Medical improvisation-based motivational interviewing for internal medicine residents: Mixed-methods evaluation of a novel course

Abstract

Purpose

Develop and assess a novel medical improvisation-based motivational interviewing (MI) curriculum for residents.

Materials and methods

A 6-h medical improv-based MI curriculum occurred in 2022 for internal medicine residents. A mixed-methods evaluation included: pre- and post-role plays using the Motivational Interviewing Treatment Integrity Score (MITI) to assess MI competency, a post-course survey assessing confidence, and focus groups to understand learning through improvisation.

Results

Participants increased their confidence in applying MI skills after the curriculum in responding to a patient’s argument against change (29% pre vs. 72% post, p < 0.001), eliciting change talk (21% vs. 86%, p < 0.001), and providing information in an MI-centric way (39% vs. 86%, p < 0.001). All role-play participants achieved at least beginning proficiency on MITI technical and relational global summary scores post-course. MI-adherent behaviors increased, and MI-non-adherent behaviors decreased in post-course role plays. Themes on learning through improvisation included: (1) improvisation can enhance the learning of MI skills, (2) using non-medical scenarios in improvisation exercises has benefits, and (3) trying improvisation had positive effects on the learning environment.

Discussion

A medical improvisation-based course is a promising, engaging way to teach residents MI skills and can improve competence and confidence with MI.

Keywords:

• Medical improvisation
• curriculum development
• motivational interviewing

Acknowledgements

The authors would like to acknowledge Belinda Fu, MD, and Dan Sipp for their feedback on the improv exercises utilized within this course. We would like to acknowledge John Encandela PhD for his support in the qualitative methodology. The qualitative portion of this research has been supported by QUALab, the Qualitative & Mixed Methods Lab, a collaboration between the Yale Child Study Center (New Haven, CT), and CESP, the Centre de recherche en Epidémiologie et Santé des Populations (Paris, France.).

Disclosure statement

The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report. We certify that the submission is original work and is not under review at any other publication.

Prior presentations

At the time of submission, this research has not been presented elsewhere.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Carolyn A. Chan

Carolyn A. Chan, MD, MHS-MedEd is an Instructor of Medicine at Yale School of Medicine. She is an internal and addiction medicine physician with 9 years of experience as an improviser actor.

Peyton Cabaniss

Peyton Cabaniss, is an MPH Candidate at Yale School of Public Health.

Kenneth L. Morford

Kenneth L. Morford, MD is an Assistant Professor of Medicine at Yale School of Medicine. He is an internal and addiction medicine physician.

Steve Martino

Steve Martino, PHD is a Professor of Psychiatry at Cale Yale School of Medicine, and the Chief of Psychology at the VA Connecticut Healthcare System.

Andrés Martin

Andrés Martin, MD, PhD is a Professor of Psychiatry at Yale School of Medicine, and the Director of Medical Studies at the Yale Child Study Center.

Donna M. Windish

Donna M. Windish, MD, MPH is a Professor of Medicine at Yale School of Medicine and is the Program Director of the Yale General Internal Medicine Medical Education fellowship.