Motivational interviewing skills practice enhanced with artificial intelligence: ReadMI.

BACKGROUND: Finding time in the medical curriculum to focus on motivational interviewing (MI) training is a challenge in many medical schools. We developed a software-based training tool, "Real-time Assessment of Dialogue in Motivational Interviewing" (ReadMI), that aims to advance the skill acquisition of medical students as they learn the MI approach. This human-artificial intelligence teaming may help reduce the cognitive load on a training facilitator. METHODS: During their Family Medicine clerkship, 125 third-year medical students were scheduled in pairs to participate in a 90-minute MI training session, with each student doing two role-plays as the physician. Intervention group students received both facilitator feedback and ReadMI metrics after their first role-play, while control group students received only facilitator feedback. RESULTS: While students in both conditions improved their MI approach from the first to the second role-play, those in the intervention condition used significantly more open-ended questions, fewer closed-ended questions, and had a higher ratio of open to closed questions. CONCLUSION: MI skills practice can be gained with a relatively small investment of student time, and artificial intelligence can be utilized both for the measurement of MI skill acquisition and as an instructional aid.

Responding to Soul Injury: Tools for Hope and Healing.

Soul Injury is defined as a wound that separates a person from their real self, caused by unmourned loss and hurt, unforgiven guilt and shame, and fear of helplessness or loss of control. Tools and interventions have been developed to guide people impacted by Soul Injury. This study assessed the effectiveness of 12 tools and interventions provided during a 4-day Soul Injury Leadership Institute. This 2-part investigation included an online survey of participants who had attended a 4-day Institute training and a post-Institute narrative inquiry conducted as virtual structured interviews. Ninety-one professionals completed the online survey, which inquired about the impact of specific Soul Injury tools and interventions on the respondents' personal and professional life. The Anchor Your Heart tool was the most frequently used tool and had the most enduring utilization across time and settings. Qualitative data collected in virtual interviews with 15 volunteers demonstrated the power of the Write/Tell Your Story technique in which storied narratives permit an individual to integrate powerful experiences such as traumatic events, serious illness, and even death, providing further validation that Soul Injury is an important human phenomenon.

Validation of the Soul Injury Self-awareness Inventory.

Traumatic lifetime experiences can complicate peaceful dying, causing latent wounds such as posttraumatic stress disorder, moral injury, and soul injury to reemerge at the end of life. Soul injury is defined as an overlooked, unassessed wound that separates a person from his/her own sense of self. The Soul Injury Self-awareness Inventory (Soul Injury Inventory) was developed to identify unresolved losses and hurts that threaten a sense of self. The Soul Injury Inventory is a brief, 10-item instrument that opens the door to meaningful conversations with patients, caregivers, and professionals. This article describes 2 validation studies conducted to measure the reliability, internal consistency, and construct validity of the Soul Injury Inventory. In study 1, the Soul Injury Inventory was demonstrated to be a psychometrically sound tool in which all questions contributed significantly to a single factor characterized as soul injury. In receiver operating characteristic analyses, scores less than 23.5 were shown to be indicative of soul injury with optimal sensitivity and specificity. Study 2 demonstrated that the Soul Injury Inventory has excellent test-retest reliability. The Soul Injury Inventory also has strong internal consistency, as demonstrated in studies 1 and 2. These 2 validation studies, taken together, demonstrate that the Soul Injury Inventory is an excellent, invariant measure of soul injury.

Advancing Motivational Interviewing Training with Artificial Intelligence: ReadMI.

BACKGROUND: Motivational interviewing (MI) is an evidence-based, brief interventional approach that has been demonstrated to be highly effective in triggering change in high-risk lifestyle behaviors. MI tends to be underutilized in clinical settings, in part because of limited and ineffective training. To implement MI more widely, there is a critical need to improve the MI training process in a manner that can provide prompt and efficient feedback. Our team has developed and tested a training tool, Real-time Assessment of Dialogue in Motivational Interviewing (ReadMI), that uses natural language processing (NLP) to provide immediate MI metrics and thereby address the need for more effective MI training. METHODS: Metrics produced by the ReadMI tool from transcripts of 48 interviews conducted by medical residents with a simulated patient were examined to identify relationships between physician-speaking time and other MI metrics, including the number of open- and closed-ended questions. In addition, interrater reliability statistics were conducted to determine the accuracy of the ReadMI's analysis of physician responses. RESULTS: The more time the physician spent talking, the less likely the physician was engaging in MI-consistent interview behaviors (r = -0.403, p = 0.007), including open-ended questions, reflective statements, or use of a change ruler. CONCLUSION: ReadMI produces specific metrics that a trainer can share with a student, resident, or clinician for immediate feedback. Given the time constraints on targeted skill development in health professions training, ReadMI decreases the need to rely on subjective feedback and/or more time-consuming video review to illustrate important teaching points.

Change in drawing placement: A measure of change in mood state reflective of hemispheric lateralization of emotion.

The Valence Hypothesis of cerebral lateralization of emotion suggests greater right hemisphere activation during negative mood and greater left hemisphere activation during positive mood. This can manifest as visual field attentional bias. Here, study participants completed an assessment of current mood state (PANAS) and made a drawing (Drawing 1). To induce positive or negative mood, participants played a game; then, the winner read a script depicting a positive interpersonal interaction and the loser read a script depicting a negative interpersonal interaction. Participants then drew a second picture (Drawing 2) and completed the PANAS. We hypothesized that the game outcome would change current mood state and hemispheric activation, which would be reflected in drawing placement. The placement of Drawing 2 moved right for winners and left for losers. Winners experienced a greater increase in positive affect from Time 1 to Time 2 than losers and had decreased negative affect from Time 1. Losers had decreased positive affect from Time 1 and had a greater increase in negative affect from Time 1 to Time 2 than winners. Our results suggest that change in current mood state may be objectively observed by evaluating hemispatial bias reflective of brain hemispheric activation with drawings.

