Figure 1. OPEN Website will house all eLearning modules. Figure 2. CPD modules currently in development. Figure 3. Graphics narrative style is used in the unfolding clinical scenario.

http://www.womenscollegehospital.ca/Education-and-Training/OPEN

The Online Psychiatric Education Network: Building capacity within communities through eLearning for physicians, health care practitioners & patientsValerie Taylor1,2, Leila Lax3, Renu Gupta1,2, Qingyang Chen3, Dana Ross1,2, Robin Mason1,2 & Sanjeev Sockalingam1,4

1Department of Psychiatry, Faculty of Medicine, University of Toronto, 2Women’s College Hospital, 3Biomedical Communication, University of Toronto, 4University Health Network, Toronto, ON, Canada

INTRODUCTION

METHODS

OUTCOMES

DISCUSSION & FUTURE RESEARCH

Access to mental health care has been identi!ed as a critical health concern1. One way to address this issue is by building community capacity through continuing professional development eLearning opportunities for family physicians and other health care providers.

To this end an interdisciplinary partnership was formed between the Department of Psychiatry at Women’s College Hospital (Dr. Valerie Taylor) and the Masters Program in Biomedical Communications (Dr. Leila Lax) at the Institute of Medical Science, Faculty of Medicine, University of Toronto, to create and evaluate an educational intervention, the Online Psychiatric Education Network (OPEN) (!g.1). The aim of OPEN is to improve the quality of care delivered, reduce costs, and overcome challenges in the current system. 

Accessing specialty mental health care can be challenging for a variety of reasons: heavy caseloads, lack of specialist services for referrals, providers with limited time, and insu#cient training and skills in managing mental illnesses1. One solution is to enable a variety of mental health practitioners (e.g. family physicians, community psychiatrists, front line support workers) to provide appropriate mental health care through up-to-date CPD educational opportunities. A cost-e$ective, e#cient, easily-accessible way to accomplish this is through the development of interactive eLearning modules, designed to o$er innovative, evidence-based training that can be systematically evaluated to ensure it is a useful resource2-4. eLearning has been identi!ed as a priority by the Mental Health Commission of Canada and was the focus of the 2014 brie!ng document5.

To create a web-based educational portal, known as the Online Psychiatric Education Network (OPEN) that will serve as an eLearning platform to improve provider knowledge about the care of mental health issues.

To design and evaluate a series of continuing education eLearning modules for health care professionals’ knowledge building and translation to practice.

OPEN addresses a clear need. In Canada, 35% of family doctors rated access to psychiatrists as poor, compared with 4% for access to internal medicine specialists and 2% for access to pediatricians. Access quickly worsens if there is a need for intradisciplinary subspecialty care as required for trauma, eating disorders or medical psychiatry6. This results in a reliance on family doctors, general community psychiatrists, and di$erent community mental health workers from a variety of backgrounds.

Online training modules have been successfully used in mental health in areas as varied as training residents to improve their ability to communicate with clients with addictions7 to providing mindfulness-based therapy instruction to community based nurses8. OPEN will o$er a range of courses to increase capacity and empower front line health care providers to deliver improved patient care. 

OPEN is grounded in Mayer’s theory of multimedia learning9 and Scardamalia & Bereiter’s10 theory of knowledge building. These educational theories are foundational to the eLearning design strategies for continuing professional development, created by Lax and colleagues4,11, that are employed in OPEN. Multiple media, i.e. text, graphics, animations, illustrations, videos, etc. are used to sca$old knowledge building and translation11, while enabling higher levels of !delity in case representation and demonstration of professional practice nuances.

A mixed methods evaluation will be conducted with health practitioners to evaluate content, usability, interaction, and educational design of each module. A formative and iterative design research approach will be used throughout development and implementation12. With additional funding full project feasibility, educational impact, e$ect on practice and process improvements will be investigated as this initiative grows over time13,14.

OPEN was created to support the vision of the Mental Health Commission of Canada speci!cally through the strategic direction of “mobilizing leadership and fostering collaboration” 15. OPEN eLearning is designed to enable CPD for family physicians, interprofessional education and information for patients and their families. CPD modules are currently being developed in the following thematic areas: (i) anorexia nervosa, (ii) co-morbid trauma, and (iii) antenatal depression (!g.2).

Psychiatry cases are highly nuanced and therefore pose particular design challenges for eLearning. To address these challenges the OPEN Model employs a patient-centred focus, rendered narratives and various visualization styles, such as graphic medicine for case design16. OPEN cases were written to highlight the patient voice and perspective, instead of the doctor’s. Patient-centred graphic design enabled the rendering of: Explicit dialogue between patient and doctor & Hidden narratives, i.e. thoughts that remain unexpressed by the patient and the doctor (!g. 3).

Clinical case scenarios unfold temporally through graphic drawings and narratives. This vehicle allows for the display of both patient and physician actions, dialogue and the rendering of things left unsaid - thoughts and concerns that remain hidden within the interaction that must necessarily be made explicit in the identi!cation, assessment and management of mental health.

In 2012, the Mental Health Commission of Canada released Changing Directions, Changing Lives: The Mental Health Strategy for Canada which highlights the, “...tremendous possibilities for new technology in promoting mental health and preventing mental health problems15. The OPEN project takes an innovative approach to eLearning within the !eld of psychiatry to positively impact the system by building capacity and improving access to care. Future KT and outcomes research on OPEN module implementations will evaluate impact.

1. Gamm L, Stone S, Pittman S. Mental health and mental disorders-a rural challenge: a literature review. In: Gamm L, Hutchison L, editors. Rural healthy people 2010: a companion document to healthy people 2010. 2nd ed. College Station (TX): The Texas A&M University System Health Science Center, School of Rural Public Health, Southwest Rural Health Research Center; 2003. ρ 97-113.2. Titov N, Andrews G, Davies M, McIntyre K, Robinson E & Solley K. Internet treatment for depression: a randomised controlled trial comparing clinician vs. technician assistance. PLoS ONE, 2010:5(6).3. Andrews G, Cuikpers P, Craske M.G, McEvoy P & Titov N. Computer therapy for the anxiety and depressive disorders is e$ective, acceptable and practical health care: a meta-analysis. PLoS ONE, 2010:5, e13196.4. Lax LR, Russell ML, Nelles LJ, & Smith CM. Sca$olding Knowledge Building in a Web-based Communication and Cultural Competence Program for International Medical Graduates. Academic Medicine. 2009;84(10 Suppl)S5-S8. DOI: 10.1097/ACM.0b013e3181b37b4d5. Mental Health Commission of Canada: E-technology Brie!ng document6. Section D: Patient access to care. In: National Physician Survey: 2010 national results by FP/GP or other specialist, sex, age, and all physicians. Mississauga (ON): National Physician Survey; 2010. Available from: http://www.nationalphysiciansurvey.ca/nps/2010_Survey/Results/physician1-e.asp7. Lanken PN, Novack DH, Daetwyler C, Gallop R, Landis JR, Lapin J, Subramaniam GA, Schindler BA. E#cacy of an Internet-Based Learning Module and Small-Group Debrie!ng on Trainees' Attitudes and Communication Skills Toward Patients With Substance Use Disorders: Results of a Cluster Randomized Controlled Trial. Acad Med. 2014 Oct 7. 8. Krusche A, Cyhlarova E, Williams JM. Mindfulness online: an evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression. BMJ Open. 2013 Nov 29;3(11):e003498. 9. Mayer, RE. Cognitive Theory of Multimedia Learning. In: RE Mayer (Ed.), The Cambridge Handbook of Multimedia Learning. Cambridge University Press, 2002. pp33-47.10. Scardamalia M & Bereiter C. Knowledge Building. In: JW Guthrie (Ed.), Encyclopedia of Education. 2nd edition. New York: Macmillan Reference, USA. 11. Lax L, Watt-Watson J, Lui M, Dubrowski A, McGillion M, Hunter J, MacLennan C, Knickle K, Robb A & Lapeyre J. Innovation and Design of a Web-based Pain Education Interprofessional Resource. Pain Research and Management, Journal of the Canadian Pain Society, Nov/Dec 2011, 16(6):427-432. Available at (Original Articles #2): http://www.pulsus.com:80/journals/toc.jsp?sCurrPg=journal&jnlKy=7&isuKy=1003 12. Bereiter C. Design Research for Sustained Innovation. Cognitive Studies, Bulletin of the Japanese Cognitive Science Society, 2002:9(3), 321-327. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.199.9222&rep=rep1&type=pdf 13. Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. JAMA. Internet-based learning in the health professions: a meta-analysis.2008 Sep 10;300(10):1181-96.14. Retrieved from http://www.ucdmc.ucdavis.edu/cme/course_chair_forms/Assessment-Evaluation-Framework-101613.pdf).15. Mental Health Commission of Canada. (2012). Changing directions, changing lives. The mental health strategy for Canada. Calgary.16. Green MJ & Meyrs KR. Graphic Medicine: Use of comics in medical education and patient care. BMJ. 2010 Mar 13;340: 574-577.

Contactvalerie.taylor@wchospital.ca or l.lax@utoronto.ca

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Purpose & Partners

Rationale

Project Objectives

Educational Design

OPEN Model

References

Research Design

Patient-Centered Focus, Rendered Narratives & Graphic Case Design

Qingyang Chen