Clinical Communication II- Patient centered interview

Code:

OPT96

Acronym:

CCII

Keywords
Classification	Keyword
OFICIAL	Medicine

Instance: 2017/2018 - 2S

Active?	Yes
Responsible unit:	Clinical Neurosciences and Mental Health Department
Course/CS Responsible:	Integrated Master in Medicine

Cycles of Study/Courses

Acronym	No. of Students	Study Plan	Curricular Years	Credits UCN	Credits ECTS	Contact hours	Total Time
MIMED	8	Mestrado Integrado em Medicina- Plano oficial 2013 (Reforma Curricular)