2 to the success of the new graduate nurse in the clinical environment. Increasing the amount and types of simulation exposure could enhance overall student learning and allow for the best utilization of simulation resources. Education for nursing students can be challenging when only random learning opportunities are available, and clin- ical experiences are dependent on the patient population or current practice environment. Thus, no assurance of knowl- edge acquisition of many vital concepts, such as conﬂict management, empowerment, delegation, ethics, and priority setting can be made. Simulations provide students with an opportunity to practice their skills in a safe environment, allowing for skill reﬁnement with repeated exposure over time. The use of simulation has increased in many nursing programs and due to this increase in use it may be diﬃcult to schedule all of the simulations necessary to provide students with a comprehensive skill set upon graduation. One avenue for overcoming these barriers is the use of a virtual environ- ment or virtual world as a representative training area for students to engage in simulations that focus on interpersonal skills such as communication or critical thinking skills. A vir- tual world is a “computer based, simulated multi-media en- vironment” ([9], Page 233). A virtual world is typically set up to run over the World Wide Web wherein users create and identify themselves through an avatar, an online manifesta- tion of self. Some virtual worlds are called multiuser virtual environ- ments (MUVEs) because they allow for more than one user to be in the environment and interact with other users in a synchronous fashion. The most popular and mature MUVE that is currently being used in education is Second Life [10]. Second Life (SL) is an online open-access MUVE developed and maintained by Linden Labs. SL allows anyone to open an account, set up a personalized avatar, and download their program for free. The technical requirements to run the pro- gram are found on many computers today. SL allows students to participate in real-life situations with other students in a MUVE through the use of avatars while receiving simulta- neous interactive prompting and instruction by facilitators. Students have the ability to participate in any location where they can access SL via the internet. The use of avatars allows students a feeling of being “physically” present in the SL envi- ronment, allowing training to be in a safe, controlled setting where students may practice and enhance their skills [11]. SL has been used as an educational platform for many diﬀerent medical, health, and nursing skills, such as identify- ing certain heart sounds, assessing patients, and engaging in reﬂective practice [9]. It allows students to gain experience in real-life situations in an environment that can be facilitated or set up by the educator. Students are able to gain the appropriate skills and make clinical decisions based on their learning while avoiding mishaps in patient safety that could occur in an actual clinical area. In a virtual learning environment, no harm is done to patients if an incorrect procedure or medication is administered. Unfortunately to date, there are few studies that examine the eﬀectiveness of MUVE’s such as SL on student knowledge and/or skill acquisition. This is due in part to the newness of the Nursing Research and Practice technology and the challenges in studying the environment. A brief summary of the few studies found in the literature as follows. In one study, the use of a virtual learning environment led to better reﬂection between online students, which may support the creation of communities of practice [9]. In another study, paramedic students using SL for problem- based learning, found the environment more authentic and collaborative than using paper-based problem solving sce- narios. The researchers also found the SL environment allow- ed for feedback to the students from their virtual “patients” which increased the beneﬁt of the learning envi-ronment for the learners [12]. Commercial and educational institutions are using SL or other MUVE’s to assist in their training/educational pro- grams and curriculum. MICHELIN automotive tires devel- oped a training environment in SL to train their information systems (IS) personnel in the United States, Europe, and Asia to ensure global alignment of processes and IS solutions [13]. The University of Kansas Medical Center uses SL to run training simulations for anesthesia induction in a setting that replicates their current operation room [13]. There are many uses for SL, but very few studies are published yet. One study did focus on comparing the outcomes of virtual reality (VR) training to mannequin-based simulation. In this study [14], subjects were assigned to either a manne- quin-based simulation or a VR simulation for team training in the emergency department. The results indicated both groups showed signiﬁcant improvement in performance after completing the training. Simulation can be an eﬀective education and training method educators and faculty can use to facilitate student learning, particularly in the health pro- fessions where certain critical skills are necessary for optimal and safe patient care. Therefore, measuring the ability of simulation, in particular virtual simulation, to improve learner skills is of vital importance. 2. Conceptual Framework The conceptual framework used to guide this research is based on Ericsson’s [15] work on expertise. Ericsson’s frame- work posits that to acquire expert performance one must engage in deliberate practice activities that are clearly focused on improving some aspect of performance. Most students tend to improve performance with experience; however, Ericsson’s theory states that experts are those individuals who continue to improve beyond the level needed to perform adequately and become recognized as experts in their domain. Although students are just beginning in their skill development the underpinnings of Ericsson’s theory can help educators focus deliberate eﬀorts to improve selected skills or tasks. During this process, students are instructed to improve certain aspects of their performance for a well-deﬁned task, such as communicating to a health care provider regarding a patient’s status. The student is then given immediate detailed feedback on their performance which they can reﬂect upon and continue to practice during subsequent training sessions. Simulation is one of the techniques that can be used to