Training Primary Care Physicians to Employ Self-Efficacy-Enhancing Interviewing Techniques: Randomized Controlled Trial of a Standardized Patient Intervention

Jerant, Anthony F; Kravitz, Richard L.; Tancredi, Daniel J.; Paterniti, Debora A.; White, Lynda; Baker-Nauman, Lynn; Evans-Dean, Dionne; Villarreal, Chloe; Ried, Lori; Hudnut, Andrew; Franks, Peter

doi:10.1007/s11606-016-3644-z

Cited by 14 publications

(19 citation statements)

References 39 publications

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“…The findings provide partial support for our a priori hypotheses, and expand upon our previous work showing that SPI-delivered SEE IT training is valued by both resident and practicing primary care physicians and increases their use of the techniques in brief office visits with standardized patients [26, 42]. Nonetheless, our patient findings are preliminary in nature, since the patient component of our study was explicitly exploratory, examining effects on psychological HBCMs but not actual behavior change or health outcomes.…”

Section: Discussionsupporting

confidence: 78%

“…Details of our RCT of SEE IT training for practicing physicians were reported previously [42]. Briefly, we randomized family physicians and general internist physicians (N=50) from 12 primary care offices in the Sacramento, California area, drawn from the UCD Primary Care Network and Sutter Medical Group.…”

Section: Methodsmentioning

confidence: 99%

“…We enrolled patients for the current study from the same 12 primary care offices that participated in the physician training RCT [42]. From office visit schedule reports provided to us by the participating offices, research assistants telephoned patients who were: 1) aged ≥18 years; 2) had an assigned primary care physician who had participated in the trial; and 3) had an office visit scheduled in ≤4 weeks with a trial physician who had fully completed their participation ≥4 months previously.…”

Section: Methodsmentioning

confidence: 99%

“…SPI delivery maximizes the salience and impact of training by allowing providers to immediately practice and assimilate new skills in their regular work environment, and entails no provider time commitment beyond usual work hours. In two separate randomized controlled trials (RCTs), first resident and then practicing primary care physicians who received the intervention increased their use of SEE IT, and had favorable responses to training [26, 42]. …”

Section: Introductionmentioning

confidence: 99%

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Physician training in self-efficacy enhancing interviewing techniques (SEE IT): Effects on patient psychological health behavior change mediators

Jerant

Lichte

Kravitz

et al. 2016

Patient Education and Counseling

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Objective To explore how physician training in self-efficacy enhancing interviewing techniques (SEE IT) affects patient psychological health behavior change mediators (HBCMs). Methods We analyzed data from 131 patients visiting primary care physicians ≥4 months after the physicians participated in a randomized controlled trial. Experimental arm physicians (N=27) received SEE IT training during three ≤20 minute standardized patient instructor (SPI) visits. Control physicians (N=23) viewed a diabetes medications video during one SPI visit. Physicians were blinded to patient participation. Outcomes were self-care self-efficacy, readiness, and health locus of control (Internal, Chance, Powerful Others), examined as a summary HBCM score (average of standardized means) and individually. Analyses adjusted for pre-visit values of the dependent variables. Results Patients visiting SEE IT-trained physicians had higher summary HBCM scores (+0.42, 95% CI 0.07-0.77; p=0.021). They also had greater self-care readiness (AOR 3.04, 95% CI 1.02-9.03, p=0.046) and less Chance health locus of control (-0.27 points, 95% CI -0.50--0.04, p=0.023), with no significant differences in other HBCMs versus controls. Conclusion Improvement in psychological HBCMs occurred among patients visiting SEE IT-trained physicians, Practice implications If further research shows the observed HBCM effects improve health behaviors and outcomes, SEE IT training might be offered widely to physicians.

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Section: Discussionsupporting

confidence: 78%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Physician training in self-efficacy enhancing interviewing techniques (SEE IT): Effects on patient psychological health behavior change mediators

Jerant

Lichte

Kravitz

et al. 2016

Patient Education and Counseling

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“…A relationshipcentered communication skills course not only increased empathy and decreased burnout in physicians, but the patients of these physicians reported improved satisfaction with care. And in a randomized controlled trial conducted by Jerant et al 2 (full disclosure: RLK is a co-author), the authors evaluated a new approach to communication skills education called BSEE-IT^(self-efficacy-enhancing interviewing techniques). In contrast to more traditional forms of continuing medical education (CME), SEE-IT training was performed Bin situŵ ithin physicians' offices, and resulted in significantly higher use of recommended interviewing techniques such as negotiating goals, assessing readiness, and checking for understanding.…”

