Bob McLaughlin, Ph.D. School of Allied Health Sciences Two Innovative Simulated Patient Methodologies to Assess Health Behavior Counseling Skills

Core Competencies in Patient Communication for Healthcare Clinicians Patient Care Professionalism Interpersonal & Communication Skills 2

3 Why don’t people change? Active Listening Open questions Affirmations Reflections Summaries Health Beliefs Harm Reduction Behavioral Prescription Measurable Objectives Squarely face patient Open stance Lean forward Eye contact Relax Ask Advise Assess Assist Arrange Why do they? Health Behavioral Counseling Health Risk Behaviors Chronic Disease Management Readiness to Change Prevention & Screening Patient Activation Self-Determination Theory Shared Decision Making Patient-preferred Outcomes

Precontemplation Contemplation Determination/ Preparation/ Planning Action Maintenance Relapse/ Recycle Trans-Theoretical Model of Change TTM: Prochaska & DiClemente (1984) 4 Stages of Change Cycle

5 …a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person's own reasons for change within an atmosphere of acceptance and compassion. MI-3: Miller & Rollnick (2013) Motivational Interviewing is…

6 Health Behavioral Counseling Pre-HBC SP Encounter 2 nd week of class Not graded Video recorded 1.Introduce SP structure 2.Baseline measure of native conversational helping skills Final SP Encounter Final term of course Video recorded 1.25% course grade 2.Assess skills specific to models taught Trained coders use reliable observational measure (MITI 3.1.1) to count specific counseling skills and rate adherence to global qualities of the model. HBC: McLaughlin, Fasser, Spence & Holcomb (2010)

7 Health Behavioral Counseling Pre-HBC SP Encounter 2 nd week of class Not graded Video recorded 1.Introduce SP structure 2.Baseline measure of native conversational helping skills Professional SPs: Real-time feedback Encourage, anticipate course content Final SP Encounter Final term of course Video recorded 1.25% course grade 2.Assess skills specific to models taught Professional SPs: Elicit student self- assessment Encourage Real-time feedback Instructor feedback

8 Telephone SP Methodology Preparation SP is trained to: Enact patient vignette Make and record calls via GoogleVoice and Audacity Learner consents to receive the call Learner & SP mutually select date & time SP s reminder Sends “door note” Date of Encounter SP initiates call Reminds about recording Enacts patient role Learner conducts < 15- minute counseling intervention SP saves audio file Submits file SP provides no feedback

9 Comparing SP Methodologies Simulation Lab Restricted schedule Fixed location Mimics clinic setting Evaluation and real-time live feedback Delayed written feedback Professional SPs $35/hr): 4-hour training $1, encounters 1,890 Simulation Lab 1,265 Total$4,835 Telephone Pilot Schedule and location flexible for learner and SP Evaluation only Delayed written feedback (as piloted) Undergraduate SPs $15/hr and $5 per recording): 4-hour training$ encounters 300 Total $480

10 By tailoring SP technologies to the task required, specific objectives are met: In the HBC course: Counseling expertise of SPs promotes learning Students acquire Core Competencies Course Instructor obtains reliable evaluations In longitudinal evaluation and learning activities: Learners determine own evaluation schedules Efficiency in time and location is optimized SP encounter is geographically unlimited Costs is10% of HBC course encounters Potential application in CME and lifelong learning Conclusions

11 References McLaughlin RJ, Fasser CE, Spence LR, Holcomb JD: Development and implementation of a health behavioral counseling curriculum for physician assistant cancer education. Journal of Cancer Education 2010, 25:9-15. Miller WR, Rollnick S (2012). Motivational interviewing: Helping people change. New York, NY: Guilford Press. Prochaska J, DiClemente CC (1984). The transtheoretical approach: Crossing traditional boundaries of therapy. Homewood, OK: Do/Jones Irwin. Acknowledgement: Thank you to Sara Zendehdel, PAS-2, for implementation of the telephone pilot.