Brief "Motivational Interviewing" Training Enhances Pediatrics Residents' Counseling Skills

Nancy Fowler Larson

September 18, 2010

June 7, 2010 — Three months of brief "motivational interviewing" instruction improves the counseling abilities of pediatrics residents, according to a study published in the June issue of the Archives of Pediatric and Adolescent Medicine.

"Pediatric competency requirements now recognize pediatricians' roles in supporting healthy behaviors," write Paula Lozano, MD, MPH, from the Center for Child Health Behavior and Development, Seattle Children's Research Institute, Washington, and colleagues. "Motivational interviewing...has emerged as an approach to assisting primary care patients with behavior change."

Motivational interviewing is a directive, client-centered counseling method that facilitates gradual behavior shifts by exploring patients’ ambivalence to change. Through reflective listening, practitioners help clients identify and resolve cognitive dissonance and articulate their desire for change. Targeted behaviors include medication adherence, healthier eating habits, and quitting smoking.

The randomized controlled trial consisted of 18 pediatric residents at the University of Washington in Seattle. Half of the residents underwent a 9-hour motivational interviewing training known as Collaborative Management in Pediatrics. They also received written feedback about their communication skills as established by the 3-month Objective Standardized Clinical Evaluation.

The primary outcome was the percentage of behaviors consistent with motivational interviewing, determined by performance during interactions with patients who were role-playing as parents of asthmatic children. The residents were assessed with regard to 3 stations, based on parental readiness to change: "not ready," "unsure," and "ready."

More Frequent Assessments, Evaluation of Patient Outcomes Needed to Bolster Findings

Evaluations occurred at 3 months and 7 months after completion of the motivational interviewing curriculum, with results as follows:

  • At 3 months, motivational interviewing–trained residents scored higher at the ready station (+18%; 95% confidence interval [CI], .05 - .30; P = .009).

  • At 3 months, no significant changes were noted at the 2 other stations.

  • At 7 months, motivational interviewing–trained residents had higher scores at all stations (not ready: +18%; 95% CI, .04 - .32; P = .02; unsure: +20%; 95% CI, .10 - .30; P = .001; and ready: +16%; 95% CI, .05 - .28; P = .01), after training and feedback.

"This study provides support for the effect of training in brief [motivational interviewing] on the communication style that pediatric trainees exhibit with standardized patients," the authors write. "We found an increase in resident use of [motivational interviewing]-consistent behaviors (eg, open-ended questions, reflections, affirmations, and supportive statements) following [Collaborative Management in Pediatrics] training when compared with an untrained, randomly assigned control group."

The investigators noted several limitations to their study.

  • The small cohort, single institution, and a 38% refusal rate by residents approached about the study restrict generalizability.

  • Results were not evaluated immediately after the training, in the 3-month period after training, or beyond 7 months.

  • The 9-hour time commitment may limit future implications of the findings.

  • Patient outcomes were not assessed.

"Replication of our findings in a larger multicenter sample with a broader variety of skill indicators is needed," the authors write. "Future trials should address optimal length/format of training, integration of [motivational interviewing] into residency training, sustainability of skills, integration of behavior change counseling into the health care encounter, and the effect of adoption of [motivational interviewing] skills by pediatricians on patient outcomes."

The National Institutes of Health, the Group Health Community Foundation, and Seattle Children's Hospital supported the study. The study authors have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2010;164:561-566.

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