learning design

Project: Instructional Design for Field training of General Practitioners and Local Mental Health Workers in Vanuatu.
CONTENT PAGE
Introduction 2
Context 2
Design and Deveolpment 9
Content 9
Sequencing 10
Media 11
Assessment 13
Evaluation 13
Future Plans 18
Conclusion 18
List of References 19
Appendix 1. 27
Appendix 2 28
Appendix 3 29
Appendix 4 30






INTRODUCTION.
I have applied for a voluntary position in the Pacific island nation of Vanuatu, providing clinical training and supervision in psychiatry. This position is funded and promoted by the World Health Organisation (WHO). The population of Vanuatu is 200, 000 people, similar to my area in Toowoomba, which should have 20 psychiatrists in Australia (Australian Medical Workforce Advisory Committee, 1999). There are 30 physicians but no psychiatrists in the Vanuatu (Geneva Foundation for Medical Education and Research, 2008). This position entails three weeks initial travel to the the islands to train the local General Medical Practitioners (GP) and Local Mental Health Workers (LMHW), (who are like bare-foot doctors) in psychiatric assessment, diagnosis and treatment of mental illness. The WHO aim is to set up a relationship so that ongoing support and training will continue in the long term. The position is also aimed towards helping the country set up a mental health program and employ a psychiatrist in the future. It will also aim to set up training programmes for psychiatrists and education programmes for the general community and the government.
I would like to have some modules prepared for current training purposes, long term needs and training of new staff. I would like these to provide a forum for ongoing education for when I return to Australia. It is aimed that I would go back to Vanuatu two or three times each year for continuing training and thus I would like to establish a continuity in between these times and a method of providing ongoing training in assessment, triage, early intervention, prevention, diagnosis and treatment of psychiatric illness from Australia.
CONTEXT.
Flexibility
The programme developed then needs to be flexible to address these multiple stakeholders as well as the needs of the learners. Although this is not meant to replace a formal academic learning for qualifications, it is an apprenticeship style learning in authentic situations. I have designed and delivered these programs in outback Australia with ongoing learning support and supervision, using the same model of health care delivery (Arnold, 1994). In my experience, the GPs and LMHWs have different educational backgrounds and needs, thus the programme needs to address this flexibly. GPs usually have six months undergraduate training in psychiatry. They may be involved in some psychiatric care depending on their area of work in the field. Some GPs from developing nations have no psychiatry in their undergraduate programs. Most GPs work in large towns or the capital city and have little understanding of local or community problems (Pretorius, Milling & McGuigan, 2008). As I work in a regional town in Australia and have worked for many years in rural and remote service delivery, medical education, tertiary consultation, psychiatry and compared service delivery in many countries that I have travelled to, I have an expectation that similar issues will be found in Vanuatu. Part of the initial three week tour will be research of these factors.
LMHWs are generic positions and may be taken by staff with nursing, occupational health physiotherapy, speech therapy or psychology qualifications (allied health workers). LMHWs usually have no experience in mental health. Some LMHWs are elders of the community with no formal qualifications and no training in mental health. As I have seen in the Indigenous communities in Australia, these people are often loathe to leave their communities and do not cope with large cities very well.
Vanuatu has several cultural and religious backgrounds. Government statistics show that16% of the people, mostly on outer isolated islands, are animists (Vanuatu Tourism Board, nd). This requires flexibilities in cultural aspects of psychiatry and health care delivery as well as educational programmes (McLoughlin & Oliver, 1999). Many animists believe in witchcraft and supernatural causes of psychiatric illness. Cawte's model of cultural awareness and flexibility working with witchdoctors and Indigenous healers helps deliver appropriate care and understanding in psychiatry (Cawte, 1974; Jilek & Draguns, 2008). There is a huge cultural and knowledge gap in my understanding of the region that requires more input from the local people towards learning on my part, which will be assessed in the initial phase and in an ongoing way as part of the Instructional Design.
The task includes problems of distance and isolation. I will be distant from the country and isolated from them. The GPs and LMHWs are distributed across many hundreds of islands and ocean and many of the LMHWs will work alone. I am not sure of the Internet connectivity or access to technology in Vanuatu outside the capital city. Thus flexibility in delivery models needs to be provided. I would like Internet based resources and training modules and perhaps these can be placed on DVD for ready access but may also need to be in print form but this will require further analysis. I will probably be able to use my local community organization to obtain funds for laptops for the LMHWs.
Resources need to be assessed but extra library services may need to be resourced from the Royal Australian and New Zealand College of Psychiatrists (RANZCP), of which I am a fellow. It already has an extensive online library with connections to the major international library services. It also canvasses members to supply unused texts for developing countries.
The official language of Vanuatu includes English but I need to think about flexibility in terms of the other two major languages and the numerous other local languages in use. For this reason I will include audio readings in the instructional design, in the three official languages of Vanuatu, English, French and Bislama. Discussion will be in english.
Pedagogy
Most psychiatry is taught around the world as practice-based, authentic learning using an apprenticeship model and case-based learning. A social constructivist model may be useful in this situation (Siemens, 2002; Dougiamas, 1998). This has been a tried and tested model that can be incorporated into a social constructivist model of computer assisted online learning, but not used for psychiatry training before ( Moss, Teshima & Leszcz, 2007; Louie, Weiss Roberts & Coverdale, 2007; Zolezzi & Blake, 2008) .
The design needs to complement the computer-mediated, constructivist pedagogy but also needs to be flexible enough to be used in face-to-face, video-conferencing, paper-based and DVD based learning (Der-Thanq, Hung & Wang, 2007). Constructionism and communities of practice (COP) are important long term goals for self-generating, lifelong, learning in the field (Gokhale, 1995; Ryder, 2008). The learners already have a community and implied situational learning that can be reflected in the design of the module ( Lave &Wenger, 1990; Brown, Collins & Duguid,1989). It also provides support for isolated workers with systems to access resources. Assistance with COPs, group learning, group tasks, social presence and informal chat can be designed to create the learning outcomes required (Pask, 1975; Reushle, et al , 1999).
Using the ADDIE model, (Analysis, Design, Development, Evaluation) and Assessment with feedback loops, the analysis is the most important and certainly first step (McGriff, 2001).
Analysis
I will use this C-map to visually display my working approach to analysis of the complexities of the various systems to be analyzed in my project (McGriff, 2001; Rohse & Anderson, 2006; Ryder, 2008). (Appendix 1).
The issues can be summarized as in Table 1.
Table I: Analysis Rubric
What How Issues
Needs Needs analysis
Gap analysis
task analysis
future training
government needs
college accreditation
resource needs
WHO information
Preliminary casework
research stats
library resources
Safety for learners and patients
limited timeframes
limited resources
diversity
cultural issues
Learners Learning styles
intelligence
motivation
prior knowledge
cognitve capacity
collaborativism
technical ability
self motivation ability
personality style Preliminary meetings and case work
WHO profiles
Questionairres
interpersonal assessment Two main groups.
Diversity
Cultural issues
Languagedifferences

