stewart.pdf


Australasian Journal of
Educational Technology

2012, 28(Special issue, 3), 480-503

On the MUVE or in decline: Reflecting on the
sustainability of the Virtual Birth Centre developed in
Second Life
Sarah Stewart
Otago Polytechnic

Deborah Davis
University of Canberra

Pressures in terms of the availability of quality, real-life clinical experiences for
students have resulted in increased interest in the use of simulation in a variety of
healthcare disciplines. Te wahi whanau: The birth place is a Virtual Birth Centre (VBC)
that was created in Second Life in 2009 as part of the Second Life Education in New
Zealand (SLENZ) initiative. It was introduced to midwifery students at two New
Zealand polytechnics, with the aim of exposing the students to a birth centre
environment and providing them with an opportunity to practise midwifery through
immersion and engagement in a number of clinical scenarios. It has been just over two
years since the development of the VBC, yet it is no longer used in the midwifery
programs in which it was introduced. Using the VBC as a case study, we recount its
development and critically reflect on the factors impacting on its ongoing utilisation.
We believe our reflections offer useful insight into issues relating more broadly to the
sustainability of MUVE-based teaching and learning projects and initiatives.

Introduction

The teaching and learning landscape in tertiary education institutions is rapidly
changing. Learning is no longer confined to business hours, specific geographical
regions or the physical space of the classroom. In healthcare education, quality clinical
placements are becoming increasingly difficult to secure, and in midwifery in
particular, the predominance of obstetric environments (tertiary hospitals) and
intervention in childbirth means that it is difficult to provide midwifery students with
experience in normal birth in low-technology settings such as birth centres (Leap, 2002;
Leap, Barclay & Sheehan, 2003; Tracy, Barclay & Brodie, 2000). To meet the needs of
the 21st-century learner and the vagaries of the healthcare environment, institutions
are looking increasingly to e-learning technologies and other simulated clinical
experiences to replace or augment real-life clinical practice experiences. Three-
dimensional multi-user virtual environments (3D MUVEs or simply MUVEs, as they
are referred to in this article), while not a panacea for these problems, offer us some
exciting opportunities for education in midwifery and other healthcare disciplines.

In 2009, we (both midwifery educators) submitted a proposal to the Second Life
Education in New Zealand (SLENZ) group to be included as one of two pilot studies
in a project funded by the New Zealand Tertiary Education Commission. We were



Stewart and Davis 481

successful in our application, and Te wahi whanau, the Virtual Birth Centre (VBC), was
developed in Second Life, encompassing a range of teaching and learning strategies.
The environment and strategies were trialled in undergraduate midwifery programs at
two polytechnics located on the South Island of New Zealand. The development of the
project was resource intensive, absorbing large quantities of funding, time and energy
over a 12-month period. Two years later, the VBC gathers virtual cobwebs as it sits,
relatively unused, on its original site within Second Life.

This article describes the development of the VBC, the pedagogical strategies
employed and the learning outcomes developed for the project. Drawing on informal
discussions with professional peers who have an interest in MUVEs and healthcare
education, on the results of the project's formal evaluation, as well as on our own
reflections on the experiences of developing the VBC, this article offers commentary
and critical reflection on issues relating to the sustainability of MUVE-based teaching
and learning innovations such as the VBC. Innovation in teaching and learning is often
driven by educators who have limited e-learning and/or technical knowledge and
experience, but are motivated to explore creative solutions to the pedagogical
problems they encounter in their practice. This was the situation with the project
reported here, in which excitement over the novelty and possibilities of a new
technology obscured concern for longer-term issues like sustainability.

In this article, we explain, in retrospect, the importance of having a strategy in place
for moving a successful MUVE-based teaching and learning innovation beyond
experimental or pilot status to become an embedded component of the curriculum.
While the VBC was developed specifically for use in the discipline of midwifery, the
reflections offered here are likely to have broad applicability and be able to drawn
upon to inform aspects of educational MUVE projects across the disciplines as they
relate to innovation and sustainability. A case study such as this can sometimes be
more illuminating than an article dealing abstractly with theories of innovation or
sustainability.

Teaching and learning in virtual realities

Users of MUVEs - also known as virtual worlds - create digital representations of
themselves called avatars, which they use to interact in real time with one another in a
3D virtual environment. Emerging from multi-user online games, these virtual
landscapes of interacting individuals have been called the 'natural playgrounds' of
young adult learners (Hansen, 2008), offering engaging, effective, rich and immersive
learning experiences (Johnson, Vorderstrasse & Shaw, 2009). In terms of teaching and
learning, MUVEs lend themselves to strategies that focus on interaction (with others
and the environment) and role-play (Salt, Atkins & Blackall, 2008), and they are able to
be used in ways that position students as active participants rather than passive
observers (C. Johnson et al., 2009). Simulation and role-play are established teaching
and learning strategies in health education, wherein it is used to give students
opportunities to develop and gain confidence in exercising a variety of clinical skills
within a safe, low-risk or risk-free environment (Seropian, Brown, Gavilanes &
Driggers, 2004; Birch et al., 2007; Haigh, 2007; Lathrop, Winningham & VandeVusse,
2007; Dow, 2008). Once they have mastered basic navigation skills in the virtual
environment, individuals exploring these environments can gain a sense of presence or
'really being there' (C. Johnson et al., 2009). This sense of presence has been associated
with improved learning and performance (Witmer & Singer, 1998), as well as with



482 Australasian Journal of Educational Technology, 2012, 28(Special issue, 3)

increased knowledge transfer from the virtual world to the real world (Slater, Linakis,
Usoh & Kooper, 1996).

A range of healthcare education resources ('builds') and teaching and learning
strategies have been developed in MUVEs such as Second Life. Most of these focus on
general health promotion and education for lay residents, and some also contribute to
the education and training of health professionals, both pre-service and in-service
(Beard, Wilson, Morra & Keelan, 2009). The US Centres for Disease Control and
Prevention (CDC), for example, have a substantial presence in Second Life in the form
of CDC Island (Boulos, Hetherington & Wheeler, 2007). This site contains informative
displays and offers opportunities for users to interact with various virtual objects (e.g.
microscopes to learn about bacteria) as well as to network with one another by joining
discussions and focus groups. Another Second Life build that aims to raise awareness
about a specific health issue can be seen in the University of California, Davis Medical
Centre's Virtual Hallucinations simulation (Yellowlees & Cook, 2006). This build
simulates the auditory and visual hallucinations that many patients suffering from
schizophrenia experience, with the aim of promoting greater understanding and
empathy for those with the condition as well as to disseminate related health
information.

Strategies targeted towards the education of health professionals range from those that
involve the running of in-world symposia or seminars (Kessler & Rowell, 1998)
through to those that provide the opportunity engage in role-play with peers and/or
with virtual patients and objects (e.g. X-rays) with the aim of improving
communication, diagnosis and/or other generic and specialised clinical knowledge
and skills (Hansen, 2008). One such build that is particularly relevant to the nursing
and midwifery discipline is the postpartum haemorrhage clinical scenario developed
by academics from the Boise State University in the US and The University of
Auckland in New Zealand (Honey, Diener, Connor, Veltman & Bodily, 2009).

The body of available research literature on the use of MUVEs in the education of
health professionals is in its early stages. Most of the papers and articles published to
date in this area are descriptive (e.g. Skiba, 2007) or exploratory (e.g. Rogers, 2011),
with those that are evaluative often reporting on pilot studies (e.g. Wiecha, Heyden,
Sternthal & Merialdi, 2010) and/or studies with small sample sizes (e.g. Blyth, Loke &
Swan, 2010; McCallum, Ness & Price, 2010). There is a dearth of empirical evidence
comparing the outcomes of MUVE-based teaching and learning strategies with those
of traditional methods. In our searches, the only significant study focussing on the
education of health professionals we located that compared traditional teaching and
learning methods with teaching and learning using virtual-reality environments was
the one by Lok et al. (2006). That study, however, involved the projection of a life-sized
virtual patient on a wall rather than the use of a MUVE.

Sustainability of educational innovations in MUVEs
While a number of educational initiatives involving MUVEs are reported in the
literature, as mentioned above those reports are largely descriptive in nature, perhaps
reflecting the relative infancy of MUVE-based education as a field of scholarship. This
leaves a gap in the literature for research providing evidence of the effectiveness of
MUVE-based teaching and learning innovations (vis-à-vis traditional  methods) – and
more importantly for our purposes, the sustainability of such innovations. This is
somewhat surprising given the considerable resources (financial, expertise and time-



Stewart and Davis 483

related, etc) that have been and are being invested into these initiatives. Holt and
Segrave (2003, p. 227) claim that "The age of local thinking and action (by unit team,
course, school or faculty) has... given way to a more strategic institution-wide
approach". Although this could well be the case for e-learning in general, in particular
that involving older and more mature technologies like learning management systems
(LMSs), the assertion may not necessarily hold true for teaching and learning
innovations involving newer or more nascent technologies such as MUVEs. The
Summer 2010 snapshot of virtual world activity in UK universities and colleges
authored by Kirriemuir (2010a) suggests that while some MUVE projects are thriving
and becoming integrated within the curricula of the relevant programs, the use of
MUVEs is still largely a niche activity rather than representing mainstream practice at
institutions. We can look to the broader literature on e-learning to help inform us on
the issue to some extent; however, there are discrete and unique issues that impact on
the sustainability of teaching and learning initiatives as they apply to MUVEs
specifically.

