Teaching Motivational Interviewing to Medical Students to Improve Behavior Change Counseling Skills - Results of a Pilot Test

BACKGROUND: Patient behavior accounts for half or more of the variance in health, disease, mortality and treatment outcome and costs. Counseling using motivational interviewing (MI) effectively improves the substance use and medical compliance behavior of patients. Medical training should include substantial focus on this key issue of health promotion. The objective of the study is to test the efficacy of teaching MI to medical students. METHODS: Thirteen fourth-year medical students volunteered to participate. Seven days before and after an 8-hour interactive MI training workshop, each student performed a video-recorded interview with two standardized patients: a 60 year-old alcohol dependent female consulting a primary care physician for the first time about fatigue and depression symptoms; and a 50 year-old male cigarette smoker hospitalized for myocardial infarction. All 52 videos (13 students×2 interviews before and after training) were independently coded by two blinded clinicians using the Motivational Interviewing Training Integrity (MITI, 3.0). MITI scores consist of global spirit (Evocation, Collaboration, Autonomy/Support), global Empathy and Direction, and behavior count summary scores (% Open questions, Reflection to question ratio, % Complex reflections, % MI-adherent behaviors). A "beginning proficiency" threshold (BPT) is defined for each of these 9 scores. The proportion of students reaching BPT before and after training was compared using McNemar exact tests. Inter-rater reliability was evaluated by comparing double coding, and test-retest analyses were conducted on a sub-sample of 10 consecutive interviews by each coder. Weighted Kappas were used for global rating scales and intra-class correlations (ICC) were computed for behavior count summary scores. RESULTS: The percent of counselors reaching BPT before and after MI training increased significantly for Evocation (15% to 65%, p<.001), Collaboration (27% to 77%, p=.001), Autonomy/Support (15% to 54%, p=.006), and % Open questions (4% to 38%, p=.004). Proportions increased, but were not statistically significant for Empathy (38% to 58%, p=.18), Reflection to question ratio (0% to 15%, p=.12), % Complex reflection (35% to 54%, p=.23), and % MI-adherent behaviors (8% to 15%, p=.69). There was virtually no change for the Direction scale (92% to 88%, p=1.00). The reliability analyses produced mixed results. Weighted kappas for inter-rater reliability ranged from .14 for Direction to .51 for Collaboration, and from .27 for Direction to .80 for Empathy for test-retest. ICCs ranged from .20 for Complex reflections to .89 for Open questions (inter-rater), and from .67 for Complex reflections to .99 for Reflection to question ratio (test-retest). CONCLUSION: This pilot study indicates that a single 8-hour training in motivational interviewing for voluntary fourth-year medical students results in significant improvement of some MI skills. A larger sample of randomly selected medical students observed over longer periods should be studied to test if MI training generalizes to medical students. Inter-rater reliability and test-retest findings indicate a need for caution when interpreting the present results, as well as for more intensive training to help appropriately capture more dimensions of the process in future studies.

The Emergence of Forensic Nursing and Advanced Nursing Practice in Switzerland: An Innovative Case Study Consultation.

BACKGROUND AND METHODS:: The objectives of this article were to systematically describe and examine the novel roles and responsibilities assumed by nurses in a forensic consultation for victims of violence at a University Hospital in French-speaking Switzerland. Utilizing a case study methodology, information was collected from two main sources: (a) discussion groups with nurses and forensic pathologists and (b) a review of procedures and protocols. Following a critical content analysis, the roles and responsibilities of the forensic nurses were described and compared with the seven core competencies of advanced nursing practice as outlined by Hamric, Spross, and Hanson (2009). RESULTS:: Advanced nursing practice competencies noted in the analysis included "direct clinical practice," "coaching and guidance," and "collaboration." The role of the nurse in terms of "consultation," "leadership," "ethics," and "research" was less evident in the analysis. DISCUSSION AND CONCLUSION:: New forms of nursing are indeed practiced in the forensic clinical setting, and our findings suggest that nursing practice in this domain is following the footprints of an advanced nursing practice model. Further reflections are required to determine whether the role of the forensic nurse in Switzerland should be developed as a clinical nurse specialist or that of a nurse practitioner.

Survey No. 1, Fibrous Concrete Resurfacing Greene County, Iowa, HR-165, 1974

The three miles of fibrous concrete resurfacing in Greene County, Iowa were placed in September and early October, 1973. It was recognized in advance that cracking and other performance characteristics of the fibrous concrete sections and of the central sections would be major factors in the evaluation of the project. A low level aerial survey was made of the old pavement. During construction of the resurfacing, the aerial survey was checked to insure that cracks in the old pavement were referenced to the 100 ft. station marks placed in the resurfacing. The crack survey recorded herein was made in March and April, 1974. Those cracks in the resurfacing that are reflections of cracks in the underlying slab are identified by /\ marks. Observations (not detailed crack surveys) made in June, 1974 indicate that further cracking of the resurfacing has occurred since this report was prepared. In particular, there appears to be same additional longitudinal cracking over the widening joints.

