2.0-hour workshop for Physical Medicine & Rehabilitation (PM&R) clinicians, academic faculty and clinical instructors/field work educators Presenter: Robert Scales, Ph.D., Director of Cardiac Rehabilitation (CR) & Wellness, Mayo Clinic-Arizona (MCA); Volunteer Clinical Professor, Arizona State University (ASU), College of Health Solutions. Tel: (480) 301-8916; Email: [email protected]. Website: www.robertscales.com Purpose: To give a small group of healthcare professionals training in motivational interviewing (MI) to help promote healthful behavior in an outpatient clinical setting. Background: Value-based reimbursement demands improved patient adherence and clinical outcomes in PM&R. However, motivating patients to adopt a healthful treatment plan during brief outpatient visits provides a major challenge for clinicians (e.g. honoring scheduled appointments, taking pain medications as prescribed and following an appropriate home exercise therapy plan). Therefore, effective communication strategies that can be applied successfully during time-pressured consultations are worthy of consideration. Traditional approaches to patient care often rely on advice giving and direct persuasion. This can easily lead to confrontation and may result in resistance (dissonance) and a lack of harmony between the clinician and patient. Motivational interviewing is an alternate method of communication that has gained empirical support as an effective option to counsel patients who are ambivalent or not ready to adopt healthful behaviors. There is demonstrated success with individuals recovering from drug and alcohol addiction. Adaptations to medical settings have been effective in improving a wide range of health behaviors, including those that are promoted in PM&R. The goal of MI is to help patients identify their personal intrinsic motivation for change (i.e. what is important in their life) and to let them discover how their current behavior is helping them achieve what is important or interfering. The mindset of MI is collaboration rather than persuasion. Patients are given the opportunity to partner with the clinician to interpret personalized health information and identify solutions with shared decisions rather than being told what they must do. In the negotiation of a treatment plan, the clinician acknowledges the patient’s freedom to decide what, if anything, they will change when they leave the clinic. The primary objective of MI is to use effective health communication to arrange the conversation so the patient makes their own argument for change. This involves the skillful use of open-ended questions to encourage patients to talk about change instead of exhibiting dissonance. This is combined with empathic listening backed by reflective statements to let the person hear their own motivation for change. An analogy that has been used to describe MI is dancing with the patient, and as a partner, leading them in a meaningful direction, rather than trying to wrestle them into submission. Although grounded in psychology, MI is not exclusive to counselors or psychologists. An investigation of MI training methods identified significant short-term gains in competency with participation in an interactive workshop. MI is well suited to the daily practice of a busy clinic where improved patient adherence is a priority. When delivered effectively, patients are more receptive to the treatment plan, which makes consultations less frustrating for the clinician.