Advancing Motivational Interviewing Training with Artificial Intelligence: ReadMI

Paul J Hershberger, Yong Pei, Dean A Bricker, Timothy N Crawford, Ashutosh Shivakumar, Miteshkumar Vasoya, Raveendra Medaramitta, Maria Rechtin, Aishwarya Bositty, Josephine F Wilson, Paul J Hershberger, Yong Pei, Dean A Bricker, Timothy N Crawford, Ashutosh Shivakumar, Miteshkumar Vasoya, Raveendra Medaramitta, Maria Rechtin, Aishwarya Bositty, Josephine F Wilson

Abstract

Background: Motivational interviewing (MI) is an evidence-based, brief interventional approach that has been demonstrated to be highly effective in triggering change in high-risk lifestyle behaviors. MI tends to be underutilized in clinical settings, in part because of limited and ineffective training. To implement MI more widely, there is a critical need to improve the MI training process in a manner that can provide prompt and efficient feedback. Our team has developed and tested a training tool, Real-time Assessment of Dialogue in Motivational Interviewing (ReadMI), that uses natural language processing (NLP) to provide immediate MI metrics and thereby address the need for more effective MI training.

Methods: Metrics produced by the ReadMI tool from transcripts of 48 interviews conducted by medical residents with a simulated patient were examined to identify relationships between physician-speaking time and other MI metrics, including the number of open- and closed-ended questions. In addition, interrater reliability statistics were conducted to determine the accuracy of the ReadMI's analysis of physician responses.

Results: The more time the physician spent talking, the less likely the physician was engaging in MI-consistent interview behaviors (r = -0.403, p = 0.007), including open-ended questions, reflective statements, or use of a change ruler.

Conclusion: ReadMI produces specific metrics that a trainer can share with a student, resident, or clinician for immediate feedback. Given the time constraints on targeted skill development in health professions training, ReadMI decreases the need to rely on subjective feedback and/or more time-consuming video review to illustrate important teaching points.

Keywords: medical education; patient engagement; software development.

Conflict of interest statement

None of the authors have any conflicts of interest to report.

© 2021 Hershberger et al.

References

    1. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. New York: Guilford; 2013.
    1. Apodaca TR, Longabaugh R. Mechanisms of change in motivational interviewing: a review and preliminary evaluation of the evidence. Addiction. 2009;104(5):705–715. doi:10.1111/j.1360-0443.2009.02527.x
    1. Rubak S, Sandbæk A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55(513):305–312.
    1. Lundahl B, Burke BL. The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses. J Clin Psychol. 2009;65:1232–1245. doi:10.1002/jclp.20638
    1. Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71(5):843–861. doi:10.1037/0022-006X.71.5.843
    1. Douaihy A, Kelly TM, Gold MA, editors. Motivational Interviewing: A Guide for Medical Trainees. New York (NY): Oxford University Press; 2016.
    1. Sanders KA, Whited A, Martino S. Motivational interviewing for patients with chronic kidney disease. Semin Dial. 2013;26(2):175–179. doi:10.1111/sdi.12052
    1. Christie D, Channon S. The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in paediatric and adult populations: a clinical review. Diabetes Obes Metab. 2014;16(5):381–387. doi:10.1111/dom.12195
    1. Coleman MT, Newton KS. Supporting self-management in patients with chronic illness. Am Fam Physician. 2005;72(8):1503–1510.
    1. Anderson W. Collaborative care and motivational interviewing: improving depression outcomes through patient empowerment interventions. Am J Manag Care. 2007;13:S103–S106.
    1. Frost H, Campbell P, Maxwell M, et al. Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: a systematic review of reviews. PLoS One. 2018;13:e0204890. doi:10.1371/journal.pone.0204890
    1. Noordman J, van der Weijden T, van Dulmen S. Communication-related behavior change techniques used in face-to-face lifestyle interventions in primary care: a systematic review of the literature. Patient Educ Couns. 2012;89(2):227–244. doi:10.1016/j.pec.2012.07.006
    1. Werner JJ, Lawson PJ, Panaite V, Step MM, Flocke SA. Comparing primary care physicians’ smoking cessation counseling techniques to motivational interviewing. J Addict Med. 2013;7(2):139–142. doi:10.1097/ADM.0b013e3182879cc5
    1. Pollak KI, Nagy P, Bigger J, et al. Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices. Patient Educ Couns. 2016;99(2):300–303. doi:10.1016/j.pec.2015.08.013
    1. Barwick MA, Bennett LM, Johnson SN, McGowan J, Moore JE. Training health and mental health professionals in motivational interviewing: a systematic review. Child Youth Serv Rev. 2012;34(9):1786–1795. doi:10.1016/j.childyouth.2012.05.012
    1. Schwalbe CS, Oh HY, Zweben A. Sustaining motivational interviewing: a meta-analysis of training studies. Addiction. 2014;109:1287–1294. doi:10.1111/add.12558
    1. Hall K, Staiger PK, Simpson A, Best D, Lubman DI. After 30 years of dissemination, have we achieved sustained practice change in motivational interviewing? Addiction. 2015;111:1144–1150. doi:10.1111/add.13014
    1. Vasoya MM, Shivakumar A, Pappu S, et al. ReadMI: an innovative app to support training in motivational interviewing. J Grad Med Ed. 2019;11(3):344–346. doi:10.4300/JGME-D-18-00839.1
    1. Martino S, Paris M, Anez L, et al. The effectiveness and cost of clinical supervision for motivational interviewing: a randomized controlled trial. J Subst Abuse Treat. 2016;68:11–23. doi:10.1016/j.jsat.2016.04.005
    1. Anderson RM, Funnell MM, Butler PM, Arnold MS, Fitzgerald JT, Feste CC. Patient empowerment. Results of a randomized controlled trial. Diabetes Care. 1995;18(7):943–949. doi:10.2337/diacare.18.7.943
    1. Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff. 2013;32:207–214. doi:10.1377/hlthaff.2012.1061
    1. Hibbard JH, Greene J, Tusler M. Improving the outcomes of disease management by tailoring care to the patient’s level of activation. Am J Manag Care. 2009;15(6):353–360.
    1. Tanana M, Hallgren KA, Imel ZE, Atkins DC, Srikumar V. A comparison of natural language processing methods for automated coding of motivational interviewing. J Subst Abuse Treat. 2016;65:43–50. doi:10.1016/j.jsat.2016.01.006
    1. Webster CS. Artificial intelligence and the adoption of new technology in medical education. Med Educ. 2021;55(1):6–7. doi:10.1111/medu.14409

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit