The Associate Fellowship in Integrative Medicine is a 2-year distributed learning program that relies heavily on a threaded dialogue system to build and maintain community among our 44 physician-participants. Six months into the first class of Fellows, the dialogue system contains more than 30 separate dialogues resulting in more than 3,200 unique postings. Although each dialogue itself is a standard format, but we have found that by framing the entrance into the dialogue and carefully moderating the ongoing interaction within the dialogue, we can greatly impact the nature and quality of the interactions between participants.

Different strategies for presenting the dialogues result in different types of interactions between learners. Depending on how a dialogue is setup, learners may feel ownership over a particular domain of information,or they may look to the faculty expert for advice. Some dialogues focus more on debating controversial issues, others on sharing clinical information, and yet others on sharing personal experience. Diversity across these dialogues helps, we believe, keep our learners engaged and motivated to participate.

* Debate-style dialogue where learners must take a position on a topic and justify that position before entering the dialogue.

* Clinical sharing where learners answer structured questions in order to tell a story about a particular patient. These stories serve as the springboard for a collegial, focused discussion.

* Research projects where learners report on a given topic and their reports feed into the top level of a dialogue, making them the 'expert' on their report topic.

* Small group projects where learners collaborate in a small dialogue to compile and discuss information they've gathered on a topic, then they report their findings to a large group dialogue and can view and discuss their colleagues' reports.

* Article-based dialogues where thought-provoking questions based on readings are posed by a faculty expert, who then closely moderates the resulting discussion.

* Informal "watercooler" dialogues where learners share resources,information on conferences, discuss related current events, and request advice from their colleagues and program faculty.

* "Post and consult" dialogues where Learner A poses a clinical situation,and Learner B proposes an approach to that situation. Learner A's clinical situation becomes a top-level posting; Learner B's response becomes a reply to that posting and then faculty and other learners can add their commentary below.

* Case conference-style dialogue where the top-level posting is a robust patient story and learners discuss the patient cases among themselves and faculty.

Notes from this presentation will be available at:http://integrativemedicine.arizona.edu/dialogues/