptic Simulators. En V. Grant & A. Cheng (Eds.), Comprehensive Healthcare Simulation: Pediatrics (pp. 105-114). Springer. https://doi.org/10.1007/978-3-319-24187-6_9). Nonetheless, although authors tend to describe 2D Virtual patients as non-immersive simulations and 3D Virtual worlds as immersive simulations (Chang et al., 2016Chang, T., Gerard, J. & Pusic, M. (2016). Screen-Based Simulation, Virtual Reality, and Haptic Simulators. En V. Grant & A. Cheng (Eds.), Comprehensive Healthcare Simulation: Pediatrics (pp. 105-114). Springer. https://doi.org/10.1007/978-3-319-24187-6_9; Sim et al., 2022Sim, J. J. M., Rusli, K. D. B., Seah, B., Levett-Jones, T., Lau, Y. & Liaw, S. Y. (2022). Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis. Clinical Simulation in Nursing, 69, 26-39. https://doi.org/10.1016/j.ecns.2022.05.006), it is important, in order to efficiently implement VS in practice, to deepen into the elements that make a VS immersive, so that 2D simulations are considered as partially immersive (Foronda et al., 2020Foronda, C. L., Fernández-Burgos, M., Nadeau, C., Kelley, C. N. & Henry, M. N. (2020). Virtual Simulation in Nursing Education: A Systematic Review Spanning 1996 to 2018. Simulation in Healthcare: Journal of the Society for Simulation in Healthcare, 15(1), 46-54. https://doi.org/10.1097/SIH.0000000000000411) and can relate the level of immersion with their pedagogical and content characteristics.

Attending to the specific objectives three and four, interesting findings have emerged when exploring the relationships between the level of immersion of the VS and its learning objectives. On the one hand, based on the specific objective three, learning objectives rarely gather the whole range of competences that are trained with the VS, paying a lot of attention to the technical content of the simulation, but not to other related skills that are also directly improved with the use of the VS. On the other hand, based on the specific objective four it has been found that the more immersive simulations tend to cover a wider range of competencies. Nonetheless, it is also worth mentioning that learning objectives hardly ever are formulated taking into account taxonomies like the Bloom’s one. So, they usually have a poor formulation and tend to put a lot of attention to the technical content of the simulation, but not to other related skills that are also directly improved with the use of the VS.

In terms of the specific objectives two and five, another interesting finding for practitioners has been made. Although Situated and Experiential learning are the most common theories to justify the use VS, the educational theories are mostly related with the kind of VS used: the more immersive elements included in the VS, the more complete the pedagogical theories are, tending to take into consideration not just the specific content to be learnt, but also the whole context or situation in which the use of that content may arise.

Finally, regarding the specific objective six, a slighter relation can be spotted when combining the pedagogical theories of the VS and its learning objectives. Simulations that give importance to the whole situation that involves the problem to be solved tend to use more complete learning theories such as the experiential learning or the situational learning, whose goal is far beyond the learning of technical aspects of their field of knowledge, but also include the development of other soft skills also highly valuable for the correct performance of their professional activity. Meanwhile, other simulations that are more focused on the development and understanding of specific and technical knowledge use learning theories that pay a closer attention to the specific task or problem to be solved regardless of the situation in which it appears, or the people involved in it.

All these findings allow us to consider the TPACK model as a suitable paradigm for the analysis of this new learning tool that is widely spreading in higher education. Nonetheless, in spite of the wide amount of research articles found in the first stage of the literature review related with the implementation of VS in higher education, just a few describe their features according with the TPACK requirements, what implies to consider their technological, pedagogical and content characteristics in the explanation of the tool.

Further research it is needed to achieve a deeper understanding of VS by using the TPACK model, and to extract more conclusive findings as a result of maximizing the number of VS analysed by including other educational levels.

