Motivational Interviewing Training Research 2017- Present
Motivational Interviewing Training Research 2017- Present
Scales, R., Meister, J. M., Pallagi, P. J., Patnaud, J., Ivy, C. C., Fitz-Patrick, D., Buckner Petty , S., Vorseth, K. S., Fernandes, R., Van Nuland, S. E. (2020). Alternate methods of healthcare delivery in Physical Medicine and Rehabilitation: Clinician attitude after medical education. Archives of Physical Medicine & Rehabilitation, Abstract 1382006, 101, 11: E71-72. DOI: http://doi.org/10.1016/j.apmr.2020.09.217.
Scales, R., Meister, J. M., Pallagi, P. J., Patnaud, J., Ivy, C. C., Fitz-Patrick, D., Buckner Petty , S., Vorseth, K. S., Fernandes, R., Van Nuland, S. E. (2020). Alternate methods of healthcare delivery in Physical Medicine and Rehabilitation: Clinician attitude after medical education. Archives of Physical Medicine & Rehabilitation, Abstract 1382006, 101, 11: E71-72. DOI: http://doi.org/10.1016/j.apmr.2020.09.217.
Value-driven reimbursement may challenge clinicians to improve patient adherence and clinical outcomes with alternate methods of healthcare delivery. This investigation evaluated the attitude of Physical Medicine and Rehabilitation (PM&R) clinicians to incorporate technology and motivational interviewing (MI) strategies into clinical practice. A confidential pre and post survey evaluated the needs, demands and attitude (0-10 Likert scale) associated with the role of technology to enhance the patient experience and the clinician’s responsibility to increase patient adherence. Pre to post change in scores was analyzed using Wilcoxon signed-rank tests with continuity correction. A self-selected group was recruited from an outpatient PM&R setting. Twenty-two practitioners (82% physical therapists, 70% female) received a 30-minute classroom presentation taught by a medical educator. Time series still image photography was used in combination with an interactive three-dimensional virtual tour to illustrate the strategic design of a PM&R workspace. Video recordings of a role play between a clinician and a standardized patient living with chronic pain demonstrated an in-person clinical encounter. There were four examples of technology: (1) touchscreen display monitors to interact with the patient (2) video recording and analysis of a physical performance evaluation with the capacity to send images to the Electronic Medical Record (3) Movement Sensor Technology that quantifies objective metrics about movement and performance and (4) a Connected Health mobile device (m-Health) application that enables the clinician to monitor and prescribe a home treatment plan. Attitude scores increased significantly about the role of technology to enhance the patient experience (7.4 vs 8.7, SD=1.4, p<0.001) and the clinician’s responsibility to increase patient adherence with a prescribed home exercise plan (7.0 vs 7.9, SD=2.0, p<0.05). No one was opposed to using the examples of technology in their future practice. The majority was interested in learning more about MI (86%) and clinical applications of technology (100%). Everyone agreed that further research was needed. Clinicians in this pilot study were receptive to alternate methods of delivering PM&R.
Scales, R., Ivy, C. C., Meister, J. M., Pallagi, P. J., Patnaud, J., Fitz-Patrick, D., Vorseth, K. S., Buckner Petty, S., Fernandes, R. I., Van Nuland, S. E. (2020). Demonstrating applications of technology in Physical Medicine & Rehabilitation with creative multi-media medical education. Annals of Behavioral Medicine, 54 (Suppl 1): Abstract C215, S585.
Scales, R., Ivy, C. C., Meister, J. M., Pallagi, P. J., Patnaud, J., Fitz-Patrick, D., Vorseth, K. S., Buckner Petty, S., Fernandes, R. I., Van Nuland, S. E. (2020). Demonstrating applications of technology in Physical Medicine & Rehabilitation with creative multi-media medical education. Annals of Behavioral Medicine, 54 (Suppl 1): Abstract C215, S585.
