According to MITI scores, standardised patient role-plays are similar in effectiveness to student role-plays when teaching basic motivational interviewing skills for smoking cessation to Year 3 medical students.

Background: One of the US government health goals outlined in the Healthy People 2010 document (2000) is to increase the number of physicians who counsel their patients regarding unhealthy behaviors. Studies have shown a low rate of physicians provide smoking cessation counseling. We introduced a motivational interviewing curriculum into our medical school for first and third year students and then evaluated the effect of this curriculum on third year students counseling skills. Methods: The motivational interviewing curriculum was comprised of a lecture series and small group teaching with practice in role plays. The effectiveness of the curriculum was evaluated by student performance in a videotaped interview with a standardized patient who portrayed a smoker. The interview was rated using the Motivational Interviewing Treatment Integrity scoring tool (MITI). The MITI assesses 6 criteria: empathy, MI spirit (autonomy, evocation and collaboration), MI adherence (asking permission, affirmation, emphasis of control and support), MI non adherence (advise, confront and direct), the types of questions (open or closed) and the number of reflections. Secondary outcomes included a knowledge exam related to motivational interviewing and students' evaluations of the effectiveness of the motivational interviewing curriculum. Results: Analysis of the MITI scores showed that students reached a proficiency level on the rate of reflections, were just below proficiency in assessment of empathy and motivational interviewing spirit and substantially below proficiency in the percent of open ended questions. These proficiency scores were for professional counselors but nevertheless provided us with information on the effectiveness of the new curriculum and where the focus of our teaching should be. On the optional evaluation of the first-year MI curriculum by 112 students, 83% felt that the MI curriculum had helped them be more comfortable in discussing behavior change with patients and 98% felt it was an important skill for physicians to have.

Academic health centers (AHCs) face increasing pressures from federal, state, and community stakeholders to fulfill their social missions to the communities they serve. Yet, in the 21st century, rural communities in the United States face an array of health care problems, including a shortage of physicians, health problems that disproportionately affect rural populations, a need to improve quality of care, and health disparities related to disproportionate levels of poverty and shifting demographics. AHCs have a key role to play in addressing these issues. AHCs can increase physician supply by targeting their admissions policies and educational programs. Specific health concerns of rural populations can be further addressed through increased use of telemedicine consultations. By partnering with providers in rural areas and through the use of innovative technologies, AHCs can help rural providers increase the quality of care. Partnerships with rural communities provide opportunities for participatory research to address health disparities. In addition, collaboration between AHCs, regional planning agencies, and rural communities can lead to mutually beneficial outcomes. At a time when many AHCs are operating in an environment with dwindling resources, it is even more critical for AHCs to build creative partnerships to help meet the needs of their regional communities.