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Schaper K, Woelber JP, Jaehne A. Can the spirit of motivational interviewing be taught online? A comparative study in general practitioners. PATIENT EDUCATION AND COUNSELING 2024; 125:108297. [PMID: 38728998 DOI: 10.1016/j.pec.2024.108297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Motivational Interviewing (MI) is an evidence-based approach to enhance patients' motivation and is increasingly in demand in medical practice. Online teaching methods offer advantages to train health care professionals, but only very few studies examined whether MI-specific interviewing skills (""MI-skills""), and especially MIspecific attitudes (the "MI-spirit"), can be taught online and whether learning gains differ from those in face-to-face courses. This study compared the effects of 7 h of basic training for experienced general practitioners (GP) in either an online or a traditional face-to-face format with a non-trained control group. METHODS "MI-skills" and "MI-spirit" were measured in a prospective analysis in 49 experienced GPs before and one week after training RESULTS: An ANOVA on gain-scores demonstrated significant differences between groups in both MI-specific skills (VASE-R, p = 0.006) and "MIspirit" (MIKAT, p = 0.029; HRQ, p < 0.001) from pre- to posttest. Post-hoc comparisons revealed significant improvement only in the training groups (VASE-R, p < 0.001; MIKAT, p = 0.014 for online, p = 0.003 for face-to-face; HRQ, p < 0.001). CONCLUSION The results suggest similar effects of both online and face-to-face training of "MI-skills" and "MI-spirit" to GPs. PRACTICE IMPLICATION Online learning opportunities should be integrated in MIT programs for general practitioners where appropriate.
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Affiliation(s)
- Karsten Schaper
- Faculty of Medicine, Albert-Ludwigs-University, Breisacher Str. 153, 79106 Freiburg im Breisgau, Germany
| | - Johan Peter Woelber
- Policlinic of Operative Dentistry, Periodontology, and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Andreas Jaehne
- Oberberg Specialist Clinic Rhein-Jura, Schneckenhalde 13, 79713 Bad Säckingen, Germany.
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Massouh A, Alayan N, Shatila M, Wehbeh S. Assessing REflective simulation-based e-Training on motivational interviewing among multidisciplinary healthcare practitioners [RESeT-MI]: a mixed methods pilot study. BMC MEDICAL EDUCATION 2024; 24:711. [PMID: 38956587 PMCID: PMC11218146 DOI: 10.1186/s12909-024-05711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Many health science curricula have integrated behavioral modification techniques in their plans. Motivational Interviewing is one such technique. Educational interventions to promote Motivational Interviewing have had limited success. Integrating simulation-based learning in health science curricula might offer a platform whereby students can train in well controlled environments with increased authenticity, provision of standardized experiences and the capacity for immediate feedback to participants. Using motivational interviewing as an exemplar, the purpose of this study was to assess the impact of a simulation-based reflective e-training program on knowledge, attitudes, and confidence in Motivational Interviewing among healthcare practitioners from diverse healthcare disciplines. A secondary aim was to explore whether self-reflection can promote reflective learning. METHODS This was a mixed-method study design. Fifteen participants from different health disciplines were included in the quantitative phase of the study, the simulated interview, and the reflective assignments while five participated in the focus group. Pre and post tests were used to examine the effect of training on knowledge, attitudes, and confidence in Motivational Interviewing. Assessment of Motivational Interviewing Treatment Integrity [MITI] scores in a simulation-based scenario was used. A qualitative content analysis of a focus group provided a more in-depth understanding of the participants experiences. Excerpts from reflective assignments were analyzed using Transformative Learning Theory concepts. RESULTS A Wilcoxon test showed that the training elicited a change in confidence in performing Motivational Interviewing [Z= -2.766, p = 0.006], median scores increased from 29 to 34. A quarter of technical scores and half of the relational scores indicated good competence. Participants reflected content transformation through feelings of empowerment and satisfaction when they were successful in engaging and motivating clients. Process transformation was evident in reflections on how to improve core skills specifically reflective listening. Reflections on Motivational Interviewing spirit related values showed premise transformation, which may indicate attitude changes. CONCLUSION A simulation-based e-training program on Motivational Interviewing represents an important educational modality for training in the health disciplines. Results of this study provide evidence supporting the integration of reflective simulation-based e-training into the education curricula of health disciplines in MI and beyond.