Community Stakeholders' Perceptions of the Role of Family in HIV Prevention in Iringa, Tanzania.

Although HIV is identified as a family disease, the overall response to the global HIV epidemic continues to predominantly focus on individuals. The aim of this qualitative study was to explore how the role of the family in HIV prevention is perceived by community-based stakeholders. Understanding the role of the family within the context of the HIV/AIDS is essential for community/public health nurses. In total, 34 stakeholders participated in the study. Three major categories were identified namely: fostering positive intra-familial relations, utilizing external resources, and barriers to family roles. The study findings have implications for community-based HIV family interventions.

The PALS prevention program and its long-term impact on student intentions to use alcohol, tobacco, and marijuana.

A unique Alcohol, Tobacco, and Other Drug (ATOD) prevention program called PALS (Prevention through Alternative Learning Styles) was implemented with middle school students with the goal of enhancing student knowledge of the harmful effects of ATOD, promoting the use of refusal skills and reducing intentions to use ATOD in the future. Intentions to use were measured at four points: pre-PALS, post-PALS, and at 1-year and 2-year follow-ups. Student survey responses were then matched and compared across the four time periods. This article reports on the long-term effectiveness of PALS on student intentions to use ATOD in high school. When follow-up surveys of PALS students were compared to students not exposed to PALS (comparison group), the PALS students had significantly lower intentions to use alcohol and tobacco, providing evidence that the PALS intervention did have a long-term impact on intentions to use these substances.

Childhood emotional neglect related to posttraumatic stress disorder symptoms and body mass index in adult women.

The relationships among the severity of childhood abuse and neglect, posttraumatic stress disorder (PTSD), and adult obesity were investigated. 207 women (M age = 26.5 yr., SD = 6.7) completed the Childhood Trauma Questionnaire, Millon Clinician Multiaxial Inventory, and a demographic questionnaire. Analyses of variance indicated that women who reported moderate-to-extreme emotional neglect (n = 71) had significantly higher PTSD scores and increased BMI compared to women who reported low emotional neglect (n = 84). Women who reported severe sexual or emotional abuse also had higher PTSD scores, but no relationship was found with BMI when other factors were controlled. Although PTSD scores and self-reported severity of childhood emotional neglect were strongly correlated (r = .61, p < .001), PTSD was not found to be a mediating factor in obesity in women who reported childhood emotional neglect, although depression was.

Childhood abuse related to nicotine, illicit and prescription drug use by women: pilot study.

A sample of 811 women ages 18 to 59 (M=26.0, SD=6.5) responded to an advertisement by telephone. Inquiries were made about childhood abuse status and adult use of alcohol, nicotine, and prescription and illicit drugs. Significant associations were noted for reported sexual, physical, and emotional childhood abuse with use of nicotine, marijuana, and antidepressants in adulthood. Reported childhood physical and emotional abuses were also significantly associated with use of cocaine and anxiolytics, and sexual abuse with antipsychotic use in adulthood. Only childhood emotional abuse was associated with the use of sleeping pills. Number of types of abuse was significantly related with use of nicotine, marijuana, cocaine, antidepressants, antipsychotics, and anxiolytics. Alcohol use was not related to any type of abuse. The long-term effects of childhood emotional abuse may be just as severe as physical or sexual abuse.

Sex differences in landmark learning by children aged 5 to 12 years.

Previous research has shown that men and boys learn routes faster and with fewer errors than do women and girls. Research with adults suggests that men use Euclidean cues when learning a route, whereas women use landmark-based strategies. The strategies used by children have received little study. In Exp. 1, 50 boys and girls, ages 5 to 12 years, were shown a map that contained only landmarks (no streets or roads) and were asked to learn a route consisting of 23 of the landmarks. The children used a pointer to trace the route on the map to a criterion of two successive trials without errors. The performance of boys and girls did not differ significantly on this route-learning task on three measures (number of trials to reach criterion, total time to reach criterion, and total number of errors). In Exp. 2, 52 boys and girls, ages 5 to 12 years, were shown the same map as in Exp. 1 and were asked to learn a route consisting of 12 landmarks. The children traced the route by picking pictures of landmarks in the correct order from a stack of cards with pictures of landmarks on them. Girls made significantly fewer errors than boys on this route-learning task in Exp. 2, and a significantly larger number of girls than boys completed the task. None of the boys in the 5- to 6-yr.-old age group learned the route. When Euclidean cues were minimized in Exp. 2, boys made more errors and took as much time as girls to reach the criterion of two successive correct trials.

Do landmarks help or hinder women in route learning?

Previous research on route learning has demonstrated that men learn routes faster and with fewer errors than women, whereas women are able to recall more landmarks along the route. The present study was aimed at investigating whether landmarks help or hinder women when they learn a route. 47 female and 37 male undergraduate students were randomly assigned to one of two conditions, in which they learned a route on a map with landmarks (the Landmark condition) or with no landmarks (the No-Landmark condition). Men outperformed women in the Landmark condition, learning the route in less time, with fewer errors, and in fewer trials than women did. In contrast, in the No-Landmark condition, no significant differences were found between men and women on the route-learning measures. Men learned the route faster and more accurately when landmarks were present than when they were not, but the performance of women was not affected by the presence or absence of landmarks. These results suggest that men and women may employ landmarks differently when learning a route. Men may use the positions of landmarks to make distance and direction judgments, whereas women may label the landmarks and memorize these labels, which interferes with learning the route.