39. MOTIVATIONAL INTERVIEWING: THE CURRENT STATE OF TEACHING AND ASSESSMENT IN ADOLESCENT MEDICINE FELLOWSHIPS

Abstract

Background Motivational interviewing (MI) is an evidence-based counseling approach to facilitate choosing healthier behaviors. “Demonstration of MI” is a curricular component of the Adolescent Medicine (AM) specific entrustable professional activity (EPA) “Provide care for adolescent and young adult patients with acute physical and mental health issues.” Objective To assess if and how AM fellowships teach and assess MI. Methods AM Fellowship Directors from all 33 US and Canadian programs were surveyed anonymously online about individual training and curricular inclusion of MI. Descriptive statistics and thematic analysis of comments were conducted. Results Our response rate was 91% (N=30/33). 93% (n=28/30) of respondents received training in MI; 60% (n=18/30) each during and post-fellowship. However, 40% (n=12/30) have not received any MI faculty development in the last 3 years. Teaching methods for MI include direct observation of patient encounters in real-time (63%, n=19/30), by audio/videotape (7%, n=2/30), role-play (47%, n=14/30), and simulation (20%, n=6/30). Only 30% (n=9/30) offer written observational feedback after patient encounters. Only 53% (n=16/30) felt their program's MI teaching and assessment methods result in adequate “demonstration of MI” by graduating fellows. Time, assessment, and curriculum were the most common needs reported to improve MI skills. Of the 90% (n=26/29) of programs that offer direct observation in patient encounters to give feedback on verbal communication skills (not MI specific), most observation is by an “attending”, 27% (n=7/26) offer written formative feedback, and 15% (n=4/26) ask fellows to write an improvement plan based on their feedback. Conclusions Opportunities for MI curricular improvement include longitudinal faculty development, written feedback and self-reflection after observed patient encounters. We plan to perform semi-structured interviews to better understand these preliminary findings, feasibility of collaborating with other residency faculty, and sharing of resources and experiences across AM Fellowships.