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Affiliation(s)
- Angela Massouh
- American University of Beirut School of Nursing, Beirut, Lebanon.
| | - Nour Alayan
- Turpanjian College of Health Sciences American University of Armenia, Yerevan, Armenia
| | - Mariam Shatila
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Sarah Wehbeh
- American University of Beirut School of Nursing, Beirut, Lebanon
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Ismael MN, Merlo LJ. Empowering Tomorrow's Gastroenterologists and Their Patients: Integrating Motivational Interviewing Into Fellowship Training. Gastroenterology 2024; 167:200-203. [PMID: 38685458 DOI: 10.1053/j.gastro.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Media N Ismael
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Florida, Gainesville, Florida
| | - Lisa J Merlo
- Department of Psychiatry, University of Florida, Gainesville, Florida.
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Perron NJ, Pype P, van Nuland M, Bujnowska-Fedak MM, Dohms M, Essers G, Joakimsen R, Tsimtsiou Z, Kiessling C. What do we know about written assessment of health professionals' communication skills? A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:1188-1200. [PMID: 34602334 DOI: 10.1016/j.pec.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this scoping review was to investigate the published literature on written assessment of communication skills in health professionals' education. METHODS Pubmed, Embase, Cinahl and Psychnfo were screened for the period 1/1995-7/2020. Selection was conducted by four pairs of reviewers. Four reviewers extracted and analyzed the data regarding study, instrument, item, and psychometric characteristics. RESULTS From 20,456 assessed abstracts, 74 articles were included which described 70 different instruments. Two thirds of the studies used written assessment to measure training effects, the others focused on the development/validation of the instrument. Instruments were usually developed by the authors, often with little mention of the test development criteria. The type of knowledge assessed was rarely specified. Most instruments included clinical vignettes. Instrument properties and psychometric characteristics were seldom reported. CONCLUSION There are a number of written assessments available in the literature. However, the reporting of the development and psychometric properties of these instruments is often incomplete. Practice implications written assessment of communication skills is widely used in health professions education. Improvement in the reporting of instrument development, items and psychometrics may help communication skills teachers better identify when, how and for whom written assessment of communication should be used.
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Affiliation(s)
- Noelle Junod Perron
- Unit of Development and Research in Medical Education, Geneva Faculty of Medicine and Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland.
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Marc van Nuland
- Academic Center for General Practice, Leuven University, Leuven, Belgium
| | | | | | - Geurt Essers
- Network of GP Training Programs in the Netherlands, Utrecht, The Netherlands
| | - Ragnar Joakimsen
- Department of Clinical Medicine, Faculty of Health Sciences, UIT The Artic University of Norway and Department of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Zoi Tsimtsiou
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Claudia Kiessling
- Personal and Interpersonal Development in Health Care Education, Witten/Herdecke University, Witten, Germany
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Motivational Interviewing Training for Advanced Practice Nursing Students to Address Prescription Opioid Use Disorder: A Mixed Methods Approach. J Addict Nurs 2021; 32:141-151. [PMID: 34060766 DOI: 10.1097/jan.0000000000000401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Prescription opioid use disorder in the United States has increased to epidemic proportions and poses a challenging problem to health care providers. Motivational interviewing (MI) is a patient-centered counseling style that can effectively reduce substance abuse, but MI training has not been well incorporated into advanced practice nursing curricula. Standardized patient (SP) simulation is an educational tool that is growing in popularity because of its success in improving nursing skills. Medical students and residents who underwent a formalized MI training with an SP simulation showed positive results. This study aimed to determine whether an MI training with an SP simulation improved NP students' knowledge, confidence, and skills in MI. A one-group pretest-posttest repeated measures design was used. Quantitative data were analyzed using descriptive statistics and repeated measures analysis of variance, and qualitative data were analyzed using content analysis. Results indicated that the MI training showed a significant impact on students' confidence in MI and promising impacts on students' MI knowledge and skills. Students valued the training, favoring the SP component, and plan to use MI in future practice. An MI training can be effectively incorporated into an advanced practice nursing program and would better prepare students to address prescription opioid use disorder and effectively encourage behavior change among their patients.