Value-driven reimbursement will challenge clinicians to improve patient adherence and clinical outcomes with alternate methods of healthcare delivery. In this medical education intervention, multi-media teaching modalities were used to demonstrate motivational interviewing (MI) and clinical applications of technology in an outpatient Physical Medicine and Rehabilitation (PM&R) setting. Eighty-three first and second year occupational therapy students (83% female) within an academic program received a 30-minute classroom presentation taught by a medical educator and completed a confidential pre and post survey to evaluate their needs, demands and attitude (0-10 Likert scale) about the PM&R workspace, the role of technology in the patient experience and the clinician’s responsibility to increase patient adherence. Time series still image photography was used in combination with an interactive three-dimensional virtual tour to show the strategic design of a PM&R workspace. Video recordings of a role play between and clinician and a standardized patient living with chronic pain demonstrated an in-person clinical encounter. There were four examples of technology: (1) touchscreen display monitors to interact with the patient (2) video recording and analysis of a physical performance evaluation with the capacity to send images to the Electronic Medical Record (3) Movement Sensor Technology that quantifies objective metrics about movement and performance and (4) a Connected Health (CH) mobile device application (m-Health) that enables the clinician to monitor and prescribe treatment plans to the patient in their home. Subtitles were added to the videos to highlight key teaching points. Attitude scores significantly increased (p<0.001) for the importance of the workspace in the evaluation of patients (8.1 vs 9.5, SD=1.8), the role of technology to enhance the patient experience (7.3 vs 9.2, SD=2.3) and the clinician’s responsibility to increase patient adherence with a prescribed home exercise plan (7.6 vs 8.3, SD=2.5). None of the students were opposed to using the examples of technology in their future practice. The majority were interested in learning more about MI (98%) and clinical applications of technology (96%). Creative multi-media teaching applications can provide a virtual learning experience that has the potential to enhance medical education.
Scales, R., Miller, J. H., Menghini, M., Buras, M., Elder, J., Abu Dabrh, A. M., Foxx-Orenstein, A. (2019). Motivational interviewing training and peer supervision for healthcare professionals that promote weight loss: A feasibility pilot. Annals of Behavioral Medicine, 53, (Suppl 1): Abstract D219, S760.
Scales, R., Miller, J. H., Menghini, M., Buras, M., Elder, J., Abu Dabrh, A. M., Foxx-Orenstein, A. (2019). Motivational interviewing training and peer supervision for healthcare professionals that promote weight loss: A feasibility pilot. Annals of Behavioral Medicine, 53, (Suppl 1): Abstract D219, S760.
This investigation evaluated the short-term effect of guided practice and peer supervision (PS) added to a motivational interviewing (MI) training workshop. In this mixed methods feasibility study, a self-selected volunteer group of 13 female clinicians (62% physicians and mid-levels) completed an introductory training in MI. Two experienced trainers conducted a standard 2-day workshop with a focus on weight management (WM). Trainees were taught how to independently practice, code and supervise each other in small groups (triads) for the purpose of ongoing skill development. On completion of the workshop, trainees were assigned at random to either a control treatment (CT) or to an experimental treatment (ET). The CT (n=7) received the MI workshop only and the ET (n=6) received the MI workshop plus PS consisting of 3 additional 1-hour guided practice sessions over a 6-week period. These practice sessions took place independently in assigned triads. All clinicians provided an audio-taped recording of a clinical visit of their choice at baseline (BL) and 6-weeks post workshop (6- wk PW). The recorded samples were downloaded into a secure site on the Blackboard system within the institution’s Simulation Center. The recordings were anonymously analyzed by a coding expert who was blind to group assignment and the time of recording. The MITI 4. 2 Coding Instrument scored the visits on global ratings that used a 1-5 point scale and an objective behavioral count to determine MI proficiency. The mean overall global rating (OGR) was 3. 6 (SD=0. 4) vs 3. 6 (SD=0. 4) BL and 3. 6 (SD=0. 4) vs 3. 4 (SD=0. 4) 6-wk PW (p>0. 05) for the CT and ET respectively. For the behavioral count, the mean scores for the reflection-to-question ratio (R:Q) was 0. 5 (SD=0. 2) vs 0. 3 (SD=0. 2) BL and 0. 5 (SD=0. 2) vs 0. 7 (SD=0. 2) 6-wk PW (p>0. 05) for the CT and ET respectively. This small pilot study did not yield enhanced short-term MI proficiency when guided PS was added to a standard MI training workshop. Further investigation is needed to determine optimal post workshop training methods to improve MI proficiency over time in clinicians that promote WM.
Menghini, M., Foxx-Orenstein, A., Miller, J. H., Temkit, H., Elder, J., Scales, R. (2017). Project management in healthcare communication training research. Proceedings of a conference. 26th Annual Meeting of the Society of Clinical Research Associates (SOCRA), Orlando, Florida.
Menghini, M., Foxx-Orenstein, A., Miller, J. H., Temkit, H., Elder, J., Scales, R. (2017). Project management in healthcare communication training research. Proceedings of a conference. 26th Annual Meeting of the Society of Clinical Research Associates (SOCRA), Orlando, Florida.
Behavior change counseling (BCC) in the medical setting has progressed from simple advice-giving to strategic patient-centered methods of communication such as motivational interviewing (MI). Research is needed to evaluate the effect of BCC training interventions on clinician proficiency. The purpose of this investigation was to describe the role of a clinical research coordinator (CRC) in MI training research for clinicians that promote weight management (WM). In this observational study, a self-selected group of 13 female clinicians (62% physicians/mid-levels) were evaluated before and after an introductory training in MI. Two experienced trainers conducted a standard 2-day workshop that focused on WM. Trainees were taught how to independently practice, code and supervise each other in small groups (triads) for the purpose of ongoing skill development. On completion of the workshop, the CRC randomized fifty percent of the trainees to receive 3 additional 1-hour guided practice sessions over a 6-week period. These practice sessions took place independently in the assigned triads and included the opportunity of supervision from peers that had completed the training workshop. The clinicians were evaluated with the CARE Measure for 4-weeks before and 6-weeks after the workshop. This confidential 10-item questionnaire assessed relational empathy from the patient perspective on completion of clinical visits (n=531). The CARE Measure was scored on a 1-5 Likert scale. The clinicians provided an audio-taped recording of a clinical visit of their choice pre workshop, post workshop (PW) and 6-week PW. The CRC downloaded the recorded sample into a secure site on the Blackboard system within the institution’s Simulation Center. The recording was anonymously analyzed by a coding expert who was blind to the recording time point and group assignment. The MITI 4.2 Coding Instrument scored the visits on global ratings that used a 1-5 scale and an objective behavioral count to determine MI proficiency. A pre workshop and post workshop clinician self-evaluation measured perceived proficiency and intent to use MI. The CRC managed and facilitated all methods used to evaluate the proficiency of the clinicians. The study required timely coordination with multiple professional groups; which included the clinicians, the Simulation Center, medical assistants, and data analysts. The data for this observational study is currently being analyzed. A MI training intervention needs to be evaluated in terms of measurable outcomes with a variety of methods. There are obstacles and challenges in the implementation process of high quality research. The project management role of a CRC is essential to healthcare communications training research.
Scales, R., Miller, J. H., Temkit, H., Menghini, M., Elder, J., Foxx-Orenstein, A. (2017). Methods to evaluate an introductory motivational interviewing workshop for healthcare professionals that promote weight management. Medicine & Science in Sports & Exercise, Abstract D-65, 49, 5: S586.
Scales, R., Miller, J. H., Temkit, H., Menghini, M., Elder, J., Foxx-Orenstein, A. (2017). Methods to evaluate an introductory motivational interviewing workshop for healthcare professionals that promote weight management. Medicine & Science in Sports & Exercise, Abstract D-65, 49, 5: S586.
In this observational study, a self-selected group of 13 female clinicians (62% physicians/mid-levels) were evaluated before and after an introductory training in motivational interviewing (MI). The purpose was to evaluate the effect of a behavior change counseling training intervention on clinician proficiency. Two experienced trainers conducted a standard 2-day workshop that focused on weight management. The clinicians were evaluated with the CARE Measure for 4-wks before and 6-wks after the workshop. This confidential 10-item questionnaire assessed relational empathy from the patient perspective on completion of clinical visits (n=531). The CARE Measure was scored on a 1-5 Likert scale. The clinicians provided an audio-taped recording of a clinical visit of their choice pre and post workshop (PW). The recording was anonymously analyzed by a coding expert. The MITI 4.2 Coding Instrument scored the visits on global ratings that used a 1-5 scale and an objective behavioral count to determine MI proficiency. A pre and PW clinician self-evaluation measured perceived proficiency and intent to use MI. The overall mean score for the CARE Measure was 48.8 (SD=3.1) out of a maximum of 50 at baseline (BL) and 48.9 (SD=3.0) PW (p>0.05). The overall mean global rating for the MITI was 3.6 (SD=1.2) out of a maximum 5 at BL and 3.8 (SD=0.9) PW (p>0.05). For the behavioral count, the mean reflection-to-question ratio was 0.4 (SD=0.3) at BL and 0.5 (SD=0.3) PW (p>0.05). The mean MI adherent behavior count was 7.5 (SD=6.6) at BL and 8.3 (SD=3.8) PW (p>0.05). The mean MI non-adherent behavior count was 1.4 (SD=0.6) at BL and 0.2 (SD=0.6) PW (p>0.05). The mean persuasion behavioral count with and without permission was 6.8 (SD=3.5) at BL and 2.9 (SD=1.5) at PW (p<0.05). The mean overall self-perceived proficiency and intent to use MI was 7.6 (SD=1.1) at BL and 8.8 (SD=0.7) PW (p<0.05). Preliminary findings of this pilot study did not identify significant change in MI proficiency. However, trainees used significantly less persuasion, patient evaluations remained high and clinician self-evaluation scores improved significantly. Short-term measures from these varied methods of evaluation may provide useful feedback to clinicians for ongoing MI skill development.
Scales, R., Mercer, S. W., Murphy, D., Akalan, C., Mookadam, F., Storey, E., Hall, L., Wilansky, S. (2017). Psychometric properties of the Consultation and Relational Empathy (CARE) Measure in a cardiology setting. Annals of Behavioral Medicine, 51 (Suppl 1): Abstract D061, S2484-85.
Scales, R., Mercer, S. W., Murphy, D., Akalan, C., Mookadam, F., Storey, E., Hall, L., Wilansky, S. (2017). Psychometric properties of the Consultation and Relational Empathy (CARE) Measure in a cardiology setting. Annals of Behavioral Medicine, 51 (Suppl 1): Abstract D061, S2484-85.
The Consultation and Relational Empathy (CARE) Measure is a 10-item questionnaire that rates the patient experience and the interpersonal quality of a medical visit. The measure has been validated in primary care and some sub-speciality disciplines, but it has not been assessed in cardiology. This was a preliminary study of the utility of the CARE Measure to assess physicians in cardiology fellowship training. Adult patients completed the CARE Measure after a medical visit. Face validity was estimated by the number of ‘not applicable’ responses. Statistical analysis included principal component analysis (construct validity), Cronbach’s alpha (internal consistency), and Generalisability theory (inter-rater reliability). Twenty-two cardiology trainees were assessed after 1372 total visits. The level of ‘not applicable’ responses was low, ranging from 0.2% to 5.3% per item (average 1.4% across all 10 items). Missing values were rare (0.2% overall). The measure showed high internal consistency (Cronbach’s alpha coefficient=0.97) and the removal of any of the items reduced reliability. Factor analysis revealed a single factor with high factor loading for each item. The mean CARE Measure score at the patient level (n=1372) was 48.3 (SD=4.00), with mean scores ranging from 23-50. The skew was -2.721 and the kurtosis 7.743 with 48% of patients reporting a maximum CARE score of 50. The mean CARE Measure score at the physician level (n=22) was 48.2 (SD=0.85), with an essentially normal distribution (skew -0.314, kurtosis – 0.594). Although mean CARE scores did vary significantly between physicians, the variation was limited (range 46.5-49.5, p<0.005) and thus the ability of the measure to discriminate between individuals in this sample was correspondingly low (G=0.36-0.48). Higher reliability, suitable for formative feedback (G=>0.5) would require >60 completed questionnaires/physician. Preliminary findings suggest that the CARE Measure has face and construct validity with internal reliability in cardiology fellowship training and it may provide a practical measure of interpersonal communication. Further investigation is needed with a larger number of physicians and patients in different cardiology settings to determine if the CARE Measure can differentiate between individuals within this sub-speciality.