Context Environment
time constraints
cultural issues
resources
technology and Internet

Visit Vanuatu
Research background of learners, country, mental health facilities
survery technical expertise and availability Limited time, money, resources, technical capacity
rudimentary mental health facilities
rudimentary to no prior training
Goals Self-motivated learning
Basic knowledge
Clinical skills
Understand resources
Capacity to empathy
holistic approach
identify knowledge gap
Realistic goals WHO goals
Learner goals
RANZCP goals
SME goals Keep goals manageable
Universalizability
Transposability
Keep case based
Authentic learning


I would seek more information about the country of Vanuatu, its medical services and, medical training facilities. Most of this information would be supplied by the World Health Organization (WHO).
In my project, I would aim for front- end- analysis, as well as feedback throughout the modules and final evaluation for continuous quality improvement (Bramucci, 2003; McGriff, 2001). I would seek immediate needs analysis but also medium and long term needs as this is implied in the job description as well as ethically correct behaviour towards consumers and learners (International Board of Standards for Training, Performance and Instruction, 2000; Gagne, Briggs & Wager, 1992; Jonassen, Tessmer & Hannum, 1999)
I would contact the WHO representatives (employer) seeking further information of their needs and wants as well as basic demographic information of the Gps and LMHW (age, sex, marital status, religion, cultural background and geographical location) (Rouda & Kusy, 1995). I would seek past experiences in other developing countries and advice from local medical school lecturers (SME). I would also seek liaison with medical schools and the RANZCP for support, learning materials and content analysis. I can draw on my own experiences of past training of Gps and LMHWs in similar situations in Australia.
Task analysis includes identifying a broad range of goals from WHO, Medical schools in Vanuatu, Gps, LMHWs and consumer groups.Using a Delphi approach to brainstorm these goals with a focus group would start the process although this would be an ongoing process (Jonassen, Hannum & Tessmer, 1989; Burton & Merrill, 1977). The goals then can be placed in a hierachy of needs (Jonassen, Hannum & Tessmer, 1989). Assessment of current performance can come from many places and the most available ones should be accessed due to time and cost limits (Rouda & Kusy, 1995). Statistics for the country with respect to hospital bed numbers, bed occupancy, treatment occasions, profile of diagnositc related groupings ( DRGs), use of pharmocotherapy from PBS equivalent statistics and consumer concerns can give statistical analysis that can be compared with similar statistics in Australia or other developed nations (Clark, 2006). WHO and the World Bank has probably already assessed these needs gaps and I would discuss this with Dr Harvey Whiteford, Australia's advisor in mental health to the World Bank.
The learners are important stakeholders for learning design (Daigre, nd). I would form a focus group with representative Gps in my visit to the islands. I would assess their prior knowledge and experiences and their perception of needs and gaps. I would use a questionairre to assess these (Appendix 2). I assume that they have average intelligence or above and basic medical training although will observe throughout to confirm that this is true. I can ask the Gps to fill in a basic personality assessment tool, Myers Briggs for example, to assess their personality style as well as show them this tool for their own use (Myers & Briggs, 1995). I prefer to use my skills as a psychiatrist to glean a personality assessment from the interpersonal transference. I would use a dinner meeting to ask them to each present a case for discussion. In this way, I can assses their prior level of knoweldge, understanding, personality styles, attitudes, schemas, memory style and personal psychiatric problems (Boutwell, 1977; Gagne, Briggs & Wager, 1992; Mergel, 1998).
I would have some informal focus groups to get to know the LMHWs, their educational background, reasons for chosing the job, relationship to their communities of practice, responsibilities and their past experiences in psychiatry (Clark, 2006). I would use a Ravens Progressive Matrices as a transcultural, performance, intelligence assessment tool (Raven, 1936). I would assess their motivation and perceived needs for training by asking them to present a case and use it for discussion of their assessment and management. I would also use a case for discussion to assess their level of undersanding; content of knoweldge as well as their learning styles, memory capacity, concentration, intellectual skills; behavioural, cognitive and, the connectedness aspects of the learners. They are least likely to be aware of the knowledge and experiential gaps, so information from the local GPs would also be useful to assess need. I would seek documents concerning their job descriptions, policies and procedures and aspects of mental health law, government policies and WHO policies in print to understand the system and gaps. WHO and government statistics will give me the demographics for the country, health system and local staff.
The GPs and LMHWs can give me some information about culture and travelling to some of the remote communities, in the company of the LMHW, would give me an understanding of the problems and pitfalls, cultural differences and what tools and training are required (McLoughlin & Oliver, 1999).
Discussion with the local staff and observation of their communication and technology is important towards understanding their needs and capacities for learning pedagogies (Der-Thanq, Hung, & Wang, 2007; Florida Gulf Coast University, nd). A simple questionairre would give me information required.
I am less likely to use formal assessment tools but take notes of the various observations for later analysis. I am more likely to use personal attachment to the learners towards more in depth analysis of the issues. This is a huge project in a culturally different setting and that analysis will be incomplete before launching the training but that it will be an ongoing project of analysis with feedback and continuous improvement.
DESIGN AND DEVELOPMENT
Content.
Based on Australian courses and basic textbooks, there is a large amount of information to cover which implies a cognitive load problem (Kaplan & Sadock, 2009; Sweller, van Merrienboer, & Paas,1998) Appendix 2. I have set up and run a similar course for LMHWs in child and adolescent psychiatry in a face-to-face delivery with ongoing video-conferencing using the tele-psychiatry models and in-house conferences in the past and have access to the state training co-ordinators to assist. The problem is to choose content and process that deliver enough material for the LMHW to be able to work safely by themselves and with their patients; to know when to seek help; to provide adequate support; and help but not to overwhelm them with too much information. I also need to know the prior level of knoweldge and the cognitive learning styles of the learners (Ryder, 2008).
The basics include infant, child, adolescent, adult, geriatric, forensic, preventative, social, education, women, men, hospital services, Mental Health Acts, staff safety and security, issues of abuse, community forums, support groups, carers support, political issues as well as specific illnesses, diagnosis and treatment. These areas can be broken up into modules ( Appendix 3) ( Tattersall et all, 2007). Module 2 (Appendix 4) is chosen as the preliminary prototype as it is the cornerstone of psychiatric study.