Sustainability of any initiative is closely related to adoption. While it is beyond the
scope of this article to address adoption of innovations in detail, it is noteworthy that a
number of factors have been found to impact on adoption (and therefore
sustainability) of e-learning innovations. These include perceived value to the user,
accessibility, digital literacy and competence with the technology, motivation, and
effectiveness of the innovation (Eley, Fallon, Soar, Buikstra & Hegney, 2008; Kelly,
Coburn, Hegarty, Jeffrey & Penman, 2009; Stewart, 2006; Yu, Chen, Yang, Wang &
Yen, 2007). Drawing on a survey of higher educators across Australia and New
Zealand, Dalgarno, Lee, Carlson, Gregory and Tynan (2011b; see also Dalgarno et al.
2011a; Lee, Dalgarno, Gregory, Carlson & Tynan, 2011) discuss the technical and policy
hurdles that teaching staff must negotiate to overcome barriers to the utilisation of
MUVEs in universities. These include technological issues, support issues, funding
and time, usability and familiarity, equity and ethical issues, inherent limitations of
virtual worlds, acceptance of virtual worlds, and management and planning.

For some time now, educators have expressed concern about the need to improve the
sustainability of e-learning innovations, identifying a variety of obstacles and potential
solutions in this regard (Andrews, Smyth, Tynan, Vale & Caladine, 2008; Gunn, 2011;
Holt & Segrave, 2003; Wiles & Littlejohn, 2003). Andrews et al. (2008) point to the
inability of teaching staff to alter their pedagogical approaches to make the best use of
available technologies, and the lack of infrastructure within institutions to support the
integration of those technologies. Addressing the issue of media-rich technologies
more broadly in the Australian context, they suggest that these factors contribute to a
situation in which institutions have been largely unsuccessful in implementing the
technologies in sustainable and scalable ways. Wiles and Littlejohn (2003) suggest that
the major challenges standing in the way of sustainability of e-learning innovations
relate to cultural and social rather than technical issues. They echo the sentiment that
educators moving into e-learning need to rethink their pedagogical approach,
reversing their usual processes by prioritising learning design over content
development. They also emphasise the importance of sharing and reusing resources,
suggesting that this can be best facilitated through the cultivation of communities of
practice.

A comprehensive report by Attwell (2004) addresses the sustainability of e-learning
from a variety of perspectives, including learning platforms and software, institutional



484 Australasian Journal of Educational Technology, 2012, 28(Special issue, 3)

responses, materials, pedagogical approaches, and teacher skills. The report concludes
with a sustainability 'checklist' featuring items such as the sharing and reuse of
materials, a planned approach to developing and reviewing strategies, frameworks for
professional development, integration of services, embedding of e-learning within
curricula, and developing partnerships and networks. Yet another valuable resource is
the UK Joint Information Systems Committee (JISC) 'good practice guide' on
sustaining and embedding innovations (Chatterton, 2011). This guide aims to support
those involved in innovative projects to embed them into practice by providing useful
information and resources in a number of areas: changing people and culture,
influencing organisational change, embedding or aligning innovations, creating usable
tools and resources, and commercial and open approaches to innovation.

In a report for the Australian Flexible Learning Framework, Callan and Bowman
(2010a, p. 14) identify seven factors that influence the sustainability of e-learning
innovations, which they describe as follows:

• Strategy. Vision, values, strategy and planning that underpins e-learning as a core
feature of the current and future business.

• Senior leadership. Leadership at the executive team level that supports and
champions e-learning, and promotes the use of e-learning as a tool for cultural and
structural change.

• Resourcing. Resourcing that supports initial e-learning initiatives and subsequent
efforts to embed across the organisation; this could be internal or external funding
(e.g. [Australian Flexible Learning] Framework funds).

• Local e-champions. Experts in instructional design and the application of new
technologies who promote and support others to review and introduce new ways
of delivering training to clients.

• Technological supports. Hardware and software support together with reliable and
robust network facilities.

• People supports. Competent and supportive IT staff who share the vision and
strategic goals of promoting e-learning solutions across various parts of the
business, including training.

• Make the business case. A continued business focus that promotes the business case
upon how e-learning benefits the organisation around a wide range of areas,
including more flexible training, delivered more consistently, of higher quality, and
with reduced time and financial costs.

While a number of sustainability frameworks and guides exist, most have at their core
several key elements, and these are captured succinctly in Callan and Bowman's
framework. We have therefore used their framework later in this article to structure
our reflections on the VBC and its sustainability.

Concern for sustainability reflects a desire to maximise the gains achieved by
innovations beyond the life of the project. Gunn (2011) gives an overview and
synthesis of the literature addressing the challenges and proposed solutions for
sustainability of e-learning initiatives, and in doing so makes an astute observation
with regard to the extant literature (p. 509):

The challenges of turning funded projects from e-learning innovations into
sustainable products and services have featured in the higher education literature
for more than forty years. Various guidelines and strategies designed to facilitate
the process have been developed and tested, key challenges are identified and



Stewart and Davis 485

critical success factors proposed, yet the problem persists in more or less original
form, suggesting that most of the advice has been lacking in some respect.

Another problem that Gunn points to is a lack of published evidence supporting
strategies for sustainability. The literature is replete with 'good ideas' and 'works in
progress' (see, for example, Lucas, 2006; Wiles & Littlejohn, 2003) but seriously lacking
in hard evidence and systematic retrospective analysis. This is where our case study
seeks to make a contribution. It presents an in-depth reflective analysis - a 'post-
mortem', of sorts - of an e-learning innovation, focussing particularly on the issue of
sustainability. As Gunn argues, the sustainability of e-learning innovations continues
to be a problem despite published literature providing generic advice, strategies,
guides and checklists. While there is something to be gained from the literature, this
implies that sustainability may be significantly impacted upon by the situations and
circumstances surrounding individual projects. Case studies (and a review of case
studies, as Gunn proposes) offer an opportunity to examine the innovations within the
bounds of their unique contexts. In the next section, we provide an overview and
description of the VBC project before proceeding to critically reflect on the
sustainability aspects of the project.

Development of the Virtual Birth Centre

In Australasia, the difficulty of organising quality clinical placements for healthcare
students is escalating (Australia's Health Workforce Online, 2010). Clinical placement
shortages are reaching crisis point in some quarters, with at least one university in
New South Wales in 2011 anticipating being unable to provide its nursing students
with the clinical experiences necessary to complete their degree program (McGilvray,
2011). In midwifery, increasing 'medicalisation' of childbirth (rising rates of caesarean
section and other obstetric interventions) means that it is also proving challenging to
provide midwifery students with clinical placements in settings that help them learn
about their role in the promotion of physiological birth. Childbirth is increasingly
moving to tertiary hospital maternity units, with environments that traditionally
promoted physiological birth such as home and birth centres becoming harder to
access (for both childbearing women and midwives).

We have thus seen a gradual eroding of avenues for student midwives to learn and
practise the skills that form the foundations of practice in the profession. The
landscape of tertiary education is also changing as institutions embrace flexible modes
of course delivery for a variety of reasons. Learning is no longer confined to the
physical location of the classroom or to set 'office hours', as we are having to reach out
to students who may be accessing courses from a variety of locations and at times
more convenient to them. The midwifery programs at the two New Zealand
institutions in which this project was implemented were moving towards flexible
delivery modes in order to support students studying midwifery at a distance. This
largely meant migrating existing courses to an Internet-based LMS, with the use of
synchronous web conferencing for tutorial support.

This was the professional, clinical and educational context motivating the
development of the VBC. Based in Second Life, Te wahi whanau: The birth place
(http://www.slurl.com/secondlife/Kowhai/82/213/35) was designed to be a safe,
risk-free environment in which for student midwives to hone their clinical problem-
solving and decision-making skills through engagement with a variety of



486 Australasian Journal of Educational Technology, 2012, 28(Special issue, 3)

physiological birth scenarios, as well as for them to gain exposure to a birth centre
environment, an experience that would otherwise not be available to them in real life.
The VBC was also intended to provide a (virtual) venue where geographically
dispersed students could come together to work collaboratively and form a
community of learning with their peers.

