1. Effectiveness of student facilitation in
motivational interviewing education
Juanita A Draime; Rebecca M Widder; Ginger Cameron; Aleda M Chen; Mark Pinkerton; Douglas Anderson
Cedarville University School of Pharmacy
BACKGROUND
• Patient counseling skills are becoming increasingly important for pharmacists as the profession
shifts to a more clinical role.
• Schools of pharmacy seek to prepare their students to better communicate with patients.
• AACP and ACPE recognize this need.1
• Motivational interviewing (MI) is a patient-centered style of counseling that seeks to have the
patient talk themselves into a change.
• Done through eliciting change talk from the patient and accessing the patient’s own
motivation for making the change.2,3
• Current data shows that MI education improves pharmacy student counseling abilities.1,4
• Pharmacy students are often utilized in educational settings to facilitate or assist with courses, but
little is known how this impacts outcomes.
• Use of students to facilitate in MI training frees faculty time and resources.
• Reinforces the MI skills of both the student leaders and student facilitators
• Provides valuable practice and experience for student facilitators
• Meets Cedarville University School of Pharmacy mission: “the School of Pharmacy develops
exceptional pharmacy practitioners focused on meeting the physical, emotional, and spiritual
needs of patients through servant leadership.”
To determine the impact of student or faculty facilitation on student:
1. self-assessed attitudes, confidence, and competence in motivational interviewing skills
2. actual competence
3. evaluation of facilitator performance
OBJECTIVE
METHODS
Discussion
• There were no significant differences between student and faculty facilitators on student perceived or
actual performance of motivational interviewing concepts.
• In evaluations, student facilitators were viewed as equally favorable as faculty members, with slightly
lower total and organization scores. The differences were not statistically significant.
Conclusions
• By using pharmacy students as facilitators, student outcomes were not changed. Using MI small group
student facilitators fulfils the ACPE and IOM mandate to have students teaching students, could serve
to reinforce facilitator MI skills, and may help lesson faculty workload.
Future Directions
• It would be beneficial to evaluate the impact of this experience on the student facilitators.
RESULTS
DISCUSSION AND CONCLUSIONS
1. Goggin K, Hawes SM, Duval ER, et al. A motivational interviewing course for
pharmacy students. Am J Pharm Educ. 2010;74:70.
2. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol.
2009;64:527.
3. Rollnick S, Allison J. Motivational Interviewing. In: Heather N, Stockwell T, eds. The
Essential Handbook of Treatment and Prevention of Alcohol Problems. West Sussex,
England: John Wiley & Sons Ltd; 2004: 105-115.
4. Buring SM, Brown B, Kim K, Heaton PC. Implementation and evaluation of
motivational interviewing in a doctor of pharmacy curriculum. Currents in Pharmacy
Teaching and Learning. 2011;3:78-84
• Randomized, pretest-posttest group design
• IRB approved by Cedarville University IRB
Study Population
• 2nd year professional pharmacy students (N= 44)
• Completed pretest survey in August 2014
• Engaged in 2 motivational interviewing teaching sessions during September 2014
• Participants were randomized into 8 groups of 5 to 6 students.
• Each group was then randomized to have either a student facilitator or a faculty facilitator.
• Completed a recorded patient interview session that was assessed for competence on motivational
interviewing in October 2014
• Session was assessed using the modified Motivational Interviewing Treatment Integrity
(mMITI) rubric.
• Afterwards completed a posttest survey.
Facilitators
• Consisted of 4 faculty members and 4 third year professional students.
• Completed a 2 day motivational interviewing training seminar in May 2013.
• Completed a 2 hour facilitator training session in August 2014.
Assessment Tools
• Pretest and posttest surveys were developed by adapted from previously used
surveys.
• 6 point Likert-type scale was used in a forced-choice style that eliminated the “neutral” option.
• Items varied from positive to negative statements.
• Motivational Interviewing Treatment Integrity Code was used to measure student competence in
patient interview session.
• Developed and validated by Buring4
• Used with permission
Data Analysis
• Data was de-identified and entered into Excel.
• Data was double coded to ensure accuracy of entry.
• Analyses were performed in SPSS v 22.0 (Armonk, NY).
• An a priori of α=0.05 was used for statistical significance.
• Normal distribution was checked using the Shapiro-Wilk test.
• Wilcoxon test was used to compare data from pretest and posttest surveys.
• Mann-Whitney test was used to compare survey data based on facilitator type.
• Scores on the mMITI were compared with Spearman’s correlation.