mentioning

confidence: 99%

Getting from Intention to Action

Kravitz

Reisman

2016

J GEN INTERN MED

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M any of the most pressing problems in human health are not a direct result of genetic error or environmental insult, but rather human behavior. We know quite a bit about how to be healthy: eat less, exercise more, don't smoke, and seek high-quality medical care when you need it. Judging by the prevalence of obesity, sedentary lifestyle, smoking, and inappropriate and/or poorly delivered care, this is apparently easier said than done. The problem of health-related behavior (which includes the behavior of health professionals as well as patients) is, in large measure, a matter of motivation. We have good intentions aplenty. What we need is action.So how do we motivate patients and the health professionals who care for them? Several articles in this issue of JGIM address this perpetually challenging question. Two papers focus on clinician education and skill building. As demonstrated in the observational study by Boissy et al., 1 it's hard for burned-out physicians to motivate patients. A relationshipcentered communication skills course not only increased empathy and decreased burnout in physicians, but the patients of these physicians reported improved satisfaction with care.

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Standardized Patient Communication and Low-Value Spinal Imaging

Fenton,

Cipri,

Gosdin

et al. 2024

JAMA Netw Open

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ImportanceAcute back pain is a common reason for primary care visits and often results in low-value spinal imaging.ObjectiveTo evaluate the effect of a standardized patient-delivered intervention on rates of low-value spinal imaging among primary care patients with acute low back pain.Design, Setting, and ParticipantsIn this randomized clinical trial, physicians or advanced practice clinicians were recruited from March 22 to August 5, 2021, from 10 adult primary care or urgent care clinics in Sacramento, California. The intervention period was from May 1, 2021, to March 30, 2022, with follow-up from October 28, 2021, to June 30, 2023. Analyses were performed from April 1 to June 25, 2024.InterventionClinicians were randomized 1:1 to intervention or control. Intervention clinicians received 3 simulated office visits, each with a standardized patient instructor (SPI) portraying a patient with acute uncomplicated back pain. At each visit, SPIs provided clinician feedback guided by a 3-step model: (1) set the stage for deferred imaging by building trust, (2) convey empathy, and (3) communicate optimism while advocating watchful waiting without imaging. Control clinicians received no intervention.Main Outcomes and MeasuresThe primary outcome was lumbar spinal imaging completion within 90 days of acute low back pain visits, with study clinicians assessed up to 18 months of follow-up. Secondary outcomes were cervical spine imaging completion after acute neck pain visits, any imaging completion after an adult visit, patient experience ratings of clinicians (scale range, 0-100), and use of targeted communication skills during an audio-recorded standardized patient evaluation visit at median follow-up of 16.8 months (range, 14.1-18.0 months).ResultsThe analysis included 53 clinicians; mean (SD) age was 46.7 (1.0) years, and 35 (66.0%) reported female gender. A total of 25 were in the intervention group and 28 in the control group. After adjustment for prerandomization rates, patients with acute low back pain who saw intervention and control clinicians during follow-up had similar rates of lumbar imaging (194 of 1234 clinic visits [15.7%] vs 226 of 1306 clinic visits [17.3%]; adjusted ratio of postintervention vs preintervention odds ratios [AORR], 1.00; 95% CI, 0.72-1.40). Adjusted follow-up rates of imaging for acute neck pain (AORR, 1.16; 95% CI, 0.83-1.63) and overall imaging (AORR, 1.07; 95% CI, 0.97-1.19) were not significantly different among patients of intervention and control clinicians. Intervention and control clinicians had similar mean (SD) patient experience ratings during follow-up (88.6 [28.7] vs 88.8 [28.3]; adjusted mean difference-in-differences, −1.0; 95% CI, −3.0 to 0.9). During audio-recorded standardized patient visits, intervention clinicians had significantly better ratings than controls on eliciting the patient’s perspective (adjusted standardized difference [ASD], 0.62; 95% CI, 0.05-1.19) and conveying empathy (ASD, 1.16; 95% CI, 0.55-1.77).Conclusions and RelevanceIn this randomized clinical trial of an educational intervention using simulated office visits to encourage a watchful waiting approach for acute low back pain, the intervention had no significant effect on low-value spinal imaging rates or patient experience ratings.Trial RegistrationClinicalTrials.gov Identifier: NCT04255199

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Training Primary Care Physicians to Employ Self-Efficacy-Enhancing Interviewing Techniques: Randomized Controlled Trial of a Standardized Patient Intervention

Cited by 14 publications

References 39 publications

Physician training in self-efficacy enhancing interviewing techniques (SEE IT): Effects on patient psychological health behavior change mediators

Physician training in self-efficacy enhancing interviewing techniques (SEE IT): Effects on patient psychological health behavior change mediators

Getting from Intention to Action

Standardized Patient Communication and Low-Value Spinal Imaging

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