Transparency and openness of the project and developed resources

In the spirit of open access, the VBC project was created under a Creative Commons
'Attribution-Share Alike 3.0 New Zealand' licence (Winter, 2010). This licence allows
for sharing, commercial use and modification on the proviso that the resulting work is
similarly licensed (see Creative Commons, n. d.). This means that the VBC can be
copied to any other Second Life location, or exported to another compatible virtual
world platform, to be used and/or modified for any purpose. In addition, the project
team shared, on a WikiEducator site (http://www.wikieducator.org/The_virtual_
birthing_unit_project), all supporting materials and resources created as part of the
project, such as lesson plans, Second Life orientation packages and scenario
information. Weekly postings about the project’s development were also published on
the SLENZ blog (http://slenz.wordpress.com/) in the interest of making the project
and all of its processes transparent to the wider community. It was hoped that this
approach would increase the impact of the project beyond the pilot phase by
contributing to an emerging community of practice in ways that would assist those
embarking on similar acivities, and by encouraging others to build on the work done
as part of the project.

VBC project phases

Phase 1: Birth environment
The VBC was developed in Second Life to support undergraduate midwifery education,
and was introduced to student midwives in two baccalaureate programs in New
Zealand. The development of the VBC began in 2008 and consisted of two phases. The
first phase involved building an 'ideal' birth environment within Second Life based on
design features known to support physiological birth in real life (Fahy, Foureur &
Hastie, 2008). A decision was made to construct a model of a traditional building as
opposed to creating a metaphorical or fantastical space. The VBC features two clinic-
style rooms for consultations, and on the second floor, a large meeting space. The
ground floor contains a living area and kitchen for the use of the childbearing woman
and her supporters, an office and utilities for staff, as well as two large birthing rooms
complete with a double bed, ensuite, birth pool, and props to support a woman in
active labour (e.g. things to lean on such as mantles, and exercise balls to sit on). Each
of the birthing rooms has access to a private outdoors area. Many of the objects in the
VBC are linked to evidence-based information located on the WikiEducator site.

The aim of this first phase of the project was to encourage midwifery students to think
about the effect of the environment on the physiology of normal labour and to provide
them with evidence-based information on practices that promote physiological birth
(e.g. water immersion) in an applied, authentic context. A number of learning activities
were developed to assist students in focussing on the birth environment and its
features. These included an assignment requiring them to produce a written piece
comparing and contrasting the birth environment of the VBC with other birth
environments they had encountered in real life (e.g. the tertiary maternity hospital),



Stewart and Davis 487

and a tutorial conducted within the VBC where the design of birth units was discussed
following a tour of the VBC. Specifications of these and other learning activities can be
found on the project’s WikiEducator site (http://www.wikieducator.org/The_virt
ual_birthing_unit_project#Learning_activities). These activities were voluntary and
formative, and they did not contribute to the students' grades. They were, however,
designed to complement the subjects undertaken by the students in the first year of
their program, and to contribute to the existing objectives for the first-year clinical
practice subject, in particular:

1. Demonstrate an understanding of childbirth as a normal life event which occurs
within diverse social and cultural contexts;

2. Discuss the impact of the underpinning philosophies of midwifery on the childbirth
experiences of women and the development of midwifery knowledge.

Phase 2: Clinical role-playing scenarios
The second phase involved the development of clinical scenarios based on the format
of two students working together as 'midwife' and 'mother' in role-plays centred
around physiological birth. A total of five scenarios or 'scenes' were developed, each
depicting different stages and aspects of labour and childbirth: the beginning of
labour, early labour, established labour, birth, and the first hour following birth. The
scenarios take place in the upstairs area of the VBC. In carrying out the role-plays, each
character must access information and resources relevant to him/her such as a
pregnancy suit and a script for the 'mother'. This script provides the student playing
the mother with an outline of the information she should impart and the behaviours
she should enact during the scenario. The student playing the midwife can download
the antenatal record for the childbearing woman, providing him/her with information
on the woman's medical and obstetric history and her current pregnancy. Each
character is supplied with a heads-up display (HUD) and scripted animations for use
in the scenario allowing for actions such 'change position' for the labouring woman
and 'provide comfort' or 'check fetal heart sounds' for the midwife.

The student who plays the part of the midwife is required to assess, plan and act on
the information provided and the behaviour exhibited by the 'mother'. At the end of
each scenario, the 'midwife' receives feedback from the 'mother', and is able to self-
assess his/her own performance against predefined criteria developed by the
midwifery educators. The 'mother' is asked to focus on the following in her feedback to
the 'midwife':

• How easy was the midwife to talk to?
• Was the midwife sensitive to your needs?
• How satisfied were you with the information the midwife gave you?
• How satisfied were you with the way the midwife listened and responded to your

questions and concerns?
• Were your decisions respected by the midwife?
• How satisfied with you with the action plan that the midwife developed with you?

The student playing the midwife is also required to document his/her actions and
submit them to lecturers for feedback. The scenarios are based on the core
competencies and standards of the profession as defined by the Midwifery Council of
New Zealand (2010), and on real-life clinical situations. The feedback mechanisms
used by the lecturers were based on the professional processes developed by the New
Zealand College of Midwives (n. d.).



488 Australasian Journal of Educational Technology, 2012, 28(Special issue, 3)

The scenario-based learning activities developed in the second phase are aimed at
student midwives in the second and third years of their program and were voluntary,
supplementing rather than replacing existing teaching and learning strategies and real-
life clinical experiences. Again, they were designed to contribute to existing learning
objectives:

1. Demonstrate an understanding of the role of the midwife in the normal childbirth
process;

2. Demonstrate effective, evidence-based midwifery practice guided by a sound
knowledge base;

3. Demonstrate an understanding of the significance of concepts of accountability,
responsibility and independent practice as they relate to midwifery practice in New
Zealand.

All resources used within the clinical scenarios continue to be available on the
aforementioned WikiEducator site.

Evaluation and ongoing utilisation

A formal evaluation of the two implementations carried out as part of SLENZ was
undertaken by an independent group (Winter, 2010). Using a case-study approach, the
evaluation sought to answer the following questions (p. 4):

• How and to what extent do MUVEs such as Second Life offer enhanced learning for
New Zealand tertiary students?

• What could have been done better during the design, development and delivery of
the two pilot learning activities in Second Life?

• What worked well during the design, development and delivery of the two pilot
learning activities in Second Life?

• What good practice can be identified that may help others design, develop and
deliver learning experiences in MUVEs?

Data were gathered from students, project team members and educators through face
to face interviews and focus groups, and also during an in-world meeting. The
evaluation demonstrated that student midwives particularly valued the opportunity to
role-play in the VBC without the stress of having to perform in real-life situations in
front of actual patients and practising midwives and/or in the presence of lecturers
and peers. A rather surprising result was that it was the junior students who valued
the VBC the most. They saw it as an authentic and immersive orientation to their real-
life clinical placements, allowing them to become familiar with the clinical
environment and practise their skills, making mistakes along the way as they did so
yet continuing to feel safe. Both the midwifery lecturers and students experienced
difficulties with the technology, however - computer capabilities, Internet bandwidth
limitations and institutional firewalls prevented them from fully engaging despite
much effort having been put in early on in the project to address many of these issues.
Many of them found navigation in Second Life difficult to master, requiring a longer
orientation period than had been allowed for. The main recommendations arising from
the evaluation were as follows (Winter, 2010, p. 6):

• Establish a larger development team, and adopt a 'sprint'-based development
process;



Stewart and Davis 489

• Ensure that developers and educators spend time together to familiarise themselves
with the requirements of each other's disciplines;

• Establish close collaboration with institutions' IT departments to ensure that
learners can have fully functional access to builds within institutions;

• Establish champions of the project at a senior level in each participating institution;
• Communicate with students regarding ICT requirements and expected broadband

usage to run the builds at home, and expectations in terms of participation and
learning outcomes;

• Provide a thorough, compulsory orientation to the virtual world;
• Ensure that each stage of each build incorporates highly interactive and engaging

activities for learners.

Despite a largely favourable reception, two years later, the VBC lies relatively empty
and dormant. It is no longer used by the institutions at which it was pilot tested, and to
our knowledge, there has been no ongoing interest from other educational institutions
in New Zealand or elsewhere wishing to adopt the environment and integrate it into
their programs. This is in spite of efforts to introduce and promote the project to
midwifery education audiences through a variety of forums (Stewart & Davis, 2009)
and the VBC build being copied numerous times. Using the VBC as a case study, we
now turn our attention to the issue of sustainability of educational innovations in a
MUVE.

