1. A Longitudinal Curriculum in Motivational Interviewing WT-04 Clara Keegan, MD University of Vermont Medical Center

2. Disclosures Dr. Keegan has nothing to disclose

3. Objectives Upon completion of this session, participants should be able to: 1.Describe the approach to Motivational Interviewing training under development at the University of Vermont Family Medicine Residency. 2.Access resources for personal training in Motivational Interviewing techniques. 3.Identify areas of potential improvement in this program and adapt the approach for use at other residency sites.

4. Background Motivational interviewing (MI) is a patient- centered counseling technique designed to help patients achieve behavior change. MI is a useful skill when managing chronic conditions, when the techniques taught in medical school for eliciting the history of present illness are less effective.

5. Benefits of Motivational Interviewing Begins and ends with a collaborative relationship Emphasizes that the provider is responsible for the intervention, not the outcome Evidence for efficacy in managing addictions

6. The Curriculum Four workshops, each two hours, spaced over the year during the weekly education sessions Topics follow the outline of “The Eight Stages of Learning Motivational Interviewing” by William Miller and Teresa Moyers

7. The Curriculum Pre-workshop preparation: 30-45 min presentation with slides and audio to give didactic background Workshop includes review with audience response followed by active practice of skills Uses “real-play” rather than “role-play”

8. Research Questions Is the curriculum effective at teaching residents MI skills? Are patients more satisfied when they see residents with strong MI skills? Do residents with greater adherence to MI have better job satisfaction and lower burnout?

9. Methods 1.Assess resident adherence to MI skills in patient encounters 2.Measure patients’ experience 3.Evaluate resident job satisfaction and burnout level 4.Repeat twice during each residency year 5.Compare data, including workshop attendance

10. Resident Assessment Each resident will be scheduled for two taping sessions per year Each patient that presents for care during that session will be invited to participate in the study A digital audio recorder will be used to tape the conversation

11. Patient Assessment On check-out, participating patients will be asked to complete the 10 item “Motivational Interviewing Measure of Provider Interaction” Surveys will be tagged for later comparison to data from the recording assessment

12. Resident Skill Assessment Audio tapes will be submitted to an outside resource for objective assessment using either the Behavioral Change Counseling Index (BECCI) or the Motivational Interviewing Treatment Integrity (MITI) code

13. Job Satisfaction & Burnout Assessment Selected relevant items from the Physician Worklife Survey –I am overwhelmed by the needs of my patients –I am having a positive impact on a needy population –Overall, I am pleased with my work Maslach Burnout Inventory –Validated for use with family physicians –Proprietary

14. Resources The Center for Integrated Primary Care Worcester, MA http://www.umassmed.edu/cipc/ –Online training in MI basics The Health Education and Training Institute Portland, ME http://www.hetimaine.org/ –Live training in Maine and elsewhere, including advanced practice and training of trainers –Online training in MI basics –MITI coding

15. Questions? Comments? Ideas?

16. References Konrad TR, Williams ES, Linzer M, et al. Measuring Physician Job Satisfaction in a Changing Workplace and a Challenging Environment. Medical Care 1999; 37:1174-1182. Lane C. The Behaviour Change Counselling Index (BECCI): manual for coding behavior change counselling. University of Wales College of Medicine. Accessed via motivationalinterviewing.net on November 27, 2014. Miller WR, Moyers TB. Eight stages in learning motivational interviewing. Journal of Teaching in the Addictions 2006;5:3- 17. Rafferty JP, Lemkau JP, Purdy RR, et al. Validity of the Maslach Burnout Inventory for family practice physicians. J Clin Psychol 1986; 42(3): 488-92.

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