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Lück S, Kienle R, Langenbeck S, Sehy V, Freytag J. Motivierende Gesprächsführung mit Simulationspatient_innen lehren und prüfen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2021. [DOI: 10.1026/1616-3443/a000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Simulationspatient_innen (SP) werden in der medizinischen Ausbildung zum Erlernen und Prüfen kommunikativer Kompetenzen eingesetzt. Fragestellung: Wie wird Motivierende Gesprächsführung (MI) mit SP an der Charité Berlin gelehrt und geprüft? Methode: MI wird im Modellstudiengang Medizin im 4. Semester gelehrt und im Rahmen einer Objective Structured Clinical Examination (OSCE) geprüft. Es wurden Lehr- und Prüfungsevaluationen und die Beobachtungsübereinstimmung erhoben. Die Komplexität von MI erfordert spezielle Methoden für das SP-Training. Ergebnisse: In der Lehrveranstaltungsevaluation gaben 74,5 % der Studierenden und 90 % der Dozierenden an, dass MI-Kompetenzen erworben wurden, in der Prüfungsstation erreichten Studierende einen Leistungsmittelwert von 78 % ( SD = 2.1 %). Die Beobachtungsübereinstimmung lag bei r = .74 ( p = .009), r = .88 ( p < .001) und r = .47 ( p = .091). Die Prüfenden bewerteten die MI-Prüfungsstation überwiegend (sehr) gut. Schlussfolgerungen: MI kann mit SP gelehrt und geprüft werden, birgt aber Herausforderungen für SP-Training und Testkonstruktion.
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Affiliation(s)
- Susanne Lück
- Prodekanat für Studium und Lehre, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Rolf Kienle
- Prodekanat für Studium und Lehre, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Sylke Langenbeck
- Prodekanat für Studium und Lehre, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Victoria Sehy
- Prodekanat für Studium und Lehre, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Julia Freytag
- Prodekanat für Studium und Lehre, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin
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Hurlocker MC, Madson MB, Schumacher JA. Motivational interviewing quality assurance: A systematic review of assessment tools across research contexts. Clin Psychol Rev 2020; 82:101909. [PMID: 32920371 DOI: 10.1016/j.cpr.2020.101909] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/20/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
The need for sustained skill development and quality assurance when executing behavioral interventions is best demonstrated in the empirical evolution of Motivational Interviewing (MI). As a brief behavioral intervention that identifies the therapeutic process as an active treatment ingredient, it is critical for researchers, trainers, and administrators to use psychometrically sound and theoretically congruent tools to evaluate provider skills and fidelity when executing MI. Yet, no prior work has evaluated the breadth of MI tools employed across research contexts. Therefore, this review identified MI fidelity and skill development tools across measurement, training and efficacy/effectiveness studies and evaluated their psychometric strength and fit with current MI theory. We identified 199 empirical studies that employed an MI fidelity/skill tool and we found 21 tools with varying degrees of empirical support and theoretical congruence. Specifically, we identified five observer-, two trainee- and one client-rated tool with strong empirical support, and nine observer- and two client-rated tools with preliminary empirical support. We detailed the empirical strength, including the extent to which tools were linked to trainee/client outcomes across research contexts and offer recommendations on which MI tools to use in training, efficacy, and effectiveness trials.
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Affiliation(s)
- Margo C Hurlocker
- Center on Alcoholism, Substance Abuse, and Addictions, Department of Psychology, University of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM 87106, USA.
| | - Michael B Madson
- School of Psychology, University of Southern Mississippi, 118 College Dr, Hattiesburg, MS 39406, USA.
| | - Julie A Schumacher
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State St, Jackson, MS 39216, USA.
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Abstract
OBJECTIVE The importance of physician training in communication skills for motivating patients to adopt a healthy life-style and optimize clinical outcomes is increasingly recognized. This study inventoried and systematically reviewed the psychometric properties of, and the skills assessed by, existing assessment tools used to evaluate communication skills among physicians. METHODS This review was conducted in accordance with the PRISMA guidelines (PROSPERO: CRD42018091932). Four databases (PUBMED, EMBASE, PsychINFO, and SCOPUS) were searched up to December 2018, generating 3902 unique articles, which were screened by two authors. A total of 57 articles met the inclusion criteria and underwent full data extraction. RESULTS Forty-five different assessment tools were identified. Only 47% of the studies mentioned underlying theories or models for designing the tool. Fifteen communication skills were assessed across the tools, the five most prevalent were information giving (46%) or gathering (40%), eliciting patients' perspectives (44%), planning/goal setting (37%), and closing the session (32%). Most tools (93%) assessed communication skills using in-person role play exercises with standardized (61%) or real (32%) patients, but only 54% described the expertise of the raters who performed the evaluations. Overall, reporting of the psychometric properties of the assessment tools was poor-moderate (4.5 ± 1.3 out of 9). CONCLUSIONS Despite identifying several existing physician communication assessment tools, a high degree of heterogeneity between these tools, in terms of skills assessed and study quality, was observed, and most have been poorly validated. Research is needed to rigorously develop and validate accessible, convenient, "user-friendly," and easy to administer and score communication assessment tools.