Crustal structure and reflectivity of the Swiss Alps from 3-Dimensional seismic modeling. 2. Penninic Nappes

Surface geological mapping, laboratory measurements of rock properties, and seismic reflection data are integrated through three-dimensional seismic modeling to determine the likely cause of upper crustal reflections and to elucidate the deep structure of the Penninic Alps in eastern Switzerland. Results indicate that the principal upper crustal reflections recorded on the south end of Swiss seismic line NFP20-EAST can be explained by the subsurface geometry of stacked basement nappes. In addition, modeling results provide improvements to structural maps based solely on surface trends and suggest the presence of previously unrecognized rock units in the subsurface. Construction of the initial model is based upon extrapolation of plunging surface. structures; velocities and densities are established by laboratory measurements of corresponding rock units. Iterative modification produces a best fit model that refines the definition of the subsurface geometry of major structures. We conclude that most reflections from the upper 20 km can be ascribed to the presence of sedimentary cover rocks (especially carbonates) and ophiolites juxtaposed against crystalline basement nappes. Thus, in this area, reflections appear to be principally due to first-order lithologic contrasts. This study also demonstrates not only the importance of three-dimensional effects (sideswipe) in interpreting seismic data, but also that these effects can be considered quantitatively through three-dimensional modeling.

Aprender a ser docente en un mundo en cambio. Simposio internacional

[spa] Este texto recoge el conjunto de contribuciones presentadas al simposio internacional Aprender a ser docente en un mundo en cambio, que tuvo lugar en Barcelona el 21 y 22 de noviembre de 2013, un acto organizado por los grupos de investigación consolidados Esbrina - Subjetividades y entornos de aprendizaje contemporáneos (2009SGR 503) de la Universidad de Barcelona y ELKARRIKERTUZ (IT-563-13) de la Universidad del País Vasco.El simposio nos dio la oportunidad de debatir con la comunidad educativa el sentido de ser docente en el mundo actual y nos permitió presentar y debatir los resultados del proyecto de investigación coordinado La construcción de la identidad docente del profesorado educación infantil y primaria en la formación inicial y los primeros años de trabajo (Identidoc) (Ministerio de Economía y Competitividad. EDU2010-20852-C02-01/EDU2010-20852-C02-02), e intercambiar con otros colegas conocimientos y reflexiones en torno a estos temas.[cat]Aquest text recull el conjunt de contribucions presentades al simposi internacional Aprender a ser docente en un mundo en cambio, que va tenir lloc a Barcelona el 21 i 22 de novembre de 2013, un acte organitzat pels grups de recerca consolidats ESBRINA - Subjectivitats i entorns educatius contemporanis (2009SGR 503) de la Universitat de Barcelona i ELKARRIKERTUZ (IT-563-13) de la Universitat del País Basc.El simposi ens va donar l'oportunitat de debatre amb la comunitat educativa el sentit de ser docent en el món actual i ens va permetre presentar i debatre els resultats del projecte de recerca coordinat La construcción de la identidad docente del profesorado educación infantil y primaria en la formación inicial y los primeros años de trabajo (Identidoc) (Ministeri d'Economia i Competitivitat. EDU2010-20852-C02-01/EDU2010-20852-C02-02), i intercanviar amb altres col·legues coneixements i reflexions al voltant d'aquests temes.

Aproximació geogràfica als projectes hidràulics del Ter selvatà (1850-1930). Reflexions a propòsit d’un llibre recent

This contribution tries to do a geographical approach about the hydraulic works in the River Ter, in the area of the Selva county. The reflections included here are based in the considerations of the research contained in the book of the historian Gerard Buxeda recently published. The interest will be focused in the scale of the projects proposed, in the differentiation of their characteristics according to the zone where will be proposed, in the relation of these works with the policy and the ideology dominant in the state, etc. In short, the aim is to frame the hydraulic works in a larger context and with the geographical specifies during the period 1850-1930

La conception du "dialogue" de Mikhaïl Bakhtine et ses sources sociologiques (l'exemple des "Problèmes de l'oeuvre de Dostoïevski" [1929])

