Abstract
Despite the need for effective and scalable training in motivational interviewing (MI) that includes posttraining coaching and feedback, limited evidence exists regarding the effectiveness of using virtual (computerized) standardized patients (VSPs) in such training. To evaluate the efficacy of training with a VSP on the acquisition and maintenance of MI skills compared with traditional academic study. This study was a 2-group, parallel-training randomized trial of 120 volunteer health care professionals recruited from a Department of Veterans Affairs and Department of Defense medical facility. Motivational interviewing skill was coded by external experts blinded to training group and skill assessment time points. Data were collected from October 17, 2016, to August 12, 2019. After a computer course on MI, participants trained during two 45-minute sessions separated by 3 months. The 2 randomized training conditions included a branching storyline VSP, which provided MI skill rehearsal with immediate and summative feedback, and a control condition, which included academic study of content from the computerized MI course. Measurement of MI skill was based on recorded conversations with human standardized patients, assessed using the Motivational Interviewing Treatment Integrity 4.2.1 coding system, measured at baseline, after training, and after additional training in the randomized condition 3 months later. A total of 120 volunteers (83 [69%] women), with a mean (SD) of 13.6 (10.3) years of health care experience, participated in the study; 61 were randomized to receive the intervention, and 59 were randomized to the control group. Those assigned to VSP training had significantly greater posttraining improvement in technical global scores (0.23; 95% CI, 0.03-0.44; P = .02), relational global scores (0.57; 95% CI, 0.33-0.81; P = .001), and the reflection-to-question ratio (0.23; 95% CI, 0.15-0.31; P = .001). Differences were maintained after the 3-month additional training session, with more improvements achieved after the 3-month training for the VSP trainees on the reflection-to- question ratio (0.15; 95% CI, 0.07-0.24; P = .001). This randomized trial demonstrated a successful transfer of training from a VSP to human standardized patients. The VSP MI skill outcomes were better than those achieved with academic study and were maintained over time. Virtual standardized patients have the potential to facilitate dissemination of MI and may be useful for training in other evidence-based skills and treatments. ClinicalTrials.gov Identifier: NCT04558060.
Highlights
Standardized patients are trained actors who play patients for medical training purposes
Differences were maintained after the 3-month additional training session, with more improvements achieved after the 3-month training for the Virtual standardized patient (VSP) trainees on the reflection-to- question ratio (0.15; 95% CI, 0.07-0.24; P = .001)
This randomized trial demonstrated a successful transfer of training from a VSP to human standardized patients
Summary
Standardized patients are trained actors who play patients for medical training purposes. Standardized patients are routinely used for learning and evaluation in medical school and residency but are rarely available to health care professionals (eg, physicians, nurses, and therapists) after board examination or licensure. After board examination or licensure, new evidence-based practices are adopted through continuing medical education workshops or online training. Complex, evidence-based treatments, such as motivational interviewing (MI), are often implemented without reproducible, reliable, criterion standard skills observation and assessment. Motivational interviewing is a directive, client-centered, evidence-based counseling approach that aims to increase patients’ motivation to make positive health changes.[1] The style is characterized by respect for patient autonomy and an acknowledgment that ambivalence is an expected part of change. Motivational interviewing is explicitly collaborative and explores the patient’s own arguments for change as opposed to trying to convince the patient through expertise or clinical advice. Motivational interviewing has demonstrated efficacy for improving a range of health-related outcomes[2] and is equivalent or superior to effective treatments for many health behaviors (eg, alcohol and substance use, smoking, dietary changes, gambling, unprotected sex, exercise, and treatment engagement).[3,4,5,6,7]
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