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Chang YP, Cassalia J, Warunek M, Scherer Y. Motivational interviewing training with standardized patient simulation for prescription opioid abuse among older adults. Perspect Psychiatr Care 2019; 55:681-689. [PMID: 31187888 DOI: 10.1111/ppc.12402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 04/14/2019] [Accepted: 05/05/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aimed to examine the effect of motivational interviewing (MI) education on the doctorate of nursing practice (DNP) students' learning outcomes. DESIGN AND METHODS This study used a one-group with preposttest design. The sample consisted of 31 DNP students who received an MI training, including a didactic lecture, role-playing exercise, and standardized patient simulation. FINDINGS Findings indicated a significant increase in students' knowledge and confidence regarding MI at both posttests compared with baseline. PRACTICE IMPLICATIONS Findings suggested that MI training with standardized patient simulation demonstrated preliminary promising effects on DNP students' knowledge and confidence in MI techniques to manage prescription opioid abuse among older adults. This study showed the potential to enhance the care of older adults who abuse opioids to address this problem in practice.
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Affiliation(s)
- Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York
| | - Jade Cassalia
- Newark-Wayne Community Hospital, Rochester, New York
| | - Molli Warunek
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York
| | - Yvonne Scherer
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York
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Miller-Matero LR, Tobin ET, Fleagle E, Coleman JP, Nair A. Motivating residents to change communication: the role of a brief motivational interviewing didactic. Prim Health Care Res Dev 2019; 20:e124. [PMID: 31451128 PMCID: PMC6713881 DOI: 10.1017/s146342361900015x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/18/2018] [Accepted: 03/03/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Motivational interviewing (MI) is a patient-centered approach that encourages patients to change behaviors. MI training programs have increased residents' knowledge and use of MI skills; however, many residency programs may not have the time to dedicate to lengthy MI programs. The purpose of this study was to evaluate the benefits of a brief MI didactic for residents in an academic internal medicine patient-centered medical home. METHODS Thirty-two residents completed a 1-h MI training between October 2016 and June 2017 and completed measures on their knowledge of, confidence using, and utilization of MI skills prior to the training, immediately after the training, and at a 1-month follow-up. RESULTS The residents' knowledge of and confidence using MI skills increased from pre-test to post-test and also increased from pre-test to the 1-month follow-up. CONCLUSION The utilization of MI skills increased from pre-test to the 1-month follow-up. A 1-h didactic offers benefits to residents.
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Affiliation(s)
- Lisa Renee Miller-Matero
- Internal Medicine, Henry Ford Health System, Detroit, MI, USA
- Behavioral Health, Henry Ford Health System, Detroit, MI, USA
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Erin T. Tobin
- Internal Medicine, Henry Ford Health System, Detroit, MI, USA
- Behavioral Health, Henry Ford Health System, Detroit, MI, USA
| | - Elizabeth Fleagle
- Internal Medicine, Henry Ford Health System, Detroit, MI, USA
- Behavioral Health, Henry Ford Health System, Detroit, MI, USA
| | - Joseph P. Coleman
- Internal Medicine, Henry Ford Health System, Detroit, MI, USA
- Behavioral Health, Henry Ford Health System, Detroit, MI, USA
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Anupama Nair
- Internal Medicine, Henry Ford Health System, Detroit, MI, USA
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Hemming P, Revels JA, Tran AN, Greenblatt LH, Steinhauser KE. Identifying core curricular components for behavioral health training in internal medicine residency: Qualitative interviews with residents, faculty, and behavioral health clinicians. Int J Psychiatry Med 2019; 54:188-202. [PMID: 30269631 DOI: 10.1177/0091217418802159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Behavioral health services frequently delivered by primary care providers include care for mental health and substance abuse disorders and assistance with behavioral risk factor reduction. Internal medicine residencies in the United States lack formal expectations regarding training in behavioral health for residents. This qualitative study aimed to determine learners' and teachers' perceptions about appropriate behavioral health curricular components for internal medicine residents. METHOD Focus groups and interviews were conducted with the following individuals from the Duke Outpatient Clinic: residents with continuity practice (n = 27), advanced practice providers (n = 2), internal medicine attending physicians (n = 4), internal medicine/psychiatry attending physicians (n = 2), and behavioral health clinicians (n = 4). A focus group leader asked regarding residents' successes and challenges in managing behavioral health issues and about specific learning components considered necessary to understand and manage these behavioral health conditions. Transcripts were coded using an editing analysis style to identify central themes and concordance/discordance between groups. RESULTS Regarding mental health management (Theme 1), residents emphasized a need for better care coordination with specialty mental health, while attendings and behavioral health clinicians gave priority to residents' skills in primary management of mental health. Residents, attendings, and behavioral health clinicians all emphasized advanced interviewing skills (Theme 2) with subthemes: eliciting the patient's perspective, managing time in encounters, improving patients' understanding, and patient counseling. CONCLUSIONS Internal medicine residents, attendings, and behavioral health clinicians may differ significantly in their perceptions of primary care's role in mental health care. Future internal medicine behavioral health curricula should specifically address these attitudinal differences. Curricula should also emphasize interview skills training as an essential component of behavioral health learning.
