Teaching students behavior change skills: description and assessment of a new Motivational interviewing curriculum

Abstract

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.

Motivational Interviewing in Health Care: Results of a Brief Training in Endocrinology

“…Participants also reported greater understanding of the spirit of MI, with fewer reported gains in perceived counseling skills. Findings are similar to those from previous studies reporting shortterm gains in skills 17 and improved MI-consistent attitudes after medical student trainings. 16 Competency in MI is not merely the use of techniques, but rather largely depends on embodying the spirit of this approach and applying it to behavioral counseling.…”

“…[12][13][14] However, providers and trainees have a limited amount of time available to learn a new clinical style, 15 and multiday training workshops may not be feasible. 16 Although there is currently no standardized curriculum for teaching MI, various approaches have been described [16][17][18][19] ; yet, few studies have examined MI training for specialists. 13 We developed and piloted the feasibility,…”

Teaching Motivational Interviewing to Primary Care Staff in the Veterans Health Administration

“…5 Research shows that MI is effective in supporting patients in changing various lifestyle behaviors including reducing substance use, increasing treatment engagement, and making improvements in dietary habits and chronic disease management. 6,7 Prior studies demonstrate the positive effects of teaching MI to medical students [8][9][10][11][12] and primary care staff. [13][14][15] Studies with these samples show that brief training protocols in MI can lead to learning basic MI concepts and increased confidence in applying MI-related skills to various patient problems.…”

A randomized controlled trial of behavior change counseling education for medical students

“…White et al (2007) assessed a MI curriculum, which included 3 h of lectures and additional small groups in the first year with additional training during the family medicine clerkship in the third year. They evaluated students' performance at the end of the clerkship in interviews with standardized patients (SPs) and rated their skills using the Motivational Interviewing Treatment Integrity (MITI) scoring tool (Moyers et al 2005).…”

“…This 'medicalized' version of MI is often referred to as 'brief motivational interviewing' or, more clearly, 'behavior change counseling. ' Several studies concerning medical student education in MI and behavioral change counseling strategies have been published (Brown & Oriel 1998;Poirier et al 2004;Mounsey et al 2006;Martino et al 2007;White et al 2007;Bell & Cole 2008). Poirier et al (2004) evaluated the effectiveness of a 10-h course for first-year medical students that included lectures, student role-plays, and simulated patient exercises.…”