Bean Melanie K, Biskobing Diane, Francis Gary L, Wickham Edmond
J Grad Med Educ. 2012 Sep;4(3):357-61. doi: 10.4300/JGME-D-11-00166.1.
Despite the importance of lifestyle change in disease management and the growing evidence supporting motivational interviewing (MI) as an effective counseling method to promote behavioral change, to date there are few published reports about MI training in graduate medical education.
The study aimed to pilot the feasibility and effectiveness of a brief MI training intervention for endocrinology fellows and other providers.
We used a pretest/posttest design to evaluate a brief MI training for 5 endocrinology fellows and 9 other providers. All participants completed subjective assessments of perceived confidence and beliefs about behavioral counseling at pretest and posttest. Objective assessment of MI was conducted using fellows' audiotaped patient encounters, which were coded using a validated tool for adherence to MI before and after the training. Paired t tests examined changes in objective and subjective assessments.
The training intervention was well received and feasible in the endocrinology setting. At posttest, participants reported increased endorsement of the MI spirit and improved confidence in MI skills. Objective assessment revealed relative improvements in MI skills across several domains. However, most domains, as assessed by a validated tool, did not reach competency level after the training intervention.
Although more intensive training may be needed to develop MI competence, the results of our pilot study suggest that brief, targeted MI training has short-term efficacy and is well received by endocrinology fellows and other providers.
尽管生活方式改变在疾病管理中很重要，且越来越多的证据支持动机性访谈（MI）作为促进行为改变的有效咨询方法，但迄今为止，关于研究生医学教育中MI培训的已发表报告很少。
本研究旨在试点针对内分泌科住院医师和其他医疗服务提供者的简短MI培训干预的可行性和有效性。
我们采用前测/后测设计来评估针对5名内分泌科住院医师和9名其他医疗服务提供者的简短MI培训。所有参与者在培训前和培训后完成了对行为咨询的感知信心和信念的主观评估。使用住院医师的患者会诊录音对MI进行客观评估，在培训前后使用经过验证的MI依从性工具进行编码。配对t检验检查客观和主观评估的变化。
培训干预在内分泌科环境中受到好评且可行。在培训后，参与者报告对MI精神的认可度提高，对MI技能的信心增强。客观评估显示在几个领域中MI技能有相对改善。然而，通过经过验证的工具评估，大多数领域在培训干预后未达到胜任水平。
尽管可能需要更强化的培训来培养MI能力，但我们的试点研究结果表明，简短、有针对性的MI培训具有短期效果，并且受到内分泌科住院医师和其他医疗服务提供者的好评。