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Affiliation(s)
- Patrick Hemming
- 1 Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Jessica A Revels
- 2 Department of Clinical Research, Duke University Medical Center, Durham, NC, USA
| | - Anh N Tran
- 3 Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC, USA
| | - Lawrence H Greenblatt
- 1 Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Karen E Steinhauser
- 4 Center for Health Services Research in Primary Care, Durham, VA Medical Center, Durham, NC, USA.,5 Department of Medicine, Division of General Internal Medicine, Palliative Care Section, Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
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Dragomir AI, Julien CA, Bacon SL, Boucher VG, Lavoie KL. Training physicians in behavioural change counseling: A systematic review. PATIENT EDUCATION AND COUNSELING 2019; 102:12-24. [PMID: 30172573 DOI: 10.1016/j.pec.2018.08.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/01/2018] [Accepted: 08/18/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND Poor health behaviours (e.g., smoking, physical inactivity) represent major underlying causes of non-communicable chronic diseases (NCDs). Prescriptive behaviour change interventions employed by physicians show limited effectiveness. Physician training in evidence-based behaviour change counselling (BCC) may improve behavioural risk factor management, but the efficacy and feasibility of current programs remains unclear. OBJECTIVE (1) To systematically review the efficacy of BCC training programs for physicians, and (2) to describe program content, dose and structure, informing better design and dissemination. METHODS Using PRISMA guidelines, a database search up to January 2018, yielded 1889 unique articles, screened by 2 authors; 9 studies met inclusion criteria and were retained for analysis. RESULTS 100% of studies reported significant improvements in BCC skills among physicians, most programs targeting provider-patient collaboration, supporting patient autonomy, and use of open questions to elicit "change-talk". Limitation included: poor reporting quality, high program heterogeneity, small sample sizes, 78% of studies having no comparison group, and less than 30% of skills taught being formally assessed. CONCLUSION Training programs were efficacious, but methodological weaknesses limit the ability to determine content and delivery. Caution is necessary when interpreting the results. PRACTICE IMPLICATIONS Further research emphasizing rigorous training program development and testing is warranted.
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Affiliation(s)
- Anda I Dragomir
- Department of Psychology, Université du Québec à Montréal, Canada; Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Canada
| | - Cassandre A Julien
- Department of Psychology, Université du Québec à Montréal, Canada; Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Canada; Department of Health, Kinesiology and Applied Physiology, Concordia University, Canada
| | - Vincent Gosselin Boucher
- Department of Psychology, Université du Québec à Montréal, Canada; Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Canada
| | - Kim L Lavoie
- Department of Psychology, Université du Québec à Montréal, Canada; Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Canada.