Reflecting on sustainability of the VBC

Callan and Bowman’s (2010b) sustainability framework provides a useful way for us to
structure our critical reflections on the VBC in terms of its sustainability. In the
commentary that follows, we draw on our own experiences as well as anecdotal
feedback from peers within our professional networks known to have an interest in the
VBC specifically or the use of MUVEs in midwifery education more broadly. We
acknowledge that the perspective of other relevant stakeholders (senior managers, IT
support staff, etc) is missing from this analysis, but nonetheless consider that our
perspective as frontline educators makes an important, and hopefully worthwhile,
contribution to the field.

Strategy

The VBC project was funded by the Tertiary Education Commission in New Zealand
and involved a team of researchers and educational developers from several tertiary
education institutions. While the environment, activities and resources were piloted in
midwifery programs at two New Zealand polytechnics and therefore obviously
required the cooperation of staff - including management staff, IT support staff and
midwifery teaching staff - at those sites, the project leadership originated from outside
of those institutions. This meant that while the particular organisations involved may
have had a vision and strategy for the development of e-learning innovations at the
institutional level (indeed they did), the VBC project was not integrated as part of this
strategy; it sat somewhat awkwardly to the side as a discrete, albeit potentially
interesting, innovation.

The lack of integration of this project in the overall e-learning strategy of the
participating institutions may also reflect the novelty of (and suspicion towards)
virtual reality technologies in the educational setting. The focus of the institutional



490 Australasian Journal of Educational Technology, 2012, 28(Special issue, 3)

strategy, at least from our perspective as educators within one of those institutions,
was on more mainstream e-learning technologies, including the use of web-based
LMSs to serve as a replacement for face to face teaching. A number of authors (Attwell,
2004; Gunn, 2011) have stressed the importance of devising a high-level strategy for
the implementation, integration and review of e-learning initiatives at institutions.
While e-learning represents an array of teaching and learning strategies and
technologies, innovations developed for MUVEs are often (though not always)
considered niche, and thus tend not to be included as part of this broader e-learning
strategy (Kirriemuir, 2010a).

Senior leadership

Leadership at the executive level has been identified as one of the central factors
impacting on the sustainability of e-learning innovations. This leadership may take a
variety of forms, depending on the nature of the organisation (Callan & Bowman,
2010b). While the VBC project was led by a capable and visionary project team, as
mentioned before this team was largely comprised of 'outsiders' external to the
implementation sites. Senior leaders at the sites were supportive, and this support was
necessary to ensure that the necessary adjustments could be made to the IT software,
hardware and infrastructure to accommodate the use of Second Life. It was also needed
to ensure that the relevant teaching staff and students could be introduced to and
encouraged to use the VBC, and that these individuals would be allowed to participate
in the project evaluation. However, while the project had the cooperation of the senior
leaders, it was not embraced or promoted by them, nor was it supported by them
beyond the bare minimum required to facilitate project completion. The midwifery
teaching staff who participated in the project did so on a voluntary basis, and this
work was in addition to their usual responsibilities. Managerial support for e-learning
innovations has been identified as critical to their success and sustainability (Gunn,
2011). In a case study of pedagogical innovation and the use of educational
technologies by academic staff at an Australian university, Tynan and Lee (2009)
highlight the importance of both a top-down and bottom-up approach to innovation.
Leaders should provide a vision, incentives, policies, infrastructure and funding, while
staff at all levels of the organisation need to commit to embracing change. Leadership,
however, needs to be flexible and open enough to allow innovation without stiffling it
in bureacraatic processes.

Resourcing

Developing teaching and learning strategies within MUVEs is resource intensive
(Dalgarno et al., 2011b; Kirriemuir, 2010a, 2010b; Lee et al., 2011). Many institutions
may be unwilling to invest in e-learning modalities that are considered more marginal
than mainstream, or that they may see as being cutting-edge or experimental, and in
these situations outside funding sources are important. In Callan and Bowman's
(2010b) review of institutions that received funding from the Australian Flexible
Learning Framework, they found that external funding permitted more risk taking and
opportunities to trial cutting-edge technologies than internal funds would allow. The
VBC was funded by the Tertiary Education Commission of New Zealand, and without
doubt, would not have been possible without this funding. The funding covered the
costs of overall project management, as well as of bringing into the project expertise in
midwifery curriculum design, MUVE development and learning design. Considerable
time and expertise was donated in a voluntary capacity by numerous individuals. The



Stewart and Davis 491

collaborative (and national) nature of the project brought together knowledge, skills
and experience from a variety of areas that may not be available in any one single
organisation. The project was funded to explore the way MUVEs could be used in
education in New Zealand, and did not explicitly aim to develop opportunities that
were sustainable in a given institution.

Once developed, the complex teaching and learning strategies in the MUVE require
maintenance and updating, and without ongoing funding or commitment, may
quickly become obsolete or inoperative. The ability of innovations to become
sustainable after project funding has been depleted is a common, recurring concern
(Gunn, 2011; Tynan & Lee, 2009). Along with unrealistic timeframes or expectations of
funders, this contributes to a situation whereby, according to Gunn (2011, p. 509),
"many projects with strong educational potential fail to find the means to continue
beyond the funding phase, and a low return on investiment is achieved". In our
project, there was no ongoing funding provided to maintain or further develop the
VBC on its original Second Life site, though the open-access arrangements and Creative
Commons licensing used provided a means for others to obtain a copy of the VBC for
reuse and/or further development on their own sites.

Unfortunately, we have not formally tracked the number of copies that have been
made of the VBC to date, though we are advised by our developer that it is in the
vicinity of 30. We have no way of knowing for what purposes the copies were made,
and some may have perfomed the copying in order to obtain particular artefacts rather
than to use the VBC environment in its entirety for the purposes it was originally
intended. We are aware of one educator in the USA who copied the VBC some time
ago, and has since developed and repurposed it into an aged care facility for training
nurses. Another aspect of the open-access philosophy of the project involved storing
all of our planning, curriculum, teaching and learning documents on WikiEducator. A
midwife educator in the UK who has built another birth facility in Second Life reports
that she used our planning framework to guide the development of her build (Bailey,
2012). Two midwifery educators in the UK and USA have expressed intentions to
integrate the VBC into their teaching, but at the time of writing of this article have yet
to actually do so. They have told us that this is because they have not had the time to
develop their skills to a point where they are confident enough to support students in
Second Life. They also do not have access to adequate time and funding to customise
the VBC to fit their own context. Open source, open access and the development of
shared learning repositories is a key feature of the works addressing sustainability of
e-learning innovations (Attwell, 2004; Chatterton, 2011; Holt & Segrave, 2003). Attwell
(2004) points out that a shared approach to resources, especially across a variety of
institutions and disciplines, calls for a major change in academic culture. Open access
has the potential to aid others in resourcing their projects and to contribute to
sustainability, but resources are not the only barrier to developing and sustaining
innovations in the MUVE.

Local e-champions

Local champions play a pivotal role in raising awareness of e-learning technologies
and offering local support for others wishing to integrate those technologies into their
own instructional design and teaching practice. The VBC was supported by a number
of midwifery e-champions whose enthusiasm for the potential of the project was
greater than their technological expertise. Supported by SLENZ, they did gain a level



492 Australasian Journal of Educational Technology, 2012, 28(Special issue, 3)

of expertise in the MUVE and in learning design for this environment. They were then
able to provide support, training and assistance to their peers and to the student
midwives involved in the project. At the local level, the project was largely driven by
these champions, of whom there were three at one of the sites and one at the other.
Sadly, by the end of the funded project two of the local champions at one site had left
that institution. While both institutions were embarking on the development of a new,
joint curriculum heavily reliant on e-learning technologies, the VBC was not integrated
into the new curriculum. Besides the loss of the two local champions, a number of
factors contributed to this, including the workload involved in developing a new
curriculum with a limited budget and within a very tight timeframe, which left staff
with little energy or opportunity to consider cutting-edge innovations. While increased
efficiencies have been central to the argument for adopting e-learning technologies,
Tynan and Lee (2009) note that these efficiencies have not necessarily been realised, as
this work is inherently labour intensive. They comment, "Institutions often fail to
recognise that there is a hidden cost in terms of additional, often unpaid, teaching
hours in the development and maintenance of online materials" (p. 100).

These sorts of innovations are often driven heavily by the energies and commitments
of individuals who are, in effect, the leaders and local champions for the innovation.
Often, the work involved in developing teaching and learning projects in MUVEs is
taken on by those involved on top of their regular, day-to-day responsibilities, and is
sustained by their enthusiasm for the project (Dalgarno et al., 2011b; Kirriemuir, 2010b;
Lee et al., 2011). The risk to an institution with this approach is that the project or
strategy is not sustainable beyond the commitment of the individuals, and the
expertise they have developed may not have been shared with colleagues within the
institution by the time they are ready to move on. E-champions are often early
adopters, and their role in innovation is well recognised in the literature (Tynan & Lee,
2009). However, many share concern for the sustainability of these innovations once
their enthusiasm for a project has waned or they have gone on to other projects and
roles (Gunn, 2011; Holtham, 2005; Tynan & Lee, 2009). When an innovation relies
heavily on local champions and is not otherwise integrated or supported at the
institutional level, the innovation (and the relevant expertise) is lost to the institution
upon the departure of the champions. This was a significant factor in the case of the
VBC.