Sequencing.
The learners are all adult post graduate students but with varying experience in mental health care. The design will have to promote adult learning strategies, andragogy ( Smith, 2002). It will be important to develop the position of Module 2 within the total learning. It is also important to develop course aims, objectives and course outlines, as seen in the prototype of Module 2 (National Learning Infrastructure Initiative (EDUCAUSE), 2003).
I will use chunking of information to maintain concentration of the learners. Module 2 has been chunked into three components that are hierachical and conceptual elaboration sequences which build on each other (Learning Theories Knowledgebase, 2009). I hope to use conversational style and simple language to cope with the diversity of learners. I want to use spacing, colour, concept maps and architecture of the module to facilitate easy learning using visual and auditory loop learning of concepts (Sorden, 2005). I hope to design the information in a logical sequence, always keeping it relevant to the total learning journey of psychiatry.
In the project LMHWs and Gps can learn how to access data, theory, concepts and support for their clinical practice. They will have free-flow and acquisition learning and eventually emergence of concepts through authentic processes of cognitive apprenticeship ( Siemens, 2005). They will never be psychiatrists and this is a major problem for me as they will be the only people available to provide these services. Ethically, some treatment is better than no treatment but we need safe systems for staff, patients and the community. I need to ensure that they have enough knowledge to provide essential services for patients. I also wish to provide them with enough tools and resources to be able to protect themselves. The Instructional Design could provide resources (electronic, written) and practical help with a psychiatrist and an Australian team available to create a learning ecology (Siemens, 2005). I hope to include guest SMEs to diversify input and connectivity. It would help set up COPs and learning communities. It can use modules that have been produced for Australian LMHWs rather than re-invent the wheel (Oliver, 2002). The discussion within the module can be retained, with permission of the authors, for future learners and ready reference. In this way vicarious learning and construction of knowledge are maximized.
I would provide this learning module as it is an important starting point to understanding the complexities of psychiatry. The content has already been decided as a basic unit of conceptual and theoretical sequencing (Learning Theories Knowledgebase, 2009). (Appendix 3)
Media
In keeping with the pedagogy and flexibility of delivery, there will be an online programme that will be accessible through Internet, intranet, DVD, audio and print format.I will need to be aware that this may be novel for some of the learners who may require assitance with this model and may prefer conservative models (Ingleton, Doube & Rogers, n.d.)
I will add videos of patients ( actors playing roles to protect the confidentiality of patients) to add to the authentic learning pedagogy and meaningfulness of the practice (Sorden, 2005 ). Learners may also role play or use field examples for discussion (Harasim et al, 1995).
I will add Blog style discussion points to promote interactive, social construction of knowledge and modelling for feedback (Wilson, Jonassen, Cole, 1993; Mergel, 1998). Learners without access to Internet resources can write or phone comment which can then be distributed both online and in print. I hope to promote interpersonal contact between learners or small groups that can set up learning communities of practice. In this way I will understand the prior knowledge and learning styles of the learners so that I can use this to alter the design of the module in a continuous quality mode. I will aim towards learners using reflection and critical thinking in these domains. I will hopefully achieve this by limiting the amount of content provided, proposing discussion, providing discussion areas and providing positive rewards.There will be some Face-to-face learning; online discussion, learning materials, printed medium, DVD's of content and library resources.
The learning media I would like to apply is Internet based, computer mediated, learning as the easiest way to address the geographical and time zone difficulties. Given the theoretical approach I wish to take will need to be flexible because of the large number of unknowns. Cultural and professional differences as well as task and learner differnces. If there is no Internet access, then obtaining access may be part of the volunteer process. If there is Internet access, then RANZCP library access, online modules for learning, blogs and listsevs for case based discussions, coffee and chat facilities, can be utilised as well (Bates, 1997). I have started by presenting a case and requesting reflection and ideas based on prior learning. This can be shared infromation with the group. Simple chunks of information are then presented for visual learning, using diagrams and pictures. Modelling of responses is included (Bandura, 1977). There is minimal wordage and clear spaces so as not to overwhelm the learner (Carroll, 1998). I have included three languages for the presentations to assist cultural differences. I hope to obtain videos and photos of the islands and islanders to make the presentation more culturally appropriate. I think the media can facilitate learning, so long as the learners have adequate experience in its use. Personalising the format with photographs and introductions of learners, social chat and discussion towards social presence are media factors that can enhance online learning.
There are no problems around plagiarism as this learning is meant to be open and unassessed. So long as the modules reference texts and copyrighted information, plagiarism can be redefined in this context as observational learning.
Assesment
Assessment of learning is important as a formative learning tool but learners are not expected to obtain a qualification in this project (Boud, 1998). Their motivation is internal and empathic understanding, with encouragement of their self concept as learners and clinicians, will be important learning tools (Smith, 1997, 2004). I will design feedback questions and answers as part of a quality enhancement strategy. Authentic learning is the cornerstone to this learning situation and should be the basic process of learning interventions (Arnold, 2007). For this reason I will include case studies, those I provide and those presented by the learners. The assessments form the basis of rapid feedback and learning. The assessments form a behavioural approach with positive feedback for learners and learning through their mistakes. The subject matter expert (SME) can provide timely interventions to steer learners back on course if lost or accesing wrong information. The SME can provide scafolding of learning by promoting discussion and feedback on papers and cases. A simple multiple choice test for each section of the module can be included in the design, voluntary of course but with instant feedback.


