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Electives - Internal Medicine - General Medicine

Motivating Behavior Change

Elective Number: 1517

Rotation Supervisor: Dr. Kristen Wells

Coordinator: Dr. Wells, Hospital West, Room 3916; 924-8520

Duration: 2 weeks

Available: Rotation 8a (9/29-10/11) - Class of 2015

Report to: Kristen Wells

Time to Report: 8:00 am

Place to Report: W. Complex Multistory Building, Room 3196

Typical Day: 8:00 am - 12:00 noon

Attendance: Attendance at elective activities is mandatory.

  • Anyone who is ill or has a personal or family emergency must contact Student Affairs and the Attending on Service.
  • Students are allowed to take off up to 1 day per week to interview between November 1 and February 1.
    • Specific days missed must be approved by the Attending on Service.

Number of students per rotation: 8

Course Description: Individual behavior is a principal factor underlying the major preventable causes of morbidity and mortality in the United States. The CDC estimates that approximately 50% of deaths, over one million each year, are due to potentially preventable causes. The two most important, accounting for about 20% of the deaths each, are cigarette smoking and obesity related to diet and exercise. Despite the great importance of these factors, physicians receive little training in how to most effectively facilitate behavior change among their patients. The purpose of this elective is to provide training in state of the art techniques for fostering behavior change among their patients. The two techniques that will be taught are motivational interviewing and mindfulness.

Motivational interviewing is a technique that focuses on the patient’s perspective with regard to altering his or her behavior, rather than the health care provider’s. It is based on working with the patient’s own ambivalence about change rather than overcoming the provider’s interpretation of denial. It also incorporates the stages of change model of behavior which views behavior change as a continuum with reproducible stages. Individuals respond to different motivational techniques at different stages, and matching interventions to these stages significantly increases the likelihood that successful change will occur.

Mindfulness is defined as moment-to-moment nonjudgmental awareness. This awareness can be used to provide insight into the basis for emotional and physical states. It is a practice that can be taught to patients to help them deal with stress and discomfort. It has been shown to lead to lower anxiety and pain with improved functional status for a wide variety of health problems. It can be very helpful as an adjunct to behavior change when anxiety and pain are perceived to be limiting factors.

In addition to being a very helpful technique for patients, mindfulness can be used by clinicians to improve their own effectiveness. Improved self-awareness has added benefits, as it has been shown to be a key factor in preventing physician burnout. Learning to practice moment to moment awareness allows clinicians to be more fully present with their patients, and to concentrate on what is going on at the present moment in a clinical encounter, rather than being lost in thought about other patients and what else they need to be doing. In addition, it can provide insight into the emotional aspects of caring for patients, an area that is not well addressed in medical education. Self-awareness can be very important for clinicians in helping patients change their behavior as we often have reasons that we do or do not choose to deal with certain behaviors, such as the impact of a family history of substance abuse on alcohol counseling, or the role our own body image plays in talking to patients about diet. Mindfulness can help uncover these often hidden agendas.

Goal: The goal of this elective is to improve students’ ability to counsel patients for effective behavior change and stress reduction by teaching them state of the art motivational interviewing and mindfulness techniques.

Objectives:

1. Students will understand the theory underlying motivational interviewing
2. Students will know the stages of change and how to assess these in individual patients
3. Students will know the five principals of motivational interviewing and be able to apply them in patient care: expressing empathy, developing discrepancy, avoiding argumentation, rolling with resistance and supporting self-efficacy
4. Students will know the specific strategies that can be used, and be able to demonstrate them: asking open-ended questions, listening reflectively, affirming, summarizing and eliciting self-motivational statements
5. Students will know the techniques for overcoming resistance
6. Student will understand what mindfulness is
7. Students will know the evidence-base for using mindfulness in clinical practice
8. Students will practice mindfulness techniques for at least 30 minutes per day
9. Students will understand how these practices can be used in patient care.