Technological supports

An integral component of the implementation and use of any e-learning technology is
the technical support and network facilities available not only to end users, but also
developers. Moreover, the development and implementation of MUVE-based teaching
and learning resources and strategies calls for a collaborative approach between IT
support and teaching staff - two groups who may not know a lot about each other's
worlds and who may not be accustomed to working closely with each other. MUVEs
demand certain hardware and operating system specifications and settings, require IT
support so that they can be used effectively from networked computers, and consume
significant amounts of network bandwidth. In our project, it took some time and a fair
amount of negotiation for the VBC to function as desired on campus computers. At
institutions that do not understand the benefits of MUVEs or view them with
suspicion, it can be extremely difficult for educators to gain access for staff and
students. This is particularly the case for staff employed in hospitals, where access to
Internet sites and services are heavily restricted. One midwife colleague in the UK



Stewart and Davis 493

reported that she would like to use the VBC to expose midwives working in her
tertiary hospital to a virtual birth environment, but that computing policies in force at
the hospital made this impossible. Kirriemuir (2010b; see also Kirriemuir, 2010a) claims
access issues seem to have been largely resolved for most users at UK universities and
colleges; while that may be the case for those institutions - whose core business it is to
deliver education courses - it is not necessarily so for other organisations involved in
the delivery of practice-based or clinical education, such as health services and
hospitals. There may be scope for the VBC to be used with qualified midwives and
developed further to meet the ongoing professional development needs of this group,
but difficulties gaining access for employed staff from hospital computers make this
sort of development largely prohibitive.

People supports

Supporting educators to develop and embed e-learning technologies is important, and
can be achieved in a variety of ways. Callan and Bowman (2010b) identify four
different models for this in the institutions they reviewed: a central support model, a
central unit linked to a network of e-champions, a partnering model with external
expertise linked to e-champions, and a decentralised model. In the centralised model, a
dedicated department with expertise in education, curriculum design and technical
skills provides support to educators. The second model involves a smaller central unit
that trains and supports e-champions in different areas of the institution, while the
third involves the use of an external body to supply expertise and support to the e-
champions. Finally, the decentralised model involves individual units (e.g.
departments, schools or faculties) providing their own support. Callan and Bowman
(2010b) warn that this fourth model may enable motivated educators to develop their
own e-learning innovations, but may not make the required support available to those
who are less motivated or confident. While a number of broad approaches to
supporting e-learning have been suggested in the literature (Attwell, 2004; Lucas,
2006), Gunn (2011) reminds us that there is very little in the way of empirical studies
that provide us with concrete evidence as to the most effective support mechanisms.
There may not be one best approach, as support needs differ between contexts and
projects.

The VBC project was not part of an integrated approach to e-learning in the
institutions where it was piloted. A team consisting of members with particular
expertise was formed specifically for the purposes of the project, and through this
team e-champions (the midwifery educators) were supported to interface directly with
students and other teaching staff. These e-champions were also responsible for
designing the teaching and learning strategies for use in the MUVE. This aligns
somewhat with Callan and Bowman's third model (partnering model with external
expertise linked to e-champions). One of the challenges with this model as we
experienced it was in the communication between the e-champions who possessed
considerable course content and professional knowledge (of midwifery in this case)
but limited technical knowledge, and those who had the opposite - in other words,
strong technical knowledge but limited content or curriculum design knowledge. For
the discipline of midwifery and the MUVE learning environment it is unusual to find
content, curriculum and technical knowledge in the one individual. This means that
developers, designers and educators must be able to work together successfully to
achieve a favourable outcome; good communication and strong leadership are crucial
to this. Our project may well have severely faltered if it were not for the strong



494 Australasian Journal of Educational Technology, 2012, 28(Special issue, 3)

leadership, as we seemed to be communicating across a cavernous gap in
understanding at times!

Making the business case

The business case for adopting and implementing new technologies at most
institutions takes into account cost savings, efficiencies, improved productivity and/or
added value to service users. Callan and Bowman (2010b) identify the business case as
being essential in sustaining the focus on e-learning at any institution or organisation.
Certainly, because of the resource intensitivity of the development of e-learning
initiatives, especially those in MUVEs, support for investment in these initiatives
would be difficult, if not impossible, to garner without a strong business case. Gunn
(2011) identifies a sustainable business case as one of the key attributes of e-learning
projects that have made a successful transition from innovation to sustainable practice.
In the case of the VBC, our business case focussed on several key factors, including the
opportunity to augment (rather than replace) real-life clinical practice experience, the
opportunity to expose students to a birth environment that was not available to them
locally in real life, and the opportunity for midwifery students to practise midwifery
care in normal birth within a safe and risk-free environment. These have to do with
adding value to an educational experience. Addressing the business case issue, Wiecha
et al. (2010) highlight the importance of being able to identify the rationale for the use
of a MUVE (in their case, Second Life) by answering the question, "'Why SL [Second
Life]?' before it gets asked. In other words, it is critical to take advantage of the unique
opportunities afforded by the virtual world to push the experience beyond what could
be delivered via a website or a webinar" ('Overall lessons learned', para. 2).

A major barrier to making a strong business case for the inclusion of teaching and
learning strategies in MUVEs is the dearth of solid empirical evidence demonstrating
the effectiveness of this environment for learning when compared with traditional
methods. In the absence of such evidence, it is very difficult to secure funding to
develop or build on the work undertaken in the VBC.

Discussion

The VBC was developed as part of a funded project aimed at exploring the possibilities
of Second Life for teaching and learning in educational institutions in New Zealand. The
remit of the project was therefore broad, and the resulting resources novel and highly
experimental. The project did not aim to produce high-level, generalisable empirical
results attesting to the effectiveness of the environment for learning, nor did it seek to
address issues pertaining to long-term sustainability of the resources within the
institutions where they were piloted. It is, after all, unrealistic to expect a single project
to address the multiplicity of issues that deserve attention in the MUVEs-for-education
arena. Given its limited scope and aims, the VBC project was highly successful in
giving rise to a wealth of learning and resources. In this article, we have
retrospectively turned our attention to the sustainability of the project, which could be
seen as being somewhat unfair; however, the goal of our critique is by no means to
detract from or play down the project's success, but rather to attempt to further extend
the learning and knowledge gained from the project. In the subsections that follow, we
focus on the implications of our critical reflections for practice, policy and future
research. Readers are invited to consider how the issues might apply to their own
disciplinary contexts.



Stewart and Davis 495

Building an empirical evidence base

In healthcare education, a number of factors motivate us to consider MUVEs for
teaching and learning purposes. As alluded to earlier, a lack of appropriate real-life
clinical placements is one important driver, and the increasing move towards the
provision of distance education via flexible delivery modes is another (Lok et al., 2006).
The higher education market is becoming ever more competitive, with institutions
reaching further afield geographically to attract students in an attempt to maintain the
viability of their programs (Marginson, 2006). MUVEs provide a way to bring students
and teachers together to engage in real-time, collaborative activities regardless of their
physical location (Bower, Kennedy, Dalgarno & Lee, 2011). They may also be used to
facilitate learning that is at least as effective as, or in some respects even superior to,
traditional forms of teaching and learning, though there is a lack of empirical evidence
in this regard. This lack of evidence is one of the most critical factors impacting on the
uptake and sustainability of MUVE-based teaching and learning initiatives.

Developing strategies for teaching and learning in a MUVE requires substantial effort
on the part of both educators and students, who must acquire new skill sets specific to
this environment. This does not simply involve mastering the particular tools or
technology; it often also calls for drastically altering the pedagogical approach to a
given subject area (Wiles & Littlejohn, 2003). Staff, in particular, may be reluctant to
put in the time and effort to develop these skills and invest in these strategies without
seeing compelling evidence of their effectiveness. Without robust evidence it is also
difficult to make a business case or argue that such strategies should be embedded into
a program. It is unlikely that the drivers for the use of MUVEs in education outlined
above will subside in the foreseeable future, and it is important that we do not miss
important opportunities for enhancing the learning experiences of our students -
hence, investment in the necessary research is critical to generate the needed empirical
support and to come up with evidence-based guidelines for MUVE-based teaching and
learning.

