Abstract Title
Skills, knowledge and confidence in brief motivational interviewing: Using standardized patient encounters to train healthcare providers


Elizabeth J Edwards
Peta Stapleton


9AA Teaching and assessing communication skills


Bond University - School of Medicine - Gold Coast - Australia
Bond University - School of Psychology - Gold Coast - Australia


Research has shown that simply giving advice or recommendations does not necessarily translate into improved health behaviour. Motivational Interviewing (MI), a directive, patient-centred approach to health behavioural change (see Rollnick, & Miller, 1995), has emerged as a promising counselling style that has shown much success applied to a broad range of lifestyle issues, such as problem drinking, smoking cessation, management of diabetes and cardiovascular disease, dietary changes, and treatment and prevention of HIV infections.


Favourable results have been reported by studies that have examined the efficacy of teaching MI and brief MI to medical and allied health professions (see Madson et al., 2009). A review of these studies revealed differences in trainees, training formats, and training curriculums despite some limitations such as: no overt assessment of MI skills, no control group comparisons, limited follow-up data and potential generalizability problems (e.g., Spollen et al., 2010).


The objective of the present study was to increase the capacity for health behaviour change of health and community staff through enhancing the knowledge, skills and confidence developed through brief MI training using simulated patient encounters, specifically in relation to healthy eating and physical activity.



Brief MI was selected (versus MI) on the basis that it was designed to promote health behavior changes within the time constraints imposed by busy community service offices (Martino et al., 2007). It was hypothesized that participants who received the brief MI training would demonstrate greater pre-post improvements in knowledge, skills and confidence compared to a matched control group who did not receive specific training.

Summary of Work


A total of 163 allied health professionals volunteered. The TRAINED group comprised 128 allied health professionals (males = 24, females = 104; nurses = 26%, psychologists = 5%, counsellors = 18%, community workers = 44% and other = 7%. The UNTRAINED group comprised 35 allied health professionals (males = 6, females = 29; nurses = 9%, psychologists = 9%, counsellors = 27%, community workers = 41% and other = 14%. The groups did not differ with respect to age, t < 1, and sex was proportionately distributed across groups.



Valid and reliable, self-report measures were used: the Motivational Interviewing Knowledge and Attitudes Test (MIKAT; Leffingwell, 2006) and a 6-item Multiple Choice Test (Spollen et al., 2010) measured Knowledge of brief MI and the MI Confidence Scale (Poirier et al., 2004) measured participants’ Confidence in delivery of a brief MI intervention. The Behaviour Change Counselling Index (BECCI; Lane et al., 2005) was administered by experienced facilitators at two intervals during the training to measure brief MI Skills during the simulated patient encounters.Table 1 shows the sequence of administration of the measures for each group.

Table 1

Time of Administration of Dependent Variables for Trained and Untrained Groups



A quasi-experimental design was used. The independent variables were Group (UNTRAINED vs. TRAINED) and Time (PRE vs. POST vs. 3 Month Follow-up vs. 6 Month Follow-up). The dependent variables were Knowledge, Skills and Confidence in brief MI.



Brief MI training comprised a 6-hour workshop including: 1 x 2 hour lecture-style presentation, 2 x 2 hour blocks of small group simulated patient encounters, comprehensive training materials regarding brief MI and local referral resources, and participation in an electronic peer-support system for 6-months post-training to enable group discussion and shared learning. Six workshops were conducted using experienced facilitators: 2 x clinical psychologists, 1 x psychologist and 1 x counsellor. Untrained participants completed the measures online.


Summary of Results


An independent samples t-test at PRE revealed equivalent MIKAT and Multiple Choice Test scores between UNTRAINED  and TRAINED groups, t(125) = 1.57, p = .122, t(125) < 1, respectively. A repeated measures t-test performed on the MIKAT and Multiple Choice Test data (PRE to POST) found an increase in MI knowledge for the TRAINED group, t(125) = 3.16, p = .002, t(125) = 3.27, p = .003, respectively. There were no differences between MIKAT and Multiple Choice test scores at POST relative to 3-Month Follow-up [both t(29) < 1] and 6-Month Follow-up [both t(8) < 1], indicating that improvements in Knowledge following training were sustained.



An independent samples t-test at PRE revealed that the UNTRAINED group had greater Confidence in using MI than their TRAINED counterparts, t(125) = 3.17, p = .002. A repeated measures t-test (PRE to POST) found a significant increase in Confidence for the TRAINED group, t(125) = 9.89, p < .001 (see Figure 1). A trend for further increases in Confidence scores was found from POST to 3-Month Follow-up [t(29) = 2.00, p = .055], however there were no differences between Confidence scores from POST to 6- Month Follow-up [t(8) = 1.48, p = .177].

Figure 1. Mean confidence scores at pre, post, 3 and 6 month follow-up for the trained group.



During the simulated patient encounters, the facilitators rated the TRAINED participants’ MI skills using the BECCI on two occasions (i.e., during Block 1 and Block 2 of practice). There was a significant increase in MI skills from Block 1 to Block 2 during the training, t(125) = 9.77, p < .001.


Brief MI training led to measureable improvements in Knowledge, Skills and Confidence in allied health and community staff. The present study allowed for control group comparisons to confirm that TRAINED were matched on brief MI knowledge at PRE-test. Overt assessment of brief MI skills using simulated patients confirmed that the training translated to significant  improvement in Skills. A comparison of PRE, POST, 3 and 6 Month Follow-up data for TRAINED participants confirmed that brief MI Knowledge and Confidence increased and was sustained over time. Future studies however, would do well to include a follow-up measure of Skills.


Healthcare providers can learn brief MI skills and knowledge quickly and confidence in their counselling abilities improves and is sustained over time. These results provide a baseline for implementation of brief MI training into the practice of a range of healthcare workers.



Lane, C., Huws-Thomas, M., Hood, K., Rollnick, S., Edwards, K & Robling, M., (2005). Measuring adaptations of motivational interviewing: The development and validation of the behaviour change counselling index (BECCI). Patient Education & Counselling, 56, 166-173.

Leffingwell, T. R., (2006) Motivational interviewing knowledge and attitudes test (MIKAT) for evaluation of training outcomes. MINUET, 13, 10-11.

Madson, M. B., Loignon, B. A., & Lane, C., (2009). Training in Motivational interviewing: a review. Journal of Substance Abuse Treatment, 36, 101-9.

Martino, S., Haeseler, F., Belitsky, R., Pantalon, M., & Fortin IV, A. H. (2007). Teaching brief motivational interviewing to year three medical students. Medical Education, 41(2) 160-167.

Poirier, M. K., Clark, M. M., Cerhan, J. H., Pruthi, S., Geda, Y. E., & Dale, L. C. (2004, March). Teaching motivational interviewing to first-year medical students to improve counseling skills in health behavior change. In Mayo Clinic Proceedings, 79(3) 327-331.

Rollick, S., & Miller, W.R., (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, 325-224.

Spollen, J., Thrush, C. R., Mui, D., Woods, M. B., Tariq, S. G., & Hicks, E. (2010).A randomized controlled trial of behaviour change counselling education for medical students. Medical Teacher. 32(4) 170-177.

Summary of Work
Summary of Results
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