EVALUATION.
I will set up a rapid prototype of the instructional design then test it in the field (Ceraulo, nd; Wilson, Jonassen, Cole, 1993). I can test it with Australian GPs and LMHWs; Australian academics and then in Vanuatu. I will use feedback research from users to change the design as a form of action research. In this way a continuous quality feedback and instructional design will be created. Feedback online in the form of student forums can also be useful sources of analysis (McGriff, 2001). Assessment of learning will be through authentic tasks via case discussion of learner's experiences, integration of new knowledge and outcome in changed practices. A formal feedback form can assess initial need, responses to the learning material throughout the course and future planning of instructional design. Feedback from WHO support services, consumers, medical and mental health advisory organizations towards health planning.
Evaluation is a normal, continual process, whether conscious or otherwise, that thinking people use for their everyday experience. It tests new information against previously held information and with thought, allows progress and change. It tests behaviour against projected norms. It assesses self as well as others (Western Michigan University Evaluation Center, 2002).
The two classic reasons for evaluation in education are audit and devlopment (Edstrom, 2008). Firstly I define the problem/goal which is to produce a low cost delivery of practical, clinical skills to LMHW's and Gps in Vanuatu in their new psychiatry service with the view of setting up their own training of psychiatrists in the future. This module that I have concentrated on (Bio/Psycho/Social, DSM-IV, Formulation) is the cornerstone of communication and understanding and will be a place to begin the project. As the LMHWs and Gps are already working in the field, I suspect that they are experiencing difficulties and will be motivated to learn. The level of motivation will need analysis over time as sometimes motivation may mask covert disinterest or rejection of outsiders.
Evaluation- research methodology
Most of the checklists and questionairres are qualitative or quasi-scientific approaches (Kay & Knaack, 2009). As a scientist I will need some evaluation that has validity (construct, face, predictive and convergent) and reliability ( inter-rater, test-retest) with appropriate statistical analysis although the sample will be small and culturally biased (University of Tasmania, nd).One reason for strict evaluation is that the project needs to be published in the Journal of Australian and New Zealand College of Psychiatrists (RANZCP) as there has been as little previous research on teaching, let alone in developing countries, online or with a constructivist approach. In this way the area can be promoted for further research and can promote universalizability and transferability of the program.
Systems approach
In a consumer driven model based on stakeholder theory evaluation forms an integral part of quality assurance, just-in-time management and management of costs (Freeman, 1994). The consumer based model is equivalent to the Community of Practice (COP) model that I hope to establish (Wenger & Snyder, 2004). Systems alignment approach allows ownership of the project and evaluation to be an integral part of the learning process; identification with the COP and provides motivation for learning as well as motivation to change the project as needed (Edstrom, 2008).
I identified that the stakeholders in my project are the consumers, administraton, financial backers, WHO, and professonal bodies. Evaluation needs to be practical and purpose driven given the lack of resources and time (Edstrom, 2008; University of Tasmania, nd).
I will evaluate the General Practitioners (GPs) and local mental health workers (LMHWs) using a participant oriented model of focus groups which is goal free and value oriented (Scriven, 2007). I will informally seek feedback in face to face meetings. I will seek informal feedback from course evaluation feedback online from learners.
Patients within the health care system are endload consumers and will be evaluated using a quasi-scientific model and naturalisticapproach. I will seek external evaluation from WHO and consumer advocacy groups with respect to quality of care, diagnostic grouping and treatment planning (Australian Institute of Criminology, nd) .
Carers of patients within the health care system are also important stakeholders and focus groups can assess their input as well as formal questionairres for feedback. I would use community leaders to obtain this information.
The WHO will probably have its own extenal valuation but I would use qualitative models, past models used and outcomes that are decision-based (Stufflebeam, 2007). The Government of Vanuatu needs evaluation with respect to cost effectiveness and quality of mental health care. I would use the formal statistics to compare with past figures; those of other developing nations as well as Australia's statistics.
Liaion with the RANZCP and Vanuatu Medical Association is important and their external assessment and input will be valuable.
There are numerous other issues that need evaluation. I would stage these evaluations over time so as to limit the burden of evaluation to manageable amounts.
Technology needs to be evaluated by learners for availability, ease, reliability and learner capacity
Courseware design can be evaluted by peer review, review of other programs and direct feedback from learners.I wish to evaluate the pedagogy, ensuring that it reflects the course design and implementation by assessing learner use of the discussions ( Kay & Knaack, 2009; Fitzgerald, Allen & Reeves, 1999; Russell & Taylor).
Timelines
Before, during and after design and implementation are the timesframes to consider for evaluation. This allows a continual quality management approach. End point evaluation can assess short, medium and long term outcomes of the project which will be important for ongoing or increasing funding.
I like to construct a Gantt Chart for projects so that I can keep to timelines, prepare prior needs in a timely way, keep track of all the aspects of the project. The visual approach aids cognitive processing and means that the project can be transferred to other people if I am unavailable.


Gantt Chart 1.Preliminary needs

Formative evaluation forms the most important pedagogical approach with response to case studies, use of online study unit and resources, counters for hit rate, questionairre and anonymous suggestion box.
My research lens as an active participant in the process will be important for feedback evaluation. I can use a blog for reflection (Nelson, 2009). I need to remember that evaluation that is merely teacher focussed has a counterproductive outcome and can set up a split (learner, teacher) (Edstrom, 2008). I can evaluate the how, when, where, why of teaching and design, culture and context. I can build a repetoire of teaching skills and cases for learning. I can undestand the learner's capacities and needs to be able to an effective facilitator (Edstrom, 2008). Finally, I need to evaluate the evaluation process and outcomes.

FUTURE PLANS.
Once this module is trialled and evaluated it becomes the first in a cycle of quality improvements. This programme then will be transportable to other developing mental health programs around the world. As there is an increasing recognition of mental illness in the world and need to treat this with limited resources, the current model of LMHWs and Gps at the forefront of health care delivery will continue and the role of psychiatrists in tertiary prevention and supervision will increase. This model may be helpful for other psychiatrists towards their supervision. Education and supervision is a new area for the RANZCP to consider especially online learning.
CONCLUSION.
This module, as part of a larger course in basic psychiatry, can be designed within a learner centred online pedagogy of social constructivism and communities of practice. It can be culturally flexible and a distibuted learning network for quality patient care. The ADDIE model allows for double feedback loops or analysis, design, development and evaluation towards quality learning. This is designed around adult post-graduate learners using a cognitive apprenticehip within authentic assessment for learning. The design is flexible for content, context and media.









LIST OF REFERENCES.
American Psychiatric Association, (2000) Diagnositc Statistical Manual -IV, American Psychiatric Association Press. Retrieved 25th March, 2009 from http://books.google.com.au/booksid=3SQrtpnHb9MC&dq=DSMIV&printsec=frontcover&source=bl&ots=XcI2Q1qC1E&sig=Fs8cpHgJsm1IcGfQBUOePsjK_M&hl=en&ei=lvPKSf2xMcGTkAXhsbTgCQ&sa=X&oi=book_result&resnum=8&ct=result
Arnold, J (1994) Rural training of LMHW's in Child and Adolescent Psychiatry, experiences from Toowoomba and the Darling Downs. Conference of Australia and New Zealand College of Psychiatry, Facultyof Child and Adolescent Psychiatry, Brisbane, June 4-7th.
(2007), Authentic assessment. Retrived 22nd May, 2009 from http://joyce-arnold.blogspot.com/

Australian Institute of Criminology, (nd). External and/or internal evaluation: deciding what works best for your organization., National Community Crime Prevention Programme. Retrieved 2nd May, 2009 from http://www.crimeprevention.gov.au/agd/WWW/rwpattach.nsf/VAP/(93C446DBC14FB8146219B06F1D49FA6B)~Tip+Sheet+3.pdf/$file/Tip+Sheet+3.pdf
Australian Medical Workforce Advisory Committee, (1999).Mental health workforce: Supply of psychiatrists, Retrieved 22nd April, 2009 from http://www.nhwt.gov.au/documents/Mental%20Health%20Workforce%20Activities/MHWAC%20Supply%20of%20psychiatrists.pdf
Bandura, A. (1977). Social Learning Theory. New York: General Learning Press.
Bates, A. (1997). Restructuring the university for technological change. The Carnegie Foundation for the Advancement of Teaching What Kind of University? . Retrieved 23rd March, 2009 from http://bates.cstudies.ubc.ca/carnegie/carnegie.html.
Boud, D. (1998). Assessment and learning – unlearning bad habits of assessment. Paper presented at the 'Effective Assessment at University' . Retrieved 10th April, 2009, from http://www.tedi.uq.edu.au/TEN/TEN_previous/TEN2_99/ten2_boud.html.
Boutwell, R. A. (1977). Medical education and instructional design. In L.J.Briggs (Ed.), Instructional design: principles and applications (pp. 423-439). Englewood Cliffs, New Jersey: Educational Technology Publications.
Bramucci, R. (2003). Instructional design for education and its assessment. Retrieved 31st March, 2009 from http://www.cogsim.com/idea/default.htm.
Brown, J.S., Collins, A. & Duguid, S. (1989). Situated cognition and the culture of learning. Educational Researcher, 18(1), 32-42.
Burton, J. K., & Merrill, P. F. (1977). Needs assessment: goals, needs and priorities. In L. J. Briggs (Ed.), Instructional design: principles and applications (pp. 21-48). Englewood Cliffs, New Jersey: Educational Technology Publications.
Carroll, J.M. (1998). Minimalism beyond the Nurnberg Funnel. Cambridge, MA: MIT Press.
Cawte, J.,(1974). Medicine is the law. Honolulu, University of Hawaii Press.
Ceraulo, S. C.(nd). Instructional Design for Flow in Online Teaching, The Art of Instructional Design. eLearn Magazine from http://www.elearnmag.org/subpage.cfm?section=tutorials&article=14-1.
Clark, D. (2006). Instructional system design handbook Retrieved 28th March, 2009 from http://www.nwlink.com/~donclark/hrd/sat.html
Daigre, R. M. (nd). Instructional analysis,: analyzing the learners. Retrieved 28th March, 2009, from http://www.angelfire.com/la2/learners/learners.html.
Der-Thanq, C., Hung, D., & Wang., Y. M. (2007). Educational design as a quest for congruence: The need for alternative learning design tools. British Journal of Educational Technology, 38(5), p876-884.
Dougiamas, M. (1998). A journey into Constructivism. Retrieved on 15th April, 2009 from http://dougiamas.com/writing/constructivism.html.
Edstrom, K . (2008). Doing course evaluation as if learning matters most. Higher education research and development 27(2)pps 95-106
Fitzgerald, G. E., Allen, B. L., & Reeves, T. C. (1999). A scholarly review process for interactive learning and information system products. Journal of Interactive Learning Research, 10, 59-65 from http://usqstudydesk.usq.edu.au/mod/resource/view.php?id=93498.
Florida Gulf Coast University (nd). Instructional & audience analysis 1.1 Retrieved 28th March, 2009 from http://www.fgcu.edu/onlinedesign/designdev.html
Freeman, R.E. (!994) The stakeholder theory of the modern corporation in Tom L Beauchamp, Norman E Bowie (Eds) Ethical Theory and Business, 7th ed, 2004, USA: PearsonPrentice Hall.
Gagne, R. M., Briggs, L. J., & Wager, W. W. (1992). Principles of Instructional Design (fourth ed.). Fort Worth: Harcourt Brace Jovanovich College Publishers.
Geneva Foundation for Medical Education and Research, (2008) Geneva Foundation for Medical Education and Research, 2008, Retrieved 25th March, 2009 from http://www.gfmer.ch/Medical_search/Countries/Vanuatu.htm
Gokhale, A. A. (1995). Collaborative Learning Enhances Critical Thinking. Journal of Technology Education, 7. Retrieved 5th September, 2007 from http://scholar.lib.vt.edu/ejournals/JTE/jte-v7n1/gokhale.jte-v7n1.html.
Harasim, L., Hiltz, S. R., Teles, L., & Turoff, M. (1995). Designs for learning networks. In Learning networks: A field guide to teaching and learning online (pp. 125–144.). Cambridge, Massachusett:: The MIT Press.
Ingleton, C., Doube, L., & Rogers, T. (n.d.). Leap into Collaborative Learning.. University of Adelaide Centre for Learning and Professional Development Retrieved 22nd May, 2009 from http://www.adelaide.edu.au/clpd/materia/leap/leapinto/CollaborativeLearning.pdf.
International Board of Standards for Training, Performance and Instruction, (2000). IBSTPI instructional design competencies. Retrieved 23rd March, 2009 from http://www.ibstpi.org/Downloads/InstructionalDesignCompetencies.pdf
Jilek, W.G. & Draguns, J.G (2008) Interventions by traditional healers: their impact and relevance with therpies and beyond. In Gielen, UP. Dragun, JG & Fish, JM (Eds) Principles of multicultural counseling and therapy . New York, London, CRC Press, Routledge, Chapter 14, pps 353-372
Jonassen, D. H., Hannum, W. H., & Tessmer, M. (1989). Handbook of task analysis procedures. New York, Westpoint, Connecticut, London: Praeger Publishers.
Jonassen, D. H., Tessmer, M., & Hannum, W. H. (1999). Task analysis methods for instuctional design: Lawrence Erlbaum Associates.
Kaplan, B.J. & Sadock,V.A.,(2009). Comprehensive textbook of psychiatry, 9th Edn, 2 volumes, Philadelphia, PA, Lippincott, Williams & Wilkins Publishers.
Kay, R.H. & Knaack, L (2009). Assessing learning, quality and engagement in learning objects: the Learning Object Evaluation Scale for students, Education Tech Research Development 57. pps. 147-168.
Lave, J., & Wenger, E. (1990). Situated Learning: Legitimate Periperal Participation. Cambridge, UK: Cambridge University Press.
Learning Theories Knowledgebase, (2009). Elaboration Theory (Reigeluth). Retrieved 10th April, 2009 from http://www.learning-theories.com/elaboration-theory-reigeluth.html.
Louie, A.K., Weiss Roberts, L .& Coverdale, J. (2007). The enculturation of medical students and residents. Academic Psychiatry, American Psychiatric Publishing Inc., 31, pps 253-257.
McGriff, M. (2001). Instructional System Design (ISD): Using the ADDIE Model Retrieved 23rd March, 2009 from http://ehopac.org/TransformationReports/ISD-ADDIEmodel.pdf.
McLoughlin, C., & Oliver, R. (1999). Instructional Design for cultural difference: a case study of the Indigenous online learning in a tertiary context. Retrieved 10/3/2009, from http://www.ascilite.org.au/conferences/brisbane99/papers/mcloughlinoliver.pdf.
Mergel, B. (1998). Instructional Design & Learning Theory. Retrieved 23rd March, 2009 from http://www.usask.ca/education/coursework/802papers/mergel/brenda.htm.
Moss, J, Teshima, J & Leszcz, M (2007) Peer group mentoring of junior faculty Academic Psychiatry, American Psychiatric Publishing Inc., 32 pps 230-235.
Myers, I & Briggs, P.B. (1995) Gifts Differing:Understanding Personality Type. Mountain View, CA. Davies-Black Publishing.
National Learning Infrastructure Initiative (EDUCAUSE), (2003) Supporting Learning Through Technology,. In NLII Annual Review: The New Academy (pp. 10-11).
Nelson, E.T. (2009). The conversion of traditional course material to the online learning format. Reviewed 4th May, 2009 from http://www.eric.ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/43/58/94.pdf
Oliver, R. (2002). A teaching and learning perspective on learning objects. Retrieved 10th April, 2009 from http://elrond.scam.ecu.edu.au/oliver/2002/ncodepaper.pdf.
Pretorius, R.W., Milling, D.A. & McGuigan, D. (2008) Influence of a rural background on a medical student's decision to specialize in family medicine. International Electronic Journal of Rural and Remote Health, Research, Education, Practice and Policy. Retrieved on 25th April, 2009 from http://www.rrh.org.au/articles/subviewnthamer.asp?ArticleID=928
Pask, G. (1975). Conversation, Cognition, and Learning. New York: Elsevier.
Raven, J.C. (1936) Mental tests used in genetic studies: The performance of related individuals on tests mainly educative and mainly reproductive. Msc Thesis, University of London.
Reushle S., Dorman, M., Evans, P., Kirkwood, J., & McDonald, J. (1999). Critical elements :designing for online teaching. Paper presented at the ASCILITE99 Responding to Diversity: 16th Annual Conference of the Australasian Society for Computers in Learning in Tertiary Education,. Retrieved 10th April, 2009, from http://www.ascilite.org.au/conferences/brisbane99/papers/reushledorman.pdf
Rohse, S., & Anderson, T. (2006). Design patterns for complex learning Journal of Learning Design, 1, 82-91. Retrieved 28th March, 2009 from http://www.jld.qut.edu.au/.

Rouda, R. H., & Kusy, M. E. (1995). Needs assessment: The first step. Retrieved 28th March, 2009 from http://www.alumni.caltech.edu/~rouda/T2_NA.html.
Rowntree, D. (1992). Evaluating open learning. In Exploring open and distance learning (pp. 203-231). London: Kagan Page.
Russell, R.S. & Taylor, B.W. (2000). Operations management. Third Ed. New Jersey: Prentice Hall Inc.
Ryder, M. (2008). Instructional design models. Retrieved 23rd March, 2009 from http://carbon.cudenver.edu/~mryder/itc_data/idmodels.html.
Scriven, M. (2007) The logic and methodology of checklists. Retrived 27th April, 2009 from http://www.wmich.edu/evalctr/checklists/papers/logic&methodology_dec07.pdf
Siemens, G. (2002). Instructional Design in Elearning . Retrieved 23rd March, 2009 from http://www.elearnspace.org/Articles/InstructionalDesign.htm.
-(2005). Learning development cycle: Bridging learning design and modern knowledge needs. Retrieved 10th April, 2009 from http://instructor.aviation.ca/content/view/130/71/.
Smith, M. K. (2002) 'Malcolm Knowles, informal adult education, self-direction and anadragogy', The encyclopedia of informal education, www.infed.org/thinkers/et-knowl.htm.
-(1997, 2004) 'Carl Rogers and informal education', The encyclopaedia of informal education. [www.infed.org/thinkers/et-rogers.htm.
Sorden, S. D. (2005). A Cognitive Approach to Instructional Design for Multimedia Learning Informing science journal, 8(20).
Stufflebeam, D. (2007) IPPevaluation model checklist. Retrieved 27th April, 2009 from http://www.wmich.edu/evalctr/checklists/cippchecklist_mar07.pdf
Sweller, J., van Merrienboer, J. J. G., & Paas F.G.W.C. (1998). Cognitive Architecture and Instructional Design. Educational Psychology Review, 10(3), 251-296.
Tattersall, C., Janssen, J., van den Berg, B., Hummel, H., & Koper, R. (2007). Using IMS Learning Design to Model Curricula. Interactive Learning Environments, 15(2), 181-189.
Trochim, W. M. K. (2006). Introduction to evaluation. Research Methods Knowledge Base. Retrieved 27th April, 2009 from http://www.socialresearchmethods.net/kb/intreval.php .
University of Tasmania,(nd). Project evaluation toolkit. Taken from Phillips, R., Bain, J., McNaught, C., Rice, M. & Tripp, D., (2000). Handbook for learning-centred evaluation of computer facilitated learning projets in higher education. Retrieved 2nd May, 2009 from http://www.utas.edu.au/pet/sections/developing.html
Vanuatu Tourism Board, (nd) About Vanuatu Retrieved, 25th March, 2009 from http://www.vanuatutourism.com/vanuatu/cms/en/vanuatu.html
Wenger, E., & Snyder W. (2004). Learning in Communities. LineZine. Retrieved 12th April, 2008 from http://www.linezine.com/1/features/ewwslc.htm.
Western Michigan University Evaluation Center. (2002). Evaluation checklist project. Retrieved 27th April, 2009 from http://www.wmich.edu/evalctr/checklists/
Wilson, B., Jonassen, D., & Cole, P. (1993). Cognitive Approaches to Instructional Design. In G. M. Piskurich (Ed.), The ASTD handbook of instructional technology (pp. pp. 21.21-21.22). New York: McGraw-Hill.
Zolezzi, M. & Blake, A. (2008) Principle -based learning design for an online postgraduate psychiatric pharmacy course. American Journal of Pharmaceutical Education 72(5). Retrieved 25th April, 2009 from http://www.ajpe.org/aj7205/aj7205107/aj7205107.pdf