This is complex and easier said than done, since teaching and learning strategies
developed in this environment are as diverse and  heterogeneous as they are in real-
life environments. Salmon (2005) and others (e.g. Wiles & Littlejohn 2003; Andrews et
al., 2008) are critical of e-learning in the form it exists in many higher education
institutions, suggesting that rather than reflecting true innovation, they tend to simply
entail application of existing pedagogy to new media. Salmon argues that e-learning
should instead be viewed in terms of the prospects it offers for radically rethinking
education. MUVEs provide an opportunity for such pedagogical innovation, and
research may need to extend beyond simplistic comparisons between MUVE-based
and traditional methods of teaching and learning (Oliver, 2010). More and better
consideration needs to be given to the new possibilities MUVEs open up that were not
previously available through other means, including pre-existing technologies
(Dalgarno & Lee, 2010).

Sharing of resources

While SLENZ did not explicitly set out to develop projects that were sustainable into
the long term within the institutions at which the pilot implementations took place, the
project team's decision to make all resources developed freely and openly available to
the wider community did have a favourable - even if unintended - impact on the



496 Australasian Journal of Educational Technology, 2012, 28(Special issue, 3)

sustainability of the VBC. Thus far we have identified a number of factors that have
adversely affected the sustainability of the project at the institutional level; by contrast,
the adoption of Creative Commons licensing and the commitment to an open
educational resource (OER) philosophy were very positive in terms of helping to
sustain the project beyond the borders of the institutions that were initially involved.
The Creative Commons licensing has meant that the VBC has been able to be copied
and used by other interested groups from a variety of countries and disciplines. One of
the midwifery educators who was involved in the project subsequently moved to a
new position and institution, and the licensing arrangements that were put in place
have granted her the ability to copy the VBC to a new site and continue to develop the
resources for use in another midwifery program.

OERs were identified in the 2009 Australia-New Zealand Horizon Report (Johnson,
Levine, Smith, Smythe & Stone, 2009) as being likely to have a significant impact on
higher education within two to three years after the time of writing of the report.
Rising costs associated with developing teaching and learning resources, together with
pressures on educators' time, make OER an attractive option for promoting
sustainability (Organisation for Economic Co-operation and Development [OECD],
2007). The development of teaching and learning strategies in MUVEs can be
expensive and time consuming, and significant efficiencies can be achieved through
the sharing of resources. However, analysis has shown that while educators are
motivated to create their own OERs, they are less likely to reuse OERs that have been
developed by others. When Duncan (2009) examined the Connexions OER repository
(http://www.cnx.org/) at Rice University in the USA, for example, he found that only
about 25% of the material in the repository was being reused. This reluctance to reuse
others' resources is often attributed to the fact that it is too expensive and time
consuming to appropriate or adapt materials developed for a different context, as well
as to concerns about the quality of the materials (De Liddo, 2010). The sharing and
reuse of resources is a feature of much of the work addressing sustainability of e-
learning, particularly in the UK (Attwell, 2004; Chatterton, 2011), and large-scale
initiatives such as national learning object repositories have been developed (Attwell,
2004).

The resource-intensive nature of developing and maintaining educational resources in
MUVEs lends itself to inter-institutional cooperation and resource sharing. Salmon
(2005) recognises collaborations and consortia as useful ways to explore innovations
that are relatively low-risk for the institutions concerned. The development of
resources such as the VBC may be beyond the capacity of a single institution, and
better shared by several. This may be especially true for institutions that do not have
an existing MUVE presence. In an ideal world, we would like to see the VBC
supported by a number of institutions that share in the use of the resource and the
costs associated with continuing maintenance and development. Cooperation and
collaboration within and between institutions is seen as vital to sustainability,
especially in the OER and open-source movements (OECD, 2007). This having been
said, competition for market share, research or innovation kudos and academic
rivalries often stand in the way of institutions working together (Littlejohn, 2003).
While inter-institutional collaboration is not without its challenges, in small programs
such as midwifery that tend to be more boutique than large scale, there is much to
recommend such an approach (see Tynan, Dunne & Smyth, 2007).



Stewart and Davis 497

Focussing on sustainability

The development of MUVE-based teaching and learning resources and strategies tends
to be even more demanding than other forms of e-learning development in terms of
the time, money and expertise required. Educational institutions must find ways to be
efficient in order make the most of limited and often scant resources. Sustainability
should therefore be treated as a central issue to which attention is paid from the outset
- that is, in the planning stages - of any project. This was perhaps the greatest weakness
of the VBC project.

While innovations such as the VBC are often dependent on external funding for their
development, sources and factors from within the institution will be responsible for
their sustenance. These include organisational leadership, the provision of ongoing
practical support, motivation and commitment of staff, and integration of the
innovation within existing processes or strategies. While individual champions may be
critical to an innovation's success, we can and should anticipate that such individuals
will move on from their current positions, and we need to consider how the initiative
can be sustained beyond the stewardship of those individuals.

Frameworks like Callan and Bowman's (2010a) may be useful to developers in the
planning phases of a project in the way of assisting and prompting them to consider
relevant issues impacting on sustainability. In order to maximise gains from scant
resources, it may be wise for funding bodies to focus more intently on issues of
sustainability, incorporating these into the criteria that they use to assess applications
they receive for funding.

Conclusion

The Virtual Birth Centre (VBC) is an innovative teaching and learning resource or
'build' developed in the 3D multi-user environment of Second Life. Despite the devotion
of considerable funds, time and expertise and the sharing of all resources by a project
team that embraced an open-education philosophy, the VBC sits unused for the most
part on its original site in Second Life. In this article, we have reflected on the factors
impacting on the sustainability of the VBC using a framework developed by Callan
and Bowman (2010b). While the VBC project enjoyed strong leadership from the
project team, it was not incorporated as part of the overall e-learning strategy of the
institutions in which it was pilot tested. Local e-champions were critical to the project,
but heavy reliance on these individuals without the embedding of the resource within
the relevant program meant that momentum and interest in the project died down
when the e-champions left the particular school/department or institution.

For projects such as these, seed or innovation funding is important, yet in the absence
of continued commitment from the institutions involved they are unlikely to be amply
maintained or developed on an ongoing basis. Projects like the VBC often bring
together unlikely partners (midwives and IT specialists, for example), and successful
collaboration between those partners necessitates a degree of generosity along with
open and effective lines of communication, because each party needs to understand
elements of the other's expertise. The paucity of empirical evidence supporting claims
about the effectiveness of MUVEs for teaching and learning is a persistent barrier to
the sustainability of innovations in this area, since educators are limited in their ability
to build a strong business case without such evidence. While the open sharing of



498 Australasian Journal of Educational Technology, 2012, 28(Special issue, 3)

resources associated with this project have contributed in a small way to the MUVE
endeavours of other educators, this seems like a small return for the relatively sizeable
investment that was expended on the development of the VBC.

There are a number of key issues for practice, policy and future research arising from
our critical reflection on the sustainability of the VBC. First is the need for empirical
studies to inform our understanding of teaching and learning strategies in MUVEs.
Secondly, the importance and benefits of resource sharing and inter-institutional
collaboration on MUVE-based teaching and learning initiatives (at both a national and
international level) should not be overlooked. Thirdly and lastly, our experiences with
the VBC have underscored the fact that a strategy for ensuring sustainability should be
established in the planning stages of any MUVE-based education initiative; it cannot
and must not be dealt with as an afterthought, or worse still, left to chance.

Acknowledgments

The authors would like to thank the SLENZ team, as well as the staff and students of
Otago Polytechnic and Christchurch Polytechnic Institute of Technology who
participated in the project. Funding for the project was provided by the New Zealand
Tertiary Education Commission.

References
Andrews, T., Smyth, R., Tynan, B., Vale, D. & Caladine, R. (2008). Rich media technologies and

uncertain futures: Developing sustainable, scalable models. In Hello! Where are you in the
landscape of educational technology? Proceedings ascilite Melbourne 2008 (pp. 36-40). Melbourne:
Deakin University. http://www.ascilite.org.au/conferences/melbourne08/procs/andrews.pdf

Attwell, G. (2004). E-learning and sustainability. Report for the European Commission Lefo
Learning Folders project. Pontypridd, UK: Pontydysgu. http://www.guidance-
research.org/knownet/writing/papers/sustainabilitypaper/attach/sustainibility4.doc.pdf
[viewed 29 Feb 2012]

Australia's Health Workforce Online (2010). National Health Workforce Taskforce.
http://www.ahwo.gov.au/nhwt.asp [viewed 16 Oct 2011]

Bailey, J. (2012). The age of virtual learning. Midwives, 2012(1), 34-35.
http://www.rcm.org.uk/midwives/features/the-age-of-virtual-learning/

Beard, L., Wilson, K., Morra, D. & Keelan, J. (2009). A survey of health-related activities on
Second Life. Journal of Medical Internet Research, 11(2). http://dx.doi.org/10.2196/jmir.1192