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Smith JL, Bertone P, Carpenter KM, Wain RM, Hu MC, Amrhein PC, Nunes EV. Assessment of the relationship between a written measure of empathy and an independently rated interview of Motivational Interviewing. J Subst Abuse Treat 2018; 87:56-63. [PMID: 29471927 DOI: 10.1016/j.jsat.2017.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 11/17/2022]
Abstract
Motivational Interviewing (MI) is an evidence-based practice shown to be effective when working with people in treatment for substance use disorders. However, MI is a complex treatment modality optimized by training with feedback. Feedback, assessment and monitoring of treatment fidelity require measurement, which is typically done using audiotaped sessions. The gold standard for such measurement of MI skill has been an audiotaped interview, scored by a rater with a detailed structured instrument such as the Motivational Interviewing Treatment Integrity 2.0 (MITI 2.0) Coding System (Moyers, et al., 2005). The Helpful Responses Questionnaire (HRQ) (Miller, Hedrick, & Orlofsky, 1991) is a pen-and-paper test of empathy (a foundational MI skill) that does not require an audiotaped session. A randomized trial of three different regimens for training counselors in MI (live supervision using Teleconferencing, Tape-based supervision and Workshop only) (Smith et al., 2012) offered the opportunity to evaluate the performance of the HRQ as a measure of MI ability, compared to the several MITI 2.0 global scores and subscales. Participants were counselors (N=97) working at community-based substance use treatment programs, whose MI proficiency was measured at four time points: baseline (before an initial 2-day MI workshop), post-workshop, 8weeks post-workshop (i.e., post-supervision), and 20weeks post-workshop with both MITI 2.0 and HRQ. HRQ total scores correlated significantly with the Reflection to Question Ratio from the MITI 2.0 at post-workshop (r=0.33), week 8 (r=0.34), and week 20 (r=0.38), and with the Spirit (r=0.32) and Empathy (r=0.32) global scores at week 20. Correlations of HRQ with other MITI 2.0 subscales and time points after workshop were small and not significant. As predicted, HRQ scores differed between training conditions (X2(2)=7.88, p=0.02), with counselors assigned to live supervision achieving better HRQ scores than those in Workshop only. In summary, HRQ is a modestly accurate measure, mainly of the Reflection to Question Ratio, considered a core marker of MI skill. It is sensitive to training effects and may help identify counselors needing more intensive supervision. Given its ease of administration and scoring, HRQ may be a useful marker of MI skill during training efforts.
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Affiliation(s)
- J L Smith
- NYS Psychiatric Institute, Division of Substance Use Disorders, NY, NY 10032, United States; Columbia University, Department of Psychiatry, NY, NY 10021, United States.
| | - P Bertone
- Center for HIV Educational Studies & Training, Hunter College, CUNY, NY, NY 10018, United States
| | - K M Carpenter
- NYS Psychiatric Institute, Division of Substance Use Disorders, NY, NY 10032, United States; Columbia University, Department of Psychiatry, NY, NY 10021, United States
| | - R M Wain
- NYS Psychiatric Institute, Division of Substance Use Disorders, NY, NY 10032, United States
| | - M-C Hu
- Columbia University, Department of Psychiatry, NY, NY 10021, United States
| | - P C Amrhein
- Columbia University, Department of Psychiatry, NY, NY 10021, United States; Montclair State, Montclair, NJ 07043, United States
| | - E V Nunes
- NYS Psychiatric Institute, Division of Substance Use Disorders, NY, NY 10032, United States; Columbia University, Department of Psychiatry, NY, NY 10021, United States
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Kaplonyi J, Bowles KA, Nestel D, Kiegaldie D, Maloney S, Haines T, Williams C. Understanding the impact of simulated patients on health care learners' communication skills: a systematic review. MEDICAL EDUCATION 2017; 51:1209-1219. [PMID: 28833360 DOI: 10.1111/medu.13387] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/18/2017] [Accepted: 05/31/2017] [Indexed: 05/07/2023]
Abstract
CONTEXT Effective communication skills are at the core of good health care. Simulated patients (SPs) are increasingly engaged as an interactive means of teaching, applying and practising communication skills with immediate feedback. There is a large body of research into the use of manikin-based simulation but a gap exists in the body of research on the effectiveness of SP-based education to teach communication skills that impact patient outcomes. The aim of this systematic review was to critically analyse the existing research, investigating whether SP-based communication skills training improves learner-patient communication, how communication skill improvement is measured, and who measures these improvements. METHODS The databases Medline, ProQuest (Health & Medical Complete, Nursing and Allied Health Source) and CINAHL (EBSCOhost) Education Resources Information Centre (ERIC) were searched for articles that investigated the effects of SP-based education on the communication skills of medical, nursing and allied health learners. RESULTS There were 60 studies included in the review. Only two studies reported direct patient outcomes, one reporting some negative impact, and no studies included an economic analysis. Many studies reported statistically significant third-party ratings of improved communication effectiveness following SP-based education; however, studies were unable to be pooled for meta-analysis because of the outcome collection methods. There were a small number of studies comparing SP with no training at all and there were no differences between communication skills, contradicting the results from studies reporting benefits. Of the 60 studies included for analysis, 54 (90%) met the minimum quality score of 7/11, with four articles (7%) scoring 11/11. CONCLUSION SP-based education is widely accepted as a valuable and effective means of teaching communication skills but there is limited evidence of how this translates to patient outcomes and no indication of economic benefit for this type of training over another method.
