Pilot study of the influence of self-coding on empathy within an introductory motivational interviewing training.

BACKGROUND: Motivational interviewing (MI) is a framework for addressing behavior change that is often used by healthcare professionals. Expression of empathy during MI is associated with positive client outcomes, while absence of empathy may produce iatrogenic effects. Although training in MI is linked to increased therapeutic empathy in learners, no research has investigated individual training components' contribution to this increase. The objective of this study was to test whether a self-coding MI exercise using smartphones completed at hour 6 of an 8-h MI training was superior in engendering empathy to training as usual (watching an MI expert perform in a video clip for the same duration at the same point in the training). METHODS: This was a pilot study at two sites using randomization and control groups with 1:1 allocation. Allocation was achieved via computerized assignment (site 1, United Kingdom) or facedown playing card distribution (site 2, United States). Participants were 58 students attending a university class at one of two universities, of which an 8-h segment was dedicated to a standardized MI training. Fifty-five students consented to participate and were randomized. The intervention was an MI self-coding exercise using smartphone recording and a standardized scoring sheet. Students were encouraged to reflect on areas of potential improvement based on their self-coding results. The main outcome measure was score on the Helpful Responses Questionnaire, a measure of therapeutic empathy, collected prior to and immediately following the 8-h training. Questionnaire coding was completed by 2 blinded external reviewers and assessed for interrater reliability, and students were assigned averaged empathy scores from 6 to 30. Analyses were conducted via repeated-measures ANOVA using the general linear model. RESULTS: Fifty-five students were randomized, and 2 were subsequently excluded from analysis at site 2 due to incomplete questionnaires. The study itself was feasible, and overall therapeutic empathy increased significantly and substantially among students. However, the intervention was not superior to the control condition in this study. CONCLUSIONS: Replacing a single passive learning exercise with an active learning exercise in an MI training did not result in a substantive boost to therapeutic empathy. However, consistently with prior research, this study identified significant overall increases in empathy following introductory MI training. A much larger study examining the impact of selected exercises and approaches would likely be useful and informative.

Are We There Yet? A Review of Screening, Brief Intervention, and Referral to Treatment (SBIRT) Implementation Fidelity Tools and Proficiency Checklists.

Screening and brief intervention (SBI) for alcohol is an evidence-based prevention practice designed to reduce frequency and severity of alcohol misuse. Many studies have validated the effectiveness of SBI for reducing levels of alcohol misuse, especially in primary medical care. Additional research continues to be conducted in terms of the effectiveness of including referral to treatment (SBIRT) and addressing illicit drug use and prescription drug abuse. Importantly, cross-comparison among SBIRT programs is difficult because evaluative processes vary widely between programs, which themselves often are substantively different. In this brief report, we utilized cross-comparison techniques to elucidate similarities and differences among SBIRT fidelity tools and proficiency checklists. In early 2014, researchers completed a systematic review of SBIRT fidelity tools and proficiency checklists published or made available from 2004 through April 2014; in total, eleven instruments were located and assessed. The analytic methodology consisted of creating a matrix with key SBIRT components identified from the literature prior to assessment. Three researchers populated the matrix with the identified fidelity tools and proficiency checklists before assessing each tool for the presence or absence of each component. The level of agreement between the researchers was checked for inter-rater reliability using free-marginal Kappa statistics. The results of the matrix analysis suggested heterogeneity among existing SBIRT fidelity tools and proficiency checklists. Importantly, it was not the case that this lack of concordance reflected poorly on any given fidelity tool. Rather, it emphasized the multi-partite and variable nature of SBIRT programs. It was not evident that a single standardized SBIRT fidelity tool or proficiency checklist could appropriately determine the level of fidelity to SBIRT for all programs. Suggestions for next steps in SBIRT fidelity research are provided based on the output of the comparison matrix.

Screening, Brief Intervention, Referral to Treatment (SBIRT), and Motivational Interviewing for PGY-1 Medical Residents.

BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) for alcohol use in primary care-often using motivational interviewing (MI)-is an effective preventive service. Medical residency programs have begun offering training in these areas, but little research has been conducted to examine the impact of SBIRT/MI training length on residents' satisfaction, affect, and behavioral intentions. OBJECTIVE: We measured residents' satisfaction with their training in addition to variables shown in previous research to predict medical professionals' intention to perform SBIRT. METHODS: This study focused on 2 SBIRT/MI training structures: a 4- to 6-hour training using didactic, experiential, and interactive methods and a brief 1-hour session explaining the same principles in a noninteractive format. Immediately following each training intervention, participating residents from internal medicine (IM), pediatrics (PEDS), medicine-pediatrics (IM-PEDS), and emergency medicine (EM) programs completed a 22-item instrument derived from established questionnaires; responses to each item were dichotomized, and comparisons were conducted between the training groups using Fisher exact test. RESULTS: Of 80 participating residents, 59 IM, PEDS, and IM-PEDS residents completed the longer training, and 21 EM residents completed the shorter training. All participating residents reported high levels of satisfaction, although EM residents were comparatively less satisfied with their shorter training session. CONCLUSIONS: Both SBIRT/MI training structures were feasible and were accepted by learners, although the 2 groups' perceptions of the training differed. Future research into the underlying causes of these differences may be useful to the application of SBIRT/MI training during residency.