Birch, L., Jones, N., Doyle, P. M., Green, P., McLaughlin, A., Champney, C., ... Taylor, K. (2007).
Obstetric skills drills: Evaluation of teaching methods. Nurse Education Today, 27(8), 915-922.
http://dx.doi.org/10.1016/j.nedt.2007.01.006

Blyth, P., Loke, S. K. & Swan, J. (2010). Otago Virtual Hospital: Medical students learning to
notice clinically salient features. In Curriculum, technology & transformation for an unknown
future. Proceedings ascilite Sydney 2010 (pp. 108-112).
http://www.ascilite.org.au/conferences/sydney10/procs/Blyth-concise.pdf

Boulos, M. N. K., Hetherington, L. & Wheeler, S. (2007). Second Life: An overview of the potential
of 3-D virtual worlds in medical and health education. Health Information and Libraries Journal,
24(4), 233-245. http://dx.doi.org/10.1111/j.1471-1842.2007.00733.x



Stewart and Davis 499

Bower, M., Kennedy, G. E., Dalgarno, B. & Lee, M. J. W. (2011). Uniting on-campus and
distributed learners through media-rich synchronous tools: A national project. In Changing
demands, changing directions. Proceedings ascilite Hobart 2011 (pp. 150-155). Hobart: University
of Tasmania.
http://www.ascilite.org.au/conferences/hobart11/downloads/papers/Bower-concise.pdf

Callan, V. & Bowman, K. (2010a). Sustaining e-learning innovations: Literature review. Brisbane:
Australian Flexible Learning Framework. [viewed 16 Oct 2011]
http://www.flexiblelearning.net.au/files/Sust%20Innov_1_Lit%20rev_FINAL_1011.pdf

Callan, V. & Bowman, K. (2010b). Sustaining e-learning innovations: A review of the evidence and
future directions. Brisbane: Australian Flexible Learning Framework. [viewed 16 Oct 2011]
http://www.flexiblelearning.net.au/files/Sust%20Innov_Final%20report_FINAL_1011.pdf

Chatterton, P. (2011). Sustaining and embedding innovations: Good practice guide.
https://sustainembed.pbworks.com/ [viewed 5 Mar 2012]

Creative Commons (n. d.). Attribution-ShareAlike 3.0 New Zealand (CC BY-SA 3.0).
http://www.creativecommons.org/licenses/by-sa/3.0/nz/ [viewed 5 Mar 2012]

Dalgarno, B. & Lee, M. J. W. (2010). What are the learning affordances of 3-D virtual
environments? British Journal of Educational Technology, 40(6), 10-32.
http://dx.doi.org/10.1111/j.1467-8535.2009.01038.x

Dalgarno, B., Lee, M. J. W., Carlson, L., Gregory, S. & Tynan, B. (2011a). An Australian and New
Zealand scoping study on the use of 3D immersive virtual worlds in higher education.
Australasian Journal of Educational Technology, 27(1), 1-15.
http://www.ascilite.org.au/ajet/ajet27/dalgarno.html

Dalgarno, B., Lee, M. J. W., Carlson, L., Gregory, S. & Tynan, B. (2011b). Institutional support for
and barriers to the use of 3D immersive virtual worlds in higher education. In Changing
demands, changing directions. Proceedings ascilite Hobart 2011 (pp. 316-330). Hobart: University
of Tasmania.
http://www.ascilite.org.au/conferences/hobart11/downloads/papers/Dalgarno-full.pdf

De Liddo, A. (2010). From open content to open thinking. In J. Herrington & B. Hunter (Eds),
Proceedings of World Conference on Educational Multimedia, Hypermedia and Telecommunications
2010 (pp. 3178-3183). Chesapeake, VA: Association for the Advancement of Computers in
Education. http://www.editlib.org/p/35094

Dow, A. (2008). Clinical simulation: A new approach. British Journal of Midwifery, 16(2), 94-98.
http://www.intermid.co.uk/cgi-bin/go.pl/library/article.cgi?uid=28340;article=BJM_16_2_94_98

Duncan, S. (2009). Patterns of learning object reuse in the Connexions Repository. [viewed 16 Oct
2011]. http://www.archive.org/details/PatternsOfLearningObjectReuseInTheConnexionRepository

Eley, R., Fallon, T., Soar, J., Buikstra, E. & Hegney, D. (2008), The status of training and
education in information and computer technology of Australian nurses: A national survey.
Journal of Clinical Nursing, 17(20), 2758-2767. http://dx.doi.org/10.1111/j.1365-
2702.2008.02285.x

Fahy, K., Foureur, M. & Hastie, C. (2008). Birth territory and midwifery guardianship: Theory for
practice, education and research. Philadelphia: Books for Midwives.

Gunn, C. (2011). Sustaining elearning innovations. In Changing demands, changing directions.
Proceedings ascilite Hobart 2011 (pp. 509-519). Hobart: University of Tasmania.
http://www.ascilite.org.au/conferences/hobart11/downloads/papers/Gunn-full.pdf



500 Australasian Journal of Educational Technology, 2012, 28(Special issue, 3)

Haigh, J. (2007). Expansive learning in the university setting: The case for simulated clinical
experience. Nurse Education in Practice, 7(2), 95-102.
http://dx.doi.org/10.1016/j.nepr.2006.04.013

Hansen, M. M. (2008). Versatile immersive, creative and dynamic virtual 3-D healthcare learning
environments: A review of the literature. Journal of Medical Internet Research, 10(3).
http://dx.doi.org/10.2196/jmir.1051

Holt, D. & Segrave, S. (2003). Creating and sustaining quality e-learning environments of
enduring value for teachers and learners. In Interact, integrate, impact. Proceedings ASCILITE
Adelaide 2003 (pp. 226-235). Adelaide: The University of Adelaide.
http://www.ascilite.org.au/conferences/adelaide03/docs/pdf/226.pdf

Holtham, C. (2005). Teaching and learning champions: An institutional perspective from the UK.
Paper presented at the Society for Teaching and Learning in Higher Education Annual
Conference, Charlottetown, Canada. [viewed 29 Feb 2012]
http://www.mcmaster.ca/stlhe/3M.council/Clive%20Holtham.pdf

Honey, M. L. L., Diener, S., Connor, K., Veltman, M. & Bodily, D. (2009). Teaching in virtual
space: An interactive session demonstrating Second Life simulation for haemorrhage
management. In Same places, different spaces. Proceedings ascilite Auckland 2009 (pp. 1222-1224).
Auckland: The University of Auckland and Auckland University of Technology.
http://www.ascilite.org.au/conferences/auckland09/procs/honey-interactivesession.pdf

Johnson, L., Levine, A., Smith, R., Smythe, T. & Stone, S. (2009). The Horizon Report: 2009
Australia-New Zealand Edition. Austin, TX: The New Media Consortium.
http://www.nmc.org/pdf/2009-Horizon-Report-ANZ-Edition.pdf [viewed 16 Oct 2011]

Johnson, C. M., Vorderstrasse, A. A. & Shaw, R. (2009). 3D virtual worlds for health and
healthcare. Journal of Virtual Worlds Research, 2(2), 3-12.
https://journals.tdl.org/jvwr/article/download/699/498

Kelly, O., Coburn, D., Hegarty, B., Jeffrey, L. & Penman, M. (2009). Don't dilly dally on the way:
Driving towards digital information literacy capability. In Same places, different spaces.
Proceedings ascilite Auckland 2009 (pp. 519-523). Auckland: The University of Auckland and
Auckland University of Technology.
http://www.ascilite.org.au/conferences/auckland09/procs/kelly-o.pdf

Kessler, G. & Rowell, J. (1998). Virtual medical symposia: Communicating globally quickly and
economically. Medical Marketing & Media, 33(9), 60-64.

Kirriemuir, J. (2010a). UK university and college technical support for Second Life developers and
users. Educational Research, 52(2), 215-227. http://dx.doi.org/10.1080/00131881.2010.482756

Kirriemuir, J. (2010b). Virtual world activity in UK universities and colleges: 'What now?'. Snapshot
#9: Summer 2010. Birmingham, UK: Virtual World Watch.
http://www.virtualworldwatch.net/vww/wp-content/uploads/2011/09/Snapshot-9.pdf
[viewed 29 Feb 2012]

Lathrop, A., Winningham, B. & VandeVusse, L. (2007). Simulation-based learning for midwives:
Background and pilot implementation. Journal of Midwifery & Women's Health, 52(5), 492-498.
http://onlinelibrary.wiley.com/doi/10.1016/j.jmwh.2007.03.018/abstract

Leap, N. (2002). Identifying the midwifery practice component of Australian midwifery
education programs. Results of the Australian Midwifery Action Project (AMAP) Education
Survey. The Australian Journal of Midwifery, 15(3), 15-23. http://dx.doi.org/10.1016/S1031-
170X(02)80004-6



Stewart and Davis 501

Leap, N., Barclay, L. & Sheehan, A. (2003). Results of the Australian Midwifery Action Project
Education Survey. Paper 2: Barriers to effective midwifery education as identified by
midwifery course coordinators. Australian Midwifery, 16(3), 6-11.
http://dx.doi.org/10.1016/S1448-8272(03)80010-X

Lee, M. J. W., Dalgarno, B., Gregory, S., Carlson, L. & Tynan, B. (2011). How are Australian and
New Zealand higher educators using 3D immersive virtual worlds in their teaching? Paper
presented at the DEHub and ODLAA Education Summit 2011-2021, 15-18 February, Sydney.