Appendix 1









Appendix 2
Questionairre for General Practioners with respect to needs in mental health education.
Do you have many psychiatric problems in your practice?
Do you need more knowledge to manage mental health problems in your practice?
Have you been to any conferences in Psychiatry? If so, list them please.
Which areas do you want more knowledge in ( tick those applicable)
Psychoses Mood disorder
Personality disorders Child and adolescent psychiatry
Geriatric Psychiatry Forensic Psychiatry
Social psychiatry Consultation liaison psychiatry
Assessment Diagnoses
Pharmacotherapy Psychotherapies
Technology questions
Do have have access to a computer at home?
Have you used a computer in the past?
Have you used the Internet?
Have you used computer aided learning in the past?
Have you used the Internet to talk to friends, family or at work?
If so, what programs have you used ( eg Facebook, MSN Chat, Skype?).
If you have answered No to all of the above, would you use a computer ever?



APPENDIX 3
Module 1 Introduction
Module 2 Bio/psycho/social/spiritual; systems theory; classificatory systems
Module 3 Psychosis
Module 4 Neuroses
Module 5 Old age psychiatry
Module 6 Child and Adolescent Psychiatry
Module 7 Forensic Psychiatry
Module 8 Medical/ Psychiatry; Consultation liaison; Substance abuse disorder; Toxic confusional states
Module 9 Medications
Module10 Electroconvulsive therapy
Module 11 Psychotherapies
Module 12 Social theory
Module 13 Prevention strategies
Module 14 Self help



Appendix 4
Proposed prototype
Module 2 Multiaxial diagnoses.
Choose a language for audio reading
English French Bislama

There are three objectives of this module:
-Understanding of the bio/psycho/social/spiritual aspects of patients
-Understanding formulation and
-Understanding the mulit-axial classification of psychiatry.
Aims of the module
-Authentic learning for the real patient/ clinician interventions.
-Communication across disciplines and roles.
-Ability to understand research and further education in psychiatry.
-Holistic assessment and treatment planning to provide culturally specific care of a patient and his community.
Introduce yourselves and have a chat
Discussion board

2: 1 Bio/ psycho/ social/ spirtual.

People are complex. If we think about them as people who live in families and communities but also suffer illness as a unique experience within themselves we can start to evaluate, diagnose and treat them holistically.
We often say things like 'have you seen the liver in Bed 14?'
We know what we mean but we disembody that liver. We fail then to think about the effect of the family, occupation, community and the other body systems and what that liver mean to that person. The liver effects all these parameters but they also effect the liver. This is called systems theory. We have a hepato-biliairy system, a body and mind, a social and family sytem, a community and occupational system, a spiritual system and even a universal system.
Can you name some other systems?
Add your systems here:

Discussions









BIO/ PSYCHO/ SOCIAL/ SPIRITUAL Figure 1.

Here is a short interview with a patient. Think about the biological, psychological, social and spiritual aspects of this patient
Add video clip here
Video clip

Describe your assessment of the Bio/ psycho/ social/ spiritual aspects of this person here.
Discussions

Some of my thoughts
Biological
Psychiatric diagnosis
Medical diagnoses- past, present, future
Substances, alcohol, drugs prescribed medications or illicit, toxins
Psychological
Resiliance factors
Developmental, trust, love, friendships, dependency, personality
Intelligence, communication style
Schemas, cognitive style
Traumas, losses
Social
Family, children? Marriage ?
School., occupation, legal issues
interests and hobbies
Culture, language
Spiritual
Concepts of support, death, social interaction, responses to illness, incorporation in illness ( ie delusions and hallucinations)
If you would like to read more about this concept you might like to start here:
Reading list

Multiple Choice Test- 1

2.2 Formulation
When we think about patients it is wise to ask why is this person here? Why are they here now? We again use systems thinking. We use the Bio/ Psycho/ Social/ Spiritual ideas in 2.1 and we can frame them in these systems:
Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors
Prognosis.
Take a look at this video of a patient and think about the framework of all the 5 Ps.