Résumé: L'article porte sur la conception du « dialogue » de Mikhaïl Bakhtine dans laquelle s'articulent deux groupes d'idées : 1) la notion de « dialogue » en tant que forme de l'interaction verbale interindividuelle (l'échange des répliques) et 2) la notion de « dialogisme » comme principe qui prévoit un rapport particulier entre le « Moi » (le « Je ») et l'« Autrui ». Son but consiste à 1) analyser ces notions au sens de Bakhtine, en s'appuyant sur le texte russe des Problèmes de l'oeuvre de Dostoïevski (1929) ; et à 2) montrer leurs sources sociologiques (principalement russes). Il y est également question de la notion de « polyphonie » introduite par Bakhtine pour caractériser la particularité de la construction des romans de Dostoïevski et d'une facette des réflexions bakhtiniennes sur le rôle de la « polyphonie » chez Dostoïevski, contenues dans le texte russe de 1929, abandonnées dans la version de 1963 et, de ce fait, méconnues des chercheurs francophones n'ayant accès qu'à la traduction des Problèmes de la poétique de Dostoïevski (1963). This paper examines the conception of "dialogue" elaborated by Mikhaïl Bakhtin in which are articulated two groups of ideas : 1) the notion of "dialogue" as a form of verbal interindividual interaction (an exchange of speech) and 2) the notion of "dialogism" as a principle which implies a relation between the "Me" (the "I") and the "Other". Its aim is 1) to analyse these notions in the sens of Bakhtin, on the base of russian text of Problems of Dostoyevsky's Art (1929) and 2) to show their sociological (mainly russian) origins. The paper also deals with the notion of "polyphony" introduced by Bakhtin to characterize the particularity of Dostoyevsky's method of constructing novels and with one facet of bakhtinian reflections (expounded in the text of 1929, omitted in the version of 1963, thereby unknown by francophone researchers who have access only to the translation of Problems of Dostoyevsky's Poetics (1963)) on the role of "polyphony" in Dostoyevsky's works.

Aprender a ser docente en un mundo en cambio. Simposio internacional

[spa] Este texto recoge el conjunto de contribuciones presentadas al simposio internacional Aprender a ser docente en un mundo en cambio, que tuvo lugar en Barcelona el 21 y 22 de noviembre de 2013, un acto organizado por los grupos de investigación consolidados Esbrina - Subjetividades y entornos de aprendizaje contemporáneos (2009SGR 503) de la Universidad de Barcelona y ELKARRIKERTUZ (IT-563-13) de la Universidad del País Vasco.El simposio nos dio la oportunidad de debatir con la comunidad educativa el sentido de ser docente en el mundo actual y nos permitió presentar y debatir los resultados del proyecto de investigación coordinado La construcción de la identidad docente del profesorado educación infantil y primaria en la formación inicial y los primeros años de trabajo (Identidoc) (Ministerio de Economía y Competitividad. EDU2010-20852-C02-01/EDU2010-20852-C02-02), e intercambiar con otros colegas conocimientos y reflexiones en torno a estos temas.[cat]Aquest text recull el conjunt de contribucions presentades al simposi internacional Aprender a ser docente en un mundo en cambio, que va tenir lloc a Barcelona el 21 i 22 de novembre de 2013, un acte organitzat pels grups de recerca consolidats ESBRINA - Subjectivitats i entorns educatius contemporanis (2009SGR 503) de la Universitat de Barcelona i ELKARRIKERTUZ (IT-563-13) de la Universitat del País Basc.El simposi ens va donar l'oportunitat de debatre amb la comunitat educativa el sentit de ser docent en el món actual i ens va permetre presentar i debatre els resultats del projecte de recerca coordinat La construcción de la identidad docente del profesorado educación infantil y primaria en la formación inicial y los primeros años de trabajo (Identidoc) (Ministeri d'Economia i Competitivitat. EDU2010-20852-C02-01/EDU2010-20852-C02-02), i intercanviar amb altres col·legues coneixements i reflexions al voltant d'aquests temes.

Aprender a ser docente en un mundo en cambio. Simposio internacional

[spa] Este texto recoge el conjunto de contribuciones presentadas al simposio internacional Aprender a ser docente en un mundo en cambio, que tuvo lugar en Barcelona el 21 y 22 de noviembre de 2013, un acto organizado por los grupos de investigación consolidados Esbrina - Subjetividades y entornos de aprendizaje contemporáneos (2009SGR 503) de la Universidad de Barcelona y ELKARRIKERTUZ (IT-563-13) de la Universidad del País Vasco.El simposio nos dio la oportunidad de debatir con la comunidad educativa el sentido de ser docente en el mundo actual y nos permitió presentar y debatir los resultados del proyecto de investigación coordinado La construcción de la identidad docente del profesorado educación infantil y primaria en la formación inicial y los primeros años de trabajo (Identidoc) (Ministerio de Economía y Competitividad. EDU2010-20852-C02-01/EDU2010-20852-C02-02), e intercambiar con otros colegas conocimientos y reflexiones en torno a estos temas.[cat]Aquest text recull el conjunt de contribucions presentades al simposi internacional Aprender a ser docente en un mundo en cambio, que va tenir lloc a Barcelona el 21 i 22 de novembre de 2013, un acte organitzat pels grups de recerca consolidats ESBRINA - Subjectivitats i entorns educatius contemporanis (2009SGR 503) de la Universitat de Barcelona i ELKARRIKERTUZ (IT-563-13) de la Universitat del País Basc.El simposi ens va donar l'oportunitat de debatre amb la comunitat educativa el sentit de ser docent en el món actual i ens va permetre presentar i debatre els resultats del projecte de recerca coordinat La construcción de la identidad docente del profesorado educación infantil y primaria en la formación inicial y los primeros años de trabajo (Identidoc) (Ministeri d'Economia i Competitivitat. EDU2010-20852-C02-01/EDU2010-20852-C02-02), i intercanviar amb altres col·legues coneixements i reflexions al voltant d'aquests temes.