References

Resumen

Un análisis de las simulaciones virtuales desde la óptica del modelo TPACK

INTRODUCCIÓN. Las simulaciones virtuales (SV) han aumentado su presencia como herramientas formativas en educación superior en los últimos años, y se han consolidado, a raíz del COVID-19, como una potente herramienta que permite suplir muchas de las limitaciones que se encuentran en las salas de simulación presenciales, como son el elevado coste y la baja replicabilidad. Ahora bien, pocos estudios han abordado el uso de modelos como el TPACK para el análisis de SV. MÉTODO. En este artículo se realiza una revisión sistemática de la literatura con el objetivo de analizar las características de las SV implementadas en educación superior durante la década 2012-2022 desde la óptica del modelo TPACK. RESULTADOS. Entre los resultados encontrados destacan el gran uso de SV en el área de la salud, y en especial en el continente americano (Estados Unidos y Canadá); los entornos de simulación 2D online con acceso a través del ordenador como las características tecnológicas más comunes de las SV; y la recurrencia a las teorías del Aprendizaje experiencial, Aprendizaje situado y el Aprendizaje basado en problemas como sus principales justificaciones pedagógicas. DISCUSIÓN. Se aprecian una serie de relaciones entre las características tecnológicas, pedagógicas y de contenido de las SV que nos ayudan a comprender mejor esta herramienta en creciente uso, en especial en el área de la salud. Además, destaca, por un lado, la escasez de artículos que propiamente describen el uso de SV de acuerdo a los requerimientos del TPACK, y, por otro, la adecuación y viabilidad de dicho modelo tanto para el análisis como el desarrollo de SV.

Palabras clave: Simulación, Virtualidad, Educación superior, Formación, Revisión sistemática.

Résumé

Analyse des simulations virtuelles dans l’optique du modèle TPACK

INTRODUCTION. Ces dernières années les simulations virtuelles (SV) ont accru leur présence en tant qu’outils de formation dans l’enseignement supérieur. Celles ont été consolidées à la suite de la COVID-19 comme outils puissants permettant de surmonter un bon nombre de limites rencontrées dans les salles de simulation présentielles, notamment son coût élevé et sa faible reproductibilité. Toutefois, peu d’études ont abordé l’utilisation du modèle TPACK pour l’analyse de la SV. MÉTHODE. Dans cet article, une revue systématique de la littérature est réalisée dans le but d’analyser les caractéristiques des SV mises en œuvre dans l’enseignement supérieur dans l’optique du modèle TPACK au cours de la décennie 2012-2022. RÉSULTATS. Parmi les résultats constatés, on s’aperçoit de l’utilisation généralisé des SV dans le domaine de la santé, en particulier sur le continent américain (États-Unis et Canada); les environnements de simulation 2D en ligne accessibles par ordinateur comme caractéristique technologique le plu habituelle dans les SV ; ainsi que l’appel aux théories de l’apprentissage expérientiel, de l’apprentissage situé et de l’apprentissage par problèmes comme leur justification pédagogique. DISCUSSION. On peut observer une série de relations entre les caractéristiques technologiques, les caractéristiques pédagogiques et celles de contenu des SV qui nous aident à mieux comprendre cet outil de plus en plus utilisé dans le domaine de la santé. En outre, il met en évidence, d’une part, la rareté des articles décrivant l’utilisation des SV conformément aux exigences du TPACK et, d’une autre part, l’adéquation et la faisabilité de ce modèle tant pour l’analyse que pour le développement des SV.

Mots-clés: Simulation, Virtualité, Enseignement supérieur, Formation, Revue systématique.

Authors profiles

Adrián Baeza González (corresponding author)

Adrián Baeza holds a degree in Pedagogy from the University of Salamanca (USAL) and a Master’s degree in Educational Technology: e-learning and knowledge management from the University Rovira i Virgili (URV). Currently, he is pursuing his PhD in Educational Technology at the University Rovira i Virgili (URV).

ORCID: https://orcid.org/0000-0002-8394-591X

Email: adrian.baeza@estudiants.urv.cat

Corresponding autor: Departamento de Pedagogía. Facultad de Ciencias de la Educación y Psicología. Carrer de Valls, s/n, 43007 Tarragona, España.

Mireia Usart Rodríguez

Mireia Usart holds a degree in Physics (Universitat de Barcelona), a MSc. In Education and ICT and a PhD in Education and ICT (Universitat Oberta de Catalunya). She is currently a Serra Húnter Lecturer on research and evaluation methods for education at the pedagogy department in Universitat Rovira i Virgili (URV) in Tarragona (Spain). She has been awarded in international conferences and has participated as a researcher in different European and Spanish R&D projects since 2011.

ORCID: http://orcid.org/0000-0003-4372-9312

Email: mireia.usart@urv.cat

Luis Marqués Molías

Luis Marqués obtained a degree in Physical Education from the University of Barcelona (UB) and completed a Pedagogical Aptitude Course in Education, followed by a Ph.D. in Physical Education from the University of Zaragoza (UNIZAR). Additionally, he holds an Official Master’s Degree in Educational Technology from Rovira i Virgili University. As a dedicated member of the ARGET (Applied Research Group in Education and Technology) research group, he has actively contributed to numerous national, Catalan, and European research and innovation projects.

ORCID: https://orcid.org/0000-0003-3370-8016

Email: luis.marques@urv.cat