Video clip

Add your thoughts here

Discussions

Some of my thoughts
Predisposing
Genetic influences, illness.
Development and early childhood input
Oldest, middle, youngest child?
Family illness, medical psychiatric
Role of child in family (scapegoat, parent, outsider, splitting)
Personality development
Traumas, losses and life events
Intelligence
Precipitating
Substances
Medical illness
Phase of life. Adolescent, midlife, retirement.
Emotional trauma, death or loss of relationship, in trouble with law, unemplyment, financial crisis, conflict at home, work
Perpetuating
Insight, compliance, rapport
family support, social network
finances
work
past history of illness
Protective factors
Bio- psychiatric diagnosis, medical fitness, wish to be healthy
Psycho- personality structure is mature with mature defense mechansisms, intelligence, communication style, self-esteem and self-confidence
Social- good family and social network, working, financially stable, access to care,
Spiritual- supports mental illness, treatment and indivudual, support network.
Prognosis
I would look at the bio/ psycho/ social/ spiritual aspects of prognosis.
Multiple Choice-2

2.3. Multi-axial diagnosis
The final topic to consider is the DSM-IV multi-axial diagnosis. The previous topics, Bio /psycho/social/ spiritual and the 5 P's will help you with this.There are five axes of diagnosis and they reflect a whole person assessment. This then helps with a whole person treatment, using a problem oriented approach.
Axis I
Psychiatric diagnosis.These are all found coded in the DSM-IV handbook.The modules following this one will look at these in more detail. So if the patient has schizophrenia, Bipolar I disorder, Substance abuse disorder, Obsessive compulsive disorder for example, this is placed here.

Axis II
Assessment of personality traits or disorders. This gives us evidence of predisposing and protective factors as well as psychological level of functioning. The disorders are all coded in DSM-IV. If a patient has an anxious personality, Borderline personality disorder or has narcissistic persoanlity disorder, this is important information and is coded here. Clearly these psychological problems will interact with the psychiatric illness in terms of symptoms, behaviour, compliance and outcomes.
This axis also addresses intellectual capacity. If the patient has an intellectual or developmental delay, this is the place to code it. This also affects all levels of assessment, diagnosis, treatment and outcomes.
Axis III
Medical diagnosis. Because many pscyhiatric diagnoses are secondary to medical problems, and vice versa, the mind/body interface is coded here. It allows us to think about the biological aspects of diagnosis and also treatment.

Axis IV
Development and social aspects that are relevant to the diagnosis. The formulation is abbreviated and summarised here. Information about the predisposing, precipitating and perpetuating features are discussed.
Axis V
Global assessment of functioning (GAF)
A score between 0 and 100 is given. 100 implies no problems. We usually use a range,
for example 51-60 means that the person is seriously unwell, suicidal, unlikely to be able to work and causing severe disruption in the family home.
The DSM-IV will give you the full scale.
Click here for access to DSM-IV
http://books.google.com.au/books?id=3SQrtpnHb9MC&dq=DSM-IV&printsec=frontcover&source=bl&ots=XcI2Q1qC1E&sig=Fs8cpHgJsm1IcGf-QBUOePsjK_M&hl=en&ei=lvPKSf2xMcGTkAXhsbTgCQ&sa=X&oi=book_result&resnum=8&ct=result
Consider this short video of a patient and think about the five axies of diagnosis for him.
Video clip

Axis I
Psychiatric diagnosis
Axis II
Development/ personality and intellectual disorder
Axsi III
Medical diagnosis
Axsi IV
Revelant social and Predisposing, Precipitating and Perpetuating aspects of the patient.
Axis V
General Assessment of Functioning(GAF)
Discuss your diagnoses here.
Discussions

You now have the tools to assess patients, diagnose them and design treatments around the problems that they have. These diagnoses become meaningful methods of communication with the patient, their family and other practionioners in mental health. DSM-IV and ICD-10 are the international classification of psychiatric disorders so you will be able to communicate on the international front and read research from all the psychiatric journals.
Further reading:
Reading list

Multiple choice- 3

Feedback form for evaluation- please send this form back so that we can make the learning better for you and your fellow practitioners- Thank you.

The people's revolution

Government's have taken liberties for which they were not elected. This problem is a global one across many nations and historical periods. They have declared war; bailed out car manufacturers, or not; set carbon emission targets; detained refugees and set Internet filters to censor information to name a few. They have done deals with large enterprises, other governments, international organisations, NGOs and lobbyists.

The partisan approach to government and politics has created an old boys club that punishes 'conscience voting' or crossing the floor. This is hardly representative democracy and unlike the system in Switzerland where each issue is independently voted for by each adult entitled to vote. Politicians are not given individual or independent votes but fully represent their electorate.

Australians wouldn't like weekly voting though. In this time of electronic and technical revolution, a voting system can be easily, inexpensively and automatically be generated so that each person has their democratic right and input to government and legislature changes.
The social networking of Web2.0 can provide a people's revolution.

Governments can then become agents of the people's needs rather than dictatorial and abusive. There is of course a long history of state abuse of individuals, from early history, slavery to genocide, Robert Mugabe, Hitler, unwanted wars, George W Bush, John Howard and Blair, political prisoners as in Guantanamo Bay, Gulags, torture and other abuses of civil rights. Sadly the system of electioneering, as seen in the recent USA debates and federal election system, promotes the aggressive, sociopathic political animal. In this way we do not elect the right people to government. We do not elect people based on their intelligence, academic record, problem solving ability, essence of moral justice or sense of caring. We elect people who are good at rhetoric and are set up by corrupt systems. It is only if you learn to play the game that you progress.

Idealistic people who care are soon destroyed by the current political system. Green groups have quickly been burnt by their idealism in combat with political systems such that one has to join them to beat them.

People have power however, not just over their individual rights but also en masse they have the power to revolution and of their vote. The revolution is gaining groundswell as information and communication provides cohesion. The common man is not happy to have his economy manipulated, his taxes paying large greedy corporations, his children's future destroyed by economic rather than environmental needs. The grass roots revolution has immense power and is only just starting to flex its muscle.