Littlejohn, A. (2003). Supporting sustainable e-learning. ALT-J, Research in Learning Technology,
11(3), 88-102. http://dx.doi.org/10.1080/0968776030110308

Lok, B., Ferdig, R. E., Raij, A., Johnsen, K., Dickerson, R., Coutts, J., ... Lind, D. S. (2006).
Applying virtual reality in medical communication education: Current findings and
potential teaching and learning benefits of immersive virtual patients. Virtual Reality, 10(3-4),
185-195. http://dx.doi.org/10.1007/s10055-006-0037-3

Lucas, B. (2006). Bringing e-learning home: An experiment in embedding e-learning using
departmental e-learning advocates. In Who's learning? Whose technology? Proceedings ascilite
Sydney 2006 (pp. 479-482). Sydney: The University of Sydney.
http://www.ascilite.org.au/conferences/sydney06/proceeding/pdf_papers/p101.pdf

Marginson, S. (2006). Dynamics of national and global competition in higher education. Higher
Education, 52(1), 1-39. http://dx.doi.org/10.1007/s10734-004-7649-x

McCallum, J., Ness, V. & Price, T. (2011). Exploring nursing students' decision making skills
whilst in a Second Life clinical simulation laboratory. Nurse Education Today, 31(7), 699-704.
http://dx.doi.org/10.1016/j.nedt.2010.03.010

McGilvray, A. (2011). Student increase causes training bottleneck. Nursing Review.
http://www.nursingreview.com.au/pages/section/article.php?s=News&idArticle=22327

Midwifery Council of New Zealand (2010). Competencies for entry to the register of midwives.
http://www.midwiferycouncil.health.nz/images/stories/pdf/competencies%20for%20entr
y%20to%20the%20register%20of%20midwives%202007.pdf [viewed 16 Oct 2011]

New Zealand College of Midwives (n. d.). Standards for practice.
http://www.midwife.org.nz/index.cfm/1,181,html [viewed 16 Oct 2011]

Oliver, M. (2010). "Everything I need to know I learnt from World of Warcraft": Why we might
need to start asking better questions about games, simulations and virtual worlds. Keynote
presentation ascilite Sydney 2010, Sydney, 5-8 December.
http://www.slideshare.net/MartinOliver/ascilite-2010-keynote [viewed 29 Mar 2012]

Organisation for Economic Co-operation and Development (2007). Giving knowledge for free: The
emergence of open educational resources. Paris: OECD. [viewed 16 Oct 2011]
http://www.oecd.org/dataoecd/35/7/38654317.pdf

Rogers, L. (2011). Developing simulations in multi-user virtual environments to enhance
healthcare education. British Journal of Educational Technology, 42(4), 608-615.
http://dx.doi.org/10.1111/j.1467-8535.2010.01057.x

Salmon, G. (2005). Flying not flapping: A strategic framework for e-learning and pedagogical
innovation in higher education institutions. ALT-J, Research in Learning Technology, 13(3), 201-
218. http://dx.doi.org/10.1080/09687760500376439



502 Australasian Journal of Educational Technology, 2012, 28(Special issue, 3)

Salt, B., Atkins, C. & Blackall, L. (2008). Engaging with Second Life: Real education in a virtual world.
Literature review. [viewed 16 Oct 2011]
http://slenz.files.wordpress.com/2008/12/slliteraturereviewa1.pdf

Seropian, M. A., Brown, K., Gavilanes, J. S. & Driggers, B. (2004). Simulation: Not just a manikin.
Journal of Nursing Education, 43(4), 164-169.
http://www.slackjournals.com/article.aspx?rid=35108

Skiba, D. J. (2007). Nursing Education 2.0: Second Life. Nursing Education Perspectives, 28(3), 156-
157. http://nlnjournals.org/doi/pdf/10.1043/1094-
2831(2007)28%5B156:NESL%5D2.0.CO%3B2

Slater, M., Linakis, V., Usoh, M. & Kooper, R. (1996). Immersion, presence, and performance in
virtual environments: An experiment with tri-dimensional chess. In M. Green (Ed.),
Proceedings of the Third ACM Symposium on Virtual Reality Software and Technology (pp. 163-
172). New York: Association for Computing Machinery.

Stewart, S. (2006). Delivering the goods: Midwives' use of the Internet. In M. Murero & R. E. Rice
(Eds), The Internet and health care: Theory, research, and practice (pp. 177-194). Mahwah, NJ:
Erlbaum.

Stewart, S. & Davis, D. (2009, 22 Sep). Using a virtual birth unit to teach midwifery students.
Paper presented at the 16th National Conference of the Australian College of Midwives,
Adelaide. http://www.slideshare.net/sarahs/using-a-virtual-birth-unit-to-teach-students
[viewed 16 Oct 2011]

Tracy, S., Barclay, L. & Brodie, P. (2000). Contemporary issues in the workforce and education of
Australian midwives. Australian Health Review, 23(4), 78-88.
http://www.publish.csiro.au/?act=view_file&file_id=AH000078a.pdf

Tynan, B., Dunne, K. & Smyth, R. (Eds) (2007). Collaborating to offer small courses/subjects forum:
Final report. Sydney: Carrick Institute for Learning and Teaching in Higher Education.
http://www.olt.gov.au/system/files/resources/grants_report_smallcourses_feb08.pdf
[viewed 26 Mar 2012]

Tynan, B. & Lee, M. J. W. (2009). Tales of adventure and change: Academic staff members' future
visions of higher education and their professional development needs. On the Horizon, 17(2),
98-108. http://dx.doi.org/10.1108/10748120910965485

Wiecha, J., Heyden, R., Sternthal, E. & Merialdi, M. (2010). Learning in a virtual world:
Experience with using Second Life for medical education. Journal of Medical Internet Research,
12(1). http://dx.doi.org/10.2196/jmir.1337

Wiles, K. & Littlejohn. A. (2003). Supporting sustainable e-learning: A UK national forum. In
Interact, integrate, impact. Proceedings ASCILITE Adelaide 2003 (pp. 730-734). Adelaide: The
University of Adelaide.
http://www.ascilite.org.au/conferences/adelaide03/docs/pdf/730.pdf

Winter, M. (2010). Second Life Education in New Zealand: Evaluation research final report.
Christchurch, New Zealand: CORE Education. [viewed 16 Oct 2011]
http://slenz.files.wordpress.com/2010/03/slenz-final-report-_milestone-2_-080310cca.pdf

Witmer, B. G. & Singer, M. J. (1998). Measuring presence in virtual environments: A presence
questionnaire. Presence: Teleoperators and Virtual Environments, 7(3), 225-224.
http://dx.doi.org/10.1162/105474698565686



Stewart and Davis 503

Yellowlees, P. & Cook, J. (2006). Education about hallucinations using an Internet virtual reality
system: A qualitative survey. Academic Psychiatry, 30(6), 534-539.
http://dx.doi.org/10.1176/appi.ap.30.6.534

Yu, S., Chen, I.-J., Yang, K.-F., Wang, T.-F. & Yen, L.-L. (2007). A feasibility study on the
adoption of e-learning for public health nurse continuing education in Taiwan. Nurse
Education Today, 27(7), 755-761. http://dx.doi.org/10.1016/j.nedt.2006.10.016

Authors: Sarah Stewart, Educational Developer
Educational Development Centre, Otago Polytechnic
Forth Street, Private Bag 1910, Dunedin 9054, New Zealand
Email: sarah.stewart@op.ac.nz Website: http://sarah-stewart.blogspot.com/

Professor Deborah Davis, Clinical Chair in Midwifery
Faculty of Health, University of Canberra, ACT 2601, Australia
Email: deborah.davis@canberra.edu.au

Please cite as: Stewart, S. & Davis, D. (2012). On the MUVE or in decline: Reflecting on
the sustainability of the Virtual Birth Centre developed in Second Life. In M. J. W. Lee,
B. Dalgarno & H. Farley (Eds), Virtual worlds in tertiary education: An Australasian
perspective. Australasian Journal of Educational Technology, 28(Special issue, 3), 480-503.
http://www.ascilite.org.au/ajet/ajet28/stewart.html