REFERENCES
Characteristic Total
(N=44)
Faculty
Facilitator
(N=21)
Student
Facilitator
(N=23)
Male 17 (38.6%) 8 (38.1%) 9 (39.1%)
Female 27 (61.4%) 13 (61.9%) 14 (60.9%)
Age
21 4 (9.1%) 1 (4.8%) 3 (13.0%)
22 27 (61.4%) 12 (57.1%) 15(65.2%)
23 8 (18.2%) 5 (23.8%) 3 (13.0%)
24 1 (2.3%) 1 (4.8%) 0 (0%)
>24 4 (9.1%) 2 (9.5%) 2 (8.7%)
Ethnicity
Caucasian 37 (84.1%) 20 (95.2%) 17 (73.9%)
African
American
4 (9.1%) 1 (4.8%) 3 (13.0%)
Asian or
Pacific
Islander
2 (4.5%) 0 (0%) 2 (8.7%)
Hispanic 1 (2.3%) 0 (0%) 1 (4.3%)
Measure Faculty
Facilitator
Student
Facilitator
Pre-Test
Comparisons
Post-Test
Comparisons
Pre Post Pre Post Z-score p-value Z-score p-value
I am interested in learning about motivational interviewing (MI).1 5 5 5 5 -0.175 0.861 -0.182 0.856
I plan to use MI in my future practice.1 5 6 5 5 -0.052 0.958 -0.618 0.537
MI is not useful to pharmacy practice.1 2 2 2 2 -0.400 0.689 -1.169 0.242
MI is effective in eliciting behavioral changes in patients.1 5 6 5 5 -0.333 0.739 -1.112 0.266
Case 1 – Smoking cessation2 4 4 4 4 -0.970 0.332 -0.883 0.377
Case 2 – HTN2 5 5 4 4 -1.522 0.128 -1.477 0.140
Use MI techniques.2 4 5 4 5 -1.432 0.152 -0.793 0.428
Maintain appropriate eye contact.2 5 5 5 5 -0.919 0.358 -0.393 0.694
Use silence.2 5 4 5 4 -1.190 0.234 -0.455 0.649
Express empathy.2 5 6 5 5 -0.297 0.766 -0.213 0.832
Develop discrepancy.2 5 5 4 5 -0.127 0.899 -0.262 0.793
Avoid arguing.2 5 6 5 5 -1.297 0.195 -0.646 0.518
Roll with resistance.2 5 5 4 4 -0.611 0.541 -1.935 0.053
Support self-efficacy.2 5 6 4 5 -0.955 0.399 -0.711 0.477
Elicit change talk.2 4 5 4 5 -1.090 0.276 -0.251 0.802
Follow the patient’s agenda.2 4 5 4 5 -0.258 0.796 -0.945 0.345
Ask permission before sharing.2 4 5 4 5 -1.777 0.076 -0.208 0.835
Help a patient set achievable goals.2 5 5 5 5 -1.539 0.124 -0.290 0.772
Use language appropriate for a patient’s health literacy level.2 5 5 4 5 -0.212 0.832 -0.075 0.940
Ask open-ended questions.2 5 5 5 5 -0.835 0.404 -0.149 0.882
Use reflective listening.2 5 5 5 5 -0.520 0.603 -0.908 0.364
Assess a patient’s readiness for change.2 5 5 4 5 -0.215 0.830 -0.234 0.815
It is easy to show an interest in what a patient is saying1
5 5 5 5 -1.217 0.244 -0.661 0.509
It is easy to use reflective listening.1
5 5 5 5 -0.621 0.535 -1.251 0.211
It is difficult to collaborate with a patient.1
2 2 3 3 -1.259 0.208 -0.956 0.339
It is difficult to accept that that patient might choose not to
change.1
4 5 4 4 -0.185 0.853 0.000 1.000
It is easy to ask permission to share.1
4 5 4 5 -1.819 0.069 -0.460 0.646
It is difficult to affirm a patient.1
3 2 3 2 -1.260 0.228 -0.627 0.531
It is easy to emphasize the patient's control over the agenda and
action plan.1
4 5 4 4 -0.237 0.813 -1.602 0.109
It is easy to express support for a patient.1
5 5 5 5 -0.460 0.646 -0.825 0.410
It is easy to avoid arguing with a patient.1
5 5 5 5 -0.674 0.500 -0.161 0.872
It is difficult to ask open ended questions.1
3 2 3 3 -0.447 0.655 -0.883 0.377
It is difficult to avoid asking close ended questions.1
4 4 5 4 -2.161 0.031 -0.145 0.885
It is easy to reflect back to a patient a summary or analysis of what
they are saying.1
5 5 5 4 -0.089 0.929 -0.237 0.812
11 = Strongly disagree, 6 = Strongly agree 21 = Very unconfident, 6 = Very confident
0
1
2
3
4
5
6
Comparison of Facilitator Evaluations
Faculty Facilitator Student Facilitator
Mann-Whitney comparison of facilitator evaluations. 1=Extremely poor, 6=Excellent. No significant differences, all p values>0.05
4 5 6 6
22
5 5 6 6
24
0
5
10
15
20
25
30
Empathy/
Understanding
Spirit of MI MI adherent Open ended
Questions
Total Score
Student mMITI Scores by Facilitator
Faculty Facilitated Students Student Faciliatated Students
Max Score Possible: 7 Max Score Possible: 8
Max Score
Possible: 30
Mann-Whitney comparison student mMITI scores. No significant differences, all p values>0.05
Demographic Information Perceived Motivational Interviewing Competence by Facilitator
ACKNOWLEDGEMENTS
The researchers wish to gratefully acknowledge
the Cedarville University School of pharmacy,
which provided grant support to complete this
project. Additionally, we thank Jordan Nicholls
and Heather Rose for their work as student
facilitators.