Deconstructing proficiency in motivational interviewing: mechanics of skilful practitioner delivery during brief simulated encounters.
Deconstructing proficiency in motivational interviewing: mechanics of skilful practitioner delivery during brief simulated encounters.
复制标题
DOI：
10.1017/s1352465810000329
复制
发表时间：
2010-10
影响因子：
1.8
通讯作者：
Baer JS
中科院分区：
文献类型：
--
作者：
Hartzler B;Beadnell B;Rosengren DB;Dunn C;Baer JS
动机性访谈（MI）的熟练交付通常由关系要素的整体评分或技术要素的累积计数来决定。然而，有限的经验证据表明，关系因素和技术因素是如何关联的，或者技能指数及其构成技术因素的比率是否在临床遭遇中有所不同。本研究试图记录在与一名“MI熟练”分娩的标准化患者的短暂临床接触中，MI技能指数及其构成技术要素的时间差异，并将这些时间模式与“MI不一致”分娩所观察到的时间模式区分开来。数据来自一项大型心肌梗死训练试验，其中对503次模拟20分钟临床遭遇的心肌梗死交付的相关和技术要素进行评分。值得注意的是，独立评分者在5分钟的片段中计算了技术元素，允许评估遇到的四分位数间隔中的潜在方差。MI精神的全球评级确定了MI精通（n = 49）和MI不一致（n = 43）交付的录音子集，用于分层分析。分析对比了mi熟练型和mi不熟练型的技术方面的时间轨迹，前者的特点是：1)启发式和反思性倾听是主要的开场白策略；2)在随后的集中治疗讨论中，增加反思性倾听的深度作为主要策略；3)在会议接近尾声时，在变更计划中增加启发和信息提供的使用。研究结果通常与心肌梗死的开创性描述一致，并记录了在短暂接触中熟练的心肌梗死交付的时间方面。
Proficient delivery of motivational interviewing (MI) is often determined by global rating of relational elements or cumulative tallies of technical elements. Yet limited empirical evidence exists to clarify how relational and technical elements are associated, or if rates of skill indices and their constituent technical elements vary within a clinical encounter. This study sought to document temporal variance in rates of MI skill indices and their constituent technical elements during brief clinical encounters with a standardized patient wherein delivery was “MI-proficient”, and to distinguish those temporal patterns from those observed in encounters with “MI-inconsistent” delivery. Data were accessed from a large MI training trial wherein relational and technical elements of MI delivery were scored for 503 recordings of a simulated 20-minute clinical encounter. Notably, independent raters tallied technical elements in 5-minute segments, allowing evaluation of potential variance among the encounter’s quartile intervals. Global ratings of MI spirit identified subsets of recordings with MI-proficient (n = 49) and MI-inconsistent (n = 43) delivery for stratified analyses. Analyses contrast temporal trajectories of technical aspects of MI-proficient and MI-inconsistent delivery, with the former characterized by: 1) elicitation and reflective listening as primary opening strategies; 2) increased depth of reflective listening as a predominant strategy in subsequent, focused therapeutic discussion; and 3) increased use of elicitation and information provision in change planning as the encounter approached conclusion. Findings are generally consistent with seminal descriptions of MI, and document temporal aspects of skilful MI delivery in brief encounters.