The Second Life Metaverse and Its Usefulness in Medical Education After a Quarter of a Century

The immersive virtual world platform Second Life (SL) was conceived 25 years ago, when Philip Rosedale founded Linden Lab in 1999 with the intention of developing computing hardware that would allow people to immerse themselves in a virtual world. This initial effort was transformed 4 years later into SL, a universally accessible virtual world centered on the user, with commercial transactions and even its own virtual currency, which fully connects with the concept of the metaverse, recently repopularized after the statements of the chief executive officer of Meta (formerly Facebook) in October 2021. SL is considered the best known virtual environment among higher education professionals. This paper aimed to review medical education in the SL metaverse; its evolution; and its possibilities, limitations, and future perspectives, focusing especially on medical education experiences during undergraduate, residency, and continuing medical education. The concept of the metaverse and virtual worlds was described, making special reference to SL and its conceptual philosophy, historical evolution, and technical aspects and capabilities for higher education. A narrative review of the existing literature was performed, including at the same time a point of view from our teaching team after an uninterrupted practical experience of undergraduate and postgraduate medical education in the last 13 years with >4000 users and >10 publications on the subject. From an educational point of view, SL has the advantages of being available 24/7 and creating in the student the important feeling of "being there" and of copresence. This, together with the reproduction of the 3D world, real-time interaction, and the quality of voice communication, makes the immersive experiences unique, generating engagement and a fluid interrelation of students with each other and with their teachers. Various groups of researchers in medical education have developed experiences during these years, which have shown that courses, seminars, workshops and conferences, problem-based learning experiences, evaluations, teamwork, gamification, medical simulation, and virtual objective structured clinical examinations can be successfully carried out. Acceptance from students and faculty is generally positive, recognizing its usefulness for undergraduate medical education and continuing medical education. In the 25 years since its conception, SL has proven to be a virtual platform that connects with the concept of the metaverse, an interconnected, open, and globally accessible system that all humans can access to socialize or share products for free or using a virtual currency. SL remains active and technologically improved since its creation. It is necessary to continue carrying out educational experiences, outlining the organization, objectives, and content and measuring the actual educational impact to make SL a tool of more universal use.