– Healthcare organizations promoting motivational interviewing as a provider communication technique may consider using simulated patient interactions to train providers, according to new data published in JAMA Network Open.
Providers who trained in motivational interviewing using a patient simulator tended to receive higher assessment scores than those who only read material about motivational interviewing, the researchers said.
Motivational interviewing is a key patient engagement strategy that some evidence suggests can improve patient behavior change. The technique, which leverages strong provider empathy and interpersonal skills, helps patients and providers identify what lifestyle factors are most important to the patient. From there, patients and providers may partner in goal-setting to promote a healthy lifestyle.
“Motivational interviewing is explicitly collaborative and explores the patient’s own arguments for change as opposed to trying to convince the patient through expertise or clinical advice,” the researchers said. “Motivational interviewing has demonstrated efficacy for improving a range of health-related outcomes and is equivalent or superior to effective treatments for many health behaviors (eg, alcohol and substance use, smoking, dietary changes, gambling, unprotected sex, exercise, and treatment engagement).”
But like many provider communication strategies, it’s difficult to effectively train providers in motivational interviewing. This technique requires a lot of empathy and the ability to ask strategic open-ended questions. Training sessions that include workshops and face-to-face feedback sessions are most effective, but are out-of-reach for financially-strapped organizations.
The research team sought to analyze the efficacy of a computerized patient simulation that could provide automatic feedback to providers training in motivational interviews. Because this would be a virtual approach, the researchers said the computerized simulations were more cost- and time-efficient, potentially making it a more viable option for healthcare organizations.
Researchers recruited 120 volunteer providers practicing at Department of Veterans Affairs and Department of Defense healthcare facilities, exposing half to the computerized patient simulations.
By and large, these providers performed better on examinations of their motivational interviewing proficiency than those not training with the computerized simulations.
A team of experts using the Motivational Interviewing Treatment Integrity (MITI) measure found those training on the virtual simulations had better scores in three out of four MITI domains, including motivational interviewing technical and relational skills, and an improved proportion of reflections to questions. Scores in self-reported motivational interviewing proficiency were about equal.
What’s more, these results were long-lasting. During a three-month follow-up assessment, the independent reviewers still said those receiving motivational interviewing training via the virtual simulation were better at the communication strategy than those who did not.
“The improvement in MI skills among VSP participants by the 3-month follow-up is noteworthy,” the research team explained. “Without human instruction or an intensive training, the mean proficiency level for those in the [virtual standardized patients] group was fair for both global summary scores, and the VSP participants demonstrated greater proficiency in the proportion of reflections to questions compared with controls as well”
Much of this success may be credited to the immediate feedback the virtual simulations provided, the researchers said. The virtual simulations provided near-immediate feedback, allowing providers to assess skills to continue and areas for improvement in real-time. Providers in the virtual simulation group had the opportunity to fix problem areas quickly, rather than make a habit out of them.
This factor could help make the case for integrating the virtual simulation model into resource-constrained organizations.
“Trainees could immediately apply this feedback with the next [virtual standardized patients] training interaction, which may have consolidated learning,” the team reiterated. “In light of these affordances, VSPs may be uniquely positioned to assist with the resource-intensive role of providing posttraining MI feedback and coaching required for sustainment of [motivational interviewing] skills.”
Of note, the researchers observed no difference between the two groups in terms of self-reported knowledge of motivational interviewing. In other words, those not using the virtual simulations thought they learned just as much as their peers about motivational interviewing.
This confirms the conceit that one does not know what she doesn’t know, and that providers may not be aware of different parts of motivational interviewing they are missing in didactic learning settings.
Moving forward, researchers may look into strategies to expand the virtual simulation model, foremost by examining other behavior changes that motivational interviewing may support, the researchers concluded.
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