Students participated in small group motivational interviewing sessions facilitated by either faculty or fellow students. In a focus group, students reported that the sessions increased their confidence in using MI skills but that MI techniques still felt unnatural. They were unsure how to apply MI in pharmacy practice and unsure how student facilitators were less skilled than faculty. To improve the sessions, students recommended better introducing MI and having student facilitators receive more training. While peer practice and feedback was helpful, students felt unprepared on how to start and close MI encounters and respond to resistant patients.

1. Qualitative analysis of motivational interviewing outcomes
after small group sessions
Rebecca M Widder; Juanita A Draime; Ginger Cameron; Aleda M Chen; Mark Pinkerton; Douglas C Anderson
Cedarville University School of Pharmacy
BACKGROUND
Patient counseling skills are vital for pharmacists as the profession shifts to a more
clinical role.
• Schools of pharmacy desire to improve student communication 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
• Four key components comprise all MI techniques2:
• Expressing empathy
• Rolling with resistance
• Supporting self-efficacy
• Developing discrepancy
• MI education improves pharmacy student counseling abilitiies.1,4
MI education is also essential to fulfilling the Cedarville University School of
Pharmacy vision statement to develop “exceptional pharmacy practitioners focused
on meeting the physical, emotional, and spiritual needs of patients through servant
leadership.”
To qualitatively describe student perceptions of small group motivational
interviewing training facilitated by either faculty or students
OBJECTIVE
METHODS
MI Training
Second year pharmacy students (N=44) engaged in three motivational interviewing
sessions during the Cardiology Module in September 2014, consisting of the
following
• Brief overview of MI and patient communication
• Small group practice sessions facilitated by either a trained third year pharmacy
student or faculty member
• 5 minute recorded interview with a standardized patient
• Previous MI education of the students included lecture and practice sessions
during first year counseling lab and Self Care course
Sample
10 randomly selected second year students were invited to participate in a focus
group session, with a final sample size of nine (N=9). Students represented both
student-facilitated (N=7) and faculty-facilitated (N=2) small group sessions.
Assessment
• Guiding questions created based on overall study objectives and literature
search5,6
• Follow up questions based on participant responses
• Discussion moderated by trained research assistants
• Sessions recorded with LiveScribe® technology
Analysis
• Grounded Theory
• Content analysis to identify themes grounded in responses
• QSR NVivo 9
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.
The report from students that MI techniques still felt somewhat unnatural is likely a result of
the conflict between MI practice and their own righting reflex. Thus, it could be a natural part
of the process of learning MI. However, the themes of being unsure how MI fit into practice
and that student facilitators were less skilled in small group facilitation can be addressed in
the future through better introduction to MI, different application and practice exercises, and
training of student facilitators in management techniques.
Limitations
Study limitations include a small sample size, over-representation of participants from
student-facilitated groups, and single researcher review of the data for coding.
Conclusions
This research suggests that peer-review focused, small group settings can increase student
confidence in MI and health behavior change counseling skills, but work is still needed to
reinforce the utility of MI in practice.
ACKNOWLEDGEMENTS
RESULTS
REFERENCES
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. MilQler 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.
5. Morgan DL. Planning and designing focus groups. In: Morgan DL. Focus Groups as Qualitative Research. United States: SAGE Research
Methods; 1997: 32-46.
6. Eliot & Associates. Guidelines for conducting a focus group [available online].
http://cp0.ipnshosting.com~focusgro/documents/How_to_Conduct_a_Focus_Group.pdf. Published 2006. Accessed October 2014.
Student Comments
Faculty facilitators Student facilitators
- Had good “real world” knowledge
- Could be intimidating
- Allowed for peer feedback before
providing comments
- Some faculty did not have strong
MI knowledge
- Some had a hard time drawing out quieter students
- More relatable than faculty members
- Students were generally more comfortable with
other students than faculty
- Allowed for peer feedback before providing
feedback
- Student facilitators were confident, relatable and
knowledgeable
Motivational Interviewing
- MI “language” feels stiff and unnatural, and not sure would feel comfortable using in real
life
- Not sure how MI fits into every day pharmacy practice, especially in a retail setting
- Not confident in how to start an MI encounter in “real life”
- Since practice sessions involved short interviews, students were not sure how to close an
encounter
- Not sure how to respond to a resistant patient
Sessions overall
- The whole experience would have been more effective with a review of MI terminology,
techniques, and fit into practice before the sessions
- Repetition of practice and peer feedback process reinforced learning
- Students were unsure of the purpose of the sessions and how they were supposed to
work, negatively affecting attitude and learning
- Would like to see an example that includes a start to finish encounter in someone who
makes MI techniques seem natural with a resistant patient
99
8
9
10
6
0
2
4
6
8
10
12
Sessions
made me
better at MI
Sessions
helped
develop MI
skills
Student
facilitator
performed
well
Appreciated
peer
feedback
Repetition
and practice
was helpful
Reference to
prior MI
sessions
NumberofCodes
STRENGTHS OF THE MI SESSIONS
8 9 9
13
0
2
4
6
8
10
12
14
It would be helpful
to see an example
encounter
It would be helpful
to have an outline
of the session
Unsure why MI is
being taught in
Cardiology
It would have been
helpful to have a
review of MI
before the small
group sessions
NumberofCodes
RECOMMENDATIONS TO IMPROVE
SESSIONS
19
15
8
18
12
6
0
2
4
6
8
10
12
14
16
18
20
Using MI
techniques
feels
unnatural
Unsure how
to use MI in
pharmacy
practice
Unsure how
to close an
MI
encounter
Don't know
how to use
MI with real
patients
Don't know
how to
identify
patients to
use MI with
Unsure what
rolling with
resistance
looks like
practically
NumberofCodes
STUDENT REFLECTIONS ABOUT THE USE
OF MI