Linking a motivational interviewing curriculum to the chronic care model

Abstract

Background: Unhealthy lifestyle choices frequently cause or worsen chronic diseases. Many internal medicine residents are inadequately trained to provide effective health behavior counseling, in part, due to prioritization of acute care in the traditional model of medical education and to other systemic barriers to teaching psychosocial aspects of patient care.

Aim: To address this gap in training, we developed and piloted a curriculum for a Primary Care Internal Medicine residency program that links a practical form of motivational interviewing (MI) training to the self-management support (SMS) component of the chronic care model.

Participants and setting: All 30 primary care residents at Alameda County Medical Center were trained in the curriculum since it was initiated in 2007 during the California Academic Chronic Care Collaborative.

Program description: Residents participated in three modules during which the chronic care model was introduced and motivational interviewing skills were linked to the model's self-management support component. This training was then reinforced in the clinical setting. Case-based interactive instruction, teaching videotapes, group role-plays, faculty demonstration, and observation of resident-patient interactions in the clinical setting were used to teach the curriculum. PROGRAM ASSESSMENT: A preliminary, qualitative assessment of this curriculum was done from a program standpoint and from the perspective of the learners. Residents reported increased sense of confidence when approaching patients about health behavior change. Faculty directly observed residents during clinical encounters using MI and SMS skills to work more collaboratively with patients and to improve patient readiness for self-management goal setting.

Conclusion: A curriculum that links motivational interviewing skills to the chronic care model's self-management support component and is reinforced in the clinical setting is feasible to develop and implement. This curriculum may improve residents' confidence with health behavior counseling and with preparing patients to become active participants in management of their chronic conditions.

Figure 1

Self-management support linked to brief motivational interviewing tools and stages of change,,,,. Abbreviations: OARS, open-ended question, affirmation, reflection, summarizing. Motivational interviewing tools are italicized.

Figure 2

Curriculum linking motivational interviewing to self-management support and the chronic care model,,,,,. Each training year includes block activities (first row) and continuity clinic activities (second row). Abbreviations: CCM, chronic care model; SMS, self-management support; MI, motivational interviewing. • Module 1, ‘introducing the CCM,’ is 11 hours and includes local chronic care improvement projects presentation, observing health education classes, training in electronic population management system and panel registry reports. Module 2, ‘teaching SMS using Brief MI,’ includes 6 hours of training in the use of MI tools and action planning. † Module 3, ‘reinforcing in the clinical setting,’ includes using MI and SMS during an inpatient consultation rotation, an outpatient consultation rotation, and a brief counseling rotation. Each rotation is 3 hours per week during 4 weeks per year. ‡ MI & SMS training (Module 2) applied to substance use and chronic pain are each 3 hour didactics. § Panel management & planned visit training (Module 1) is 8 hours per week during 12 weeks per year.

Figure 3

Agenda setting and health behavior action planning tool,.