Motivational Interviewing Training Research

Motivational Interviewing Training Research

Motivational Interviewing Training Research 2017

Motivational Interviewing Training Research 2017

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.