Professor, Wake Forest School of Medicine, Department of Family & Community Medicine.
Assistant Professor, Wake Forest School of Medicine, Departments of PA Studies, Family & Community Medicine.
MedEdPORTAL. 2020 Nov 12;16:11012. doi: 10.15766/mep_2374-8265.11012.
In light of the opioid overdose epidemic in the US and the necessity of developing training to conduct difficult conversations around opioid dependence, three case-based videos were created to demonstrate providers using motivational interviewing (MI) with patients who have opioid use disorder (OUD). These vignettes displayed a primary care provider interacting with a patient seeking opioids.
Learners-including third-year medical and physician assistant (PA) students, and family medicine residents-viewed three videos set in a family medicine clinic and assessed clinician use of MI when interacting with patients with OUD. The patients were at different levels of acknowledging their need to change their opioid use behaviors and/or pursue treatment. Learners rated each video with an MI rating scale, and a facilitator debriefed strengths, weaknesses, and omissions regarding MI.
Medical and PA students, and resident family physicians provided 572 ratings. Analysis of variance of mean percent incorrect was lower in residents than in all groups combined, but failed to reach statistical significance (47% + 12.0 vs 53% + 15.0, = .43).
These case-based videos with MI ratings afforded students and residents the opportunity to assess clinician use of MI techniques with patients with OUD. The MI rating scale had clinical significance (residents scored +5 points and had more training) despite lacking statistical significance. These scenarios allowed learners to recognize how to use MI when having a difficult conversation with patients who misuse opioids. We envision individual use or use for group discussion.
鉴于美国阿片类药物过量的流行以及开发培训以进行有关阿片类药物依赖的困难对话的必要性，创建了三个基于案例的视频，以展示提供者如何使用动机性访谈（MI）与患有阿片类药物使用障碍（OUD）的患者进行互动。这些情节展示了一名初级保健提供者与寻求阿片类药物的患者进行互动。
学习者，包括三年级医学生和医师助理（PA）学生以及家庭医学住院医师，观看了三个在家庭医学诊所中设置的视频，并评估了临床医生与患有 OUD 的患者互动时使用 MI 的情况。这些患者对承认自己需要改变阿片类药物使用行为和/或寻求治疗的程度不同。学习者使用 MI 评分量表对每个视频进行评分，主持人对 MI 的优缺点和遗漏进行了解剖。
医学生和 PA 学生以及住院家庭医生提供了 572 个评分。方差分析显示，住院医师的平均错误百分比低于所有组合，但是未达到统计学意义（47%+12.0 与 53%+15.0， =.43）。
这些带有 MI 评分的基于案例的视频为学生和住院医师提供了评估临床医生与 OUD 患者使用 MI 技术的机会。尽管缺乏统计学意义，但 MI 评分量表具有临床意义（住院医师的分数增加了 5 分，并且接受了更多的培训）。这些场景使学习者能够认识到如何在与滥用阿片类药物的患者进行困难对话时使用 MI。我们设想个人使用或用于小组讨论。