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Affiliation(s)
| | - Kelly-Ann Bowles
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
| | - Debra Nestel
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Debra Kiegaldie
- Faculty of Health Science, Youth and Community Studies, Holmesglen Institute and Healthscope Hospitals, Moorabbin, Victoria, Australia
| | - Stephen Maloney
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Terry Haines
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
| | - Cylie Williams
- Peninsula Health, Allied Health, Frankston, Victoria, Australia
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
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Halbach P, Keller AO. Evaluating Motivational Interviewing in the Physician Assistant Curriculum. J Physician Assist Educ 2017; 28:132-137. [PMID: 28762991 PMCID: PMC5561004 DOI: 10.1097/jpa.0000000000000133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Motivational interviewing (MI) is an evidence-based technique that enables clinicians to help patients modify health behaviors. Although MI is an essential tool for physician assistants (PAs), the extent to which it is addressed in PA curricula in the United States is unknown. This study is a comprehensive description of MI education in PA programs in the United States. METHODS Data are from the 2014 Physician Assistant Education Association Annual Program Survey. Descriptive statistics were conducted on de-identified data from all 186 PA programs in the United States. RESULTS Of the 186 PA programs surveyed, 72.58% (n = 135) reported at least one course providing MI training. Availability of courses providing training in skills essential to the MI process varied. Having a course with verbal communication training was most frequently endorsed, and having a course with training in developing discrepancy was least frequently endorsed. The most popular teaching modality was lecture (84.95%, n = 158), whereas only 41.40% (n = 77) and 58.60% (n = 109) reported role play with evaluation and standardized patient exercises with evaluation, respectively. CONCLUSIONS More than 70% of programs included at least one course in their curriculum that provided training in MI, suggesting that PA programs recognize the importance of MI. Instruction in change talk was not provided in nearly half of the programs. Role-play and standardized patient exercises with evaluation were underused methods despite their proven efficacy in MI education. As the first comprehensive benchmark of MI education for PAs, this study shows that although most programs address MI, opportunities exist to improve MI training in PA programs in the United States.
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Affiliation(s)
- Patrick Halbach
- Patrick Halbach, MS, MPAS, PA-C, is a physician assistant in the Department of Orthopaedic Surgery at the University of Minnesota in Minneapolis. Abiola O. Keller, PhD, MPH, PA-C, is a clinical assistant professor and director of clinical research in the Department of Physician Assistant Studies at Marquette University, College of Health Sciences in Milwaukee, Wisconsin
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Peterson EB, Boland KA, Bryant KA, McKinley TF, Porter MB, Potter KE, Calhoun AW. Development of a Comprehensive Communication Skills Curriculum for Pediatrics Residents. J Grad Med Educ 2016; 8:739-746. [PMID: 28018540 PMCID: PMC5180530 DOI: 10.4300/jgme-d-15-00485.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Effective communication is an essential element of medical care and a priority of medical education. Specific interventions to teach communication skills are at the discretion of individual residency programs. OBJECTIVE We developed the Resident Communication Skills Curriculum (RCSC), a formal curriculum designed to teach trainees the communication skills essential for high-quality practice. METHODS A multidisciplinary working group contributed to the development of the RCSC, guided by an institutional needs assessment, literature review, and the Accreditation Council for Graduate Medical Education core competencies. The result was a cohesive curriculum that incorporates didactic, role play, and real-life experiences over the course of the entire training period. Methods to assess curricular outcomes included self-reporting, surveys, and periodic faculty evaluations of the residents. RESULTS Curricular components have been highly rated by residents (3.95-3.97 based on a 4-point Likert scale), and residents' self-reported communication skills demonstrated an improvement over the course of residency in the domains of requesting a consultation, providing effective handoffs, handling conflict, and having difficult conversations (intern median 3.0, graduate median 4.0 based on a 5-point Likert scale, P ≤ .002). Faculty evaluations of residents have also demonstrated improvement over time (intern median 3.0, graduate median 4.5 based on a 5-point Likert scale, P < .001). CONCLUSIONS A comprehensive, integrated communication skills curriculum for pediatrics residents was implemented, with a multistep evaluative process showing improvement in skills over the course of the residency program. Positive resident evaluations and informal comments from faculty support its general acceptance. The use of existing resources makes this curriculum feasible.
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Affiliation(s)
- Eleanor B. Peterson
- Corresponding author: Eleanor B. Peterson, MD, University of Louisville, Department of Pediatrics, 571 South Floyd Street, Suite 332, Louisville, KY 40202, 502.852.3720, fax 502.852.3998,
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Changes in Physical Therapist Students’ Self-Efficacy for Physical Activity Counseling Following a Motivational Interviewing Learning Module. ACTA ACUST UNITED AC 2016. [DOI: 10.1097/00001416-201630030-00006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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McLeod J, McLeod J. Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology. COUNSELLING PSYCHOLOGY QUARTERLY 2014. [DOI: 10.1080/09515070.2014.942774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Dunhill D, Schmidt S, Klein R. Motivational interviewing interventions in graduate medical education: a systematic review of the evidence. J Grad Med Educ 2014; 6:222-36. [PMID: 24949125 PMCID: PMC4054720 DOI: 10.4300/jgme-d-13-00124.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 08/21/2013] [Accepted: 11/25/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Motivational interviewing (MI) is a patient-centered method of behavior change counseling. It has shown promise in enabling patients to identify and improve problem health behaviors. Incorporating MI education into residency training may be beneficial. OBJECTIVE To review the current evidence regarding the impact of MI education in graduate medical education. RESULTS Of the 9 studies of MI education in graduate medical education training, most noted favorable outcomes after MI education. Outcomes included improvements in residents' view of MI, MI skill use and competency, and resident satisfaction with MI interventions. Of the 5 studies that looked at residents' views of MI, 3 found improvements in resident assessments of the importance of and confidence in using MI. Of the 4 studies of MI skills, 3 reported improvements in residents' use of and competency in the MI skill. The quality of MI education in the graduate medical education literature is limited by overreliance on preintervention and postintervention analysis as a study design, the variable intensity of educational interventions, and limited use of validated assessment tools and quantitative outcome measures. CONCLUSIONS Review of the literature shows that MI education can be successfully implemented within the residency education environment. The intensity of MI interventions, coupled with experiential learning and feedback, correlated with favorable outcomes in terms of resident use of MI skills and resident satisfaction. Further study is needed to determine which MI skills are most effectively taught to residents, the impact of MI training on resident behavior in clinical settings, and the impact on clinical outcomes.
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Kiessling C, Langewitz W. The longitudinal curriculum "social and communicative competencies" within Bologna-reformed undergraduate medical education in Basel. GMS ZEITSCHRIFT FUR MEDIZINISCHE AUSBILDUNG 2013; 30:Doc31. [PMID: 24062811 PMCID: PMC3778532 DOI: 10.3205/zma000874] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/29/2013] [Accepted: 05/02/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Within the Bologna reform, a longitudinal curriculum of "social and communicative competencies" (SOKO) was implemented into the new Bachelor-Master structure of undergraduate medical education in Basel (Switzerland). PROJECT DESCRIPTION The aim of the SOKO curriculum is to enable students to use techniques of patient-centred communication to elicit and provide information to patients in order to involve them as informed partners in decision making processes. The SOKO curriculum consists of 57 lessons for the individual student from the first bachelor year to the first master year. Teaching encompasses lectures and small group learning. Didactic methods include role play, video feedback, and consultations with simulated and real patients. Summative assessment takes place in objective structured clinical examinations (OSCE). CONCLUSION In Basel, a longitudinal SOKO curriculum based on students' cumulative learning was successfully implemented. Goals and contents were coordinated with the remaining curriculum and are regularly assessed in OSCEs. At present, most of the workload rests on the shoulders of the department of psychosomatic medicine at the university hospital. For the curriculum to be successful in the long-term, sustainable structures need to be instituted at the medical faculty and the university hospital to guarantee high quality teaching and assessment.
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Affiliation(s)
- Claudia Kiessling
- Klinikum der LMU München, Lehrstuhl für Didaktik und Ausbildungsforschung in der Medizin, München, Deutschland
| | - Wolf Langewitz
- Universitätsspital Basel, Innere Medizin, Psychosomatik, Basel, Schweiz
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