Reinventing the Reel: An Innovative Approach to Resident Skill-Building in Motivational Interviewing for Brief Intervention

Abstract

To enhance the skills of primary care residents in addressing substance misuse, residency screening, brief intervention, and referral to treatment (SBIRT) programs increasingly offer motivational interviewing (MI) training, but seldom include feedback and coaching. This innovative 2-round "Virginia Reel" approach, supplementing 3 hours of basic MI instruction, was designed to teach and coach residents to use MI while providing ongoing medical care. SBIRT/MI-competent facilitators served as both trainers and actors at 8 carefully sequenced Objective Structured Clinical Examination (OSCE) stations, providing instruction, role-play practice, and feedback on 17 microskills in 2 successive clinical "visits"/rounds addressing alcohol misuse and diabetes management. Evaluation included OSCE checklists, overall competency assessments, and responses to open-ended questions. Three residents showed improvement between rounds. Resident evaluations were strongly positive, identifying practice of MI skills and receipt of coaching and feedback from MI experts as particularly valuable. Further study is needed to confirm effectiveness of the approach and explore the impact of fewer OSCE stations of longer duration.

Motivational Interviewing Interventions in Graduate Medical Education: A Systematic Review of the Evidence

“…A few studies reported a discrete intervention, such as a single workshop, 18,22,23 whereas others described more intensive MI interventions, including multiple sessions within a communication curriculum, 20 a dedicated MI rotation, 17 and a longitudinal MI curriculum. 16 Content of the interventions was mixed.…”

“…Most interventions used skills practice with feedback via resident role play, standardized patient exercises, direct observation in clinic, and objective structured clinical examination (OSCE). 16,17,[19][20][21][22][23][24] Three studies observed residents engaging in MI during actual patient encounters. 16,17,24 Assessment and outcomes varied across studies.…”

“…[16][17][18][19][20][21][22][23][24] T A B L E 1 displays details extracted from the studies, and T A B L E 2 includes strengths and limitations of the studies. Five studies were preintervention and postintervention studies, 3 were postintervention studies, and 1 study was a randomized controlled trial.…”

“…[16][17][18][19][20] Residents' MI skill use and competency were assessed via direct observation in clinic, 17 a validated survey tool, 20 and the OSCE format. 21,22 One study looked at documentation of counseling activities and clinical endpoints from patient medical records. 24 Resident satisfaction with the educational intervention was assessed via survey and feedback.…”

“…In 4 studies, training included general MI principles and techniques. 16,17,20,21 In 5 studies, the MI intervention was focused on a specific disease or health behavior, including smoking cessation, 18,19 alcohol abuse, 22 obesity, 23 and diabetes mellitus. 24 Multidisciplinary teams were used to design and implement interventions in all studies.…”