A new paradigm for teaching behavior change: Implications for residency training in family medicine and psychiatry

Abstract

BackgroundPrimary care physicians (PCPs) provide ~50 % of all mental health services in the U.S. Given the widening gap between patient mental health needs and resources available to meet those needs, there is an increasing demand for family medicine and psychiatry trainees to master competencies in both behavioral medicine and primary care counseling during residency-if for no other reason than to accommodate the realities of medical practice given the oft present gap between the need for psychiatric services and the availability, quality, and/or affordability of specialized psychiatric care. To begin to address this gap, a skills-based, interactive curriculum based on motivational interviewing (MI) as a teaching method is presented.MethodsThe curriculum described in this paper is a four-week block rotation taught in the second year of residency. Motivational interviewing (MI) is used as a teaching approach toward the goal of clinical behavior change. Residents’ strengths, personal choice and autonomy are emphasized. Each week of the rotation, there is a clinical topic and a set of specific skills for mastery. Residents are offered a “menu” of skills, role modeling, role/real play, practice with standardized patients (SP), and direct supervision in clinic.ResultsThirty-nine residents have completed the curriculum. Based on residents’ subjective reporting using pre-post scales (i.e., importance and confidence), all participants to date have reported substantial increases in confidence/self-efficacy using primary care counseling skills in their continuity clinic.ConclusionsThis paper presents an innovative, empirically based model for teaching the essential skills necessary for physicians providing care for patients with mental/emotional health needs as well as health-behavior change concerns. Implications for training in the broader context, particularly as it relates to multi-disciplinary and collaborative models of teaching/training are discussed.

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.…”

“…[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.…”

“…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,[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. Most studies used preintervention and postintervention testing to assess the impact of the intervention on residents' view of the importance of and confidence with behavior change counseling.…”

“…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.…”