The learning design involves students conducting a simulated clinical interview. The main resource is an interactive multimedia program.The Learning Design Sequence is illustrated as follows.

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WHAT THE STUDENTS DO
Students can elect to complete a short introductory tutorial or jump straight into an interview with a patient. The tutorial provides students with information about the goals of a good clinical interview and some of the barriers to good communication in a clinical setting. This summarises some of the material covered in the early Introduction to Clinical Medicine face-to-face tutorials.

After a brief explanation of how to conduct an interview using the program, students are required to select a doctor to role-play and a patient to interview.

After selecting the doctor and the patient students embark on a simulated interview. The format of this interview and the interactions of the user are as follows:

1. The user listens to up to four audio options comprising questions the doctor could potentially ask the patient. The questions may be similar or different in terms of both content and the microskills involved.
2. The user selects what he or she believes to be the most appropriate question given the current state of the interview.
3. After selecting a question, the patient responds via an audio/visual display (QuickTime®).
4. After viewing the patient's response the user can choose to:
   1. Go back and select a different doctor question on the basis of the patient's response;
   2. Replay the patient's response for a more thorough examination; or
   3. Continue his or her interview.
5. After each doctor-patient interaction, expert "Comments and Questions" are presented in a window. Users are challenged to reflect on the last doctor-patient interaction and are asked to make notes in a window provided. Terms that may be unfamiliar to students in the "Comments and Questions" are hyperlinked to a floating glossary window. Users may also review the doctor/patient interaction at this stage. When users have finished their notes they continue their interview.
6. As users progress through their interview they are able to view a transcript of the interview at any time. The transcript allows users to review the questions they have asked, the patient's response, the expert comments made and their own notes. In addition, users can review each "doctor/patient" interaction by launching individual QuickTime® movies from the transcript.
7. At the conclusion of the interview users are presented with an interview summary which details the biopsychosocial issues raised as well as the clinical diagnosis of the patient condition.
8. Users are encouraged to complete a second interview and to consider alternative questioning strategies.

When students have completed one interview, an additional feature of the program is made available to them. Students are able to access a library of audio/video resources which exemplifies the microskills and interview techniques which may have surfaced in their interview. The resources are linked to the glossary and are usually accompanied by a small challenge or problem exercise that students are asked to complete.

SIGNIFICANCE OF ORDER
The program is designed to be integrated with face-to-face tutorials on clinical interviewing and students have some introduction to clinical interviewing in this environment before using the program. The students are asked to use the program after they have completed the third of ten ICM tutorials.

The program itself is designed to be relatively flexible and open, with users determining the sequence of their activities. As a result there are few restrictions on students within the interview. This notwithstanding, at a macro level students are only allowed to access the “library of microskills” after they have completed at least one interview. Access to the library is initially limited to encourage students to complete an interview and to encounter microskills in the realistic context of a clinical interview. Given this, students are able to access specific components of the library as they encounter particular microskills through the course of their first interview. This design feature prevents students from simply scrolling through each microskill listed in the library in order to “learn” interview skills.

CRITICAL ACTIVITIES
Face-to-face tutorials are a critical activity that support the use of the program.

There are three components to the program itself:

1. Introductory Tutorial
2. Clinical interviews
3. Library of Microskills

The clinical interviews are the backbone to the program and to a certain extent are supported by the introductory tutorial and the library. While the tutorial and library may be seen as optional for some students (depending on their interests and needs), they should not be considered optional implementations.

ACCESSIBLE RESOURCES
The program itself is a self-contained self-directed learning resource which supports a broader curriculum.

The two resources depicted in the Learning Design Sequence are the doctor-patient audio-visual couplets and the transcript of the interview. As they progress through the interview students generate and accumulate a series of discrete doctor-patient interactions. These are available for students to review at any stage of their interview and are therefore regarded as a resource. The transcript, which includes both links to the AV couplets, expert comments and the student’s reflections, is also available for review.

RESOURCES IN CONTEXT
The resources are designed to be important in two ways. First, they are self-generated and therefore seen to be intrinsically meaningful to students. Second they are designed to promote reflection.

VARYING THE RESOURCE SET
This is not really applicable given the self-contained nature of the program.

SUPPORTS SUPPLIED
The broader curriculum in which the program is embedded, particularly the Introduction to Clinical Medicine (ICM) subject stream is a support. Students are encouraged to discuss their learning outcomes after they have used the program with their ICM tutor. Before conducting an interview students are able to complete an Introductory Tutorial which is also regarded as a type of support. The resources commented upon above are a third means of student support.

The Learning Design Sequence specifies four types of support in addition to those mentioned above:

1. glossary;
2. library;
3. expert comments and questions;
4. interview summary.

SIGNIFICANCE OF SUPPORT STRATEGIES
This significant aspect of the design of the glossary and the library is that students are not directed to these aspects of the program; rather students needs and interests determine how and when the glossary and the library are accessed and used. The expert comments support students by helping them focus their attention on issues associated with both clinical diagnosis and the use of microskills in clinical interviews. Expert questions are generally open-ended, again in an effort to encourage students reflect on their interview and interviewing skills. The interview summary attempts to offer students some closure on the patient case they have encountered.

SUPPORT STRATEGY ADAPTATION
This is not really applicable given the self-contained nature of the program. The support that is given to students is critical in this relatively open learning design and is therefore not regarded as optional. Students’ activities need to be supported (or “scaffolded” to use the jargon) but not directed. A balance between student support and student-directedness was a key factor in the development teams design of the four forms of support and the timing of students’ access to them. Clearly these supports could be modified in a variety of ways to suit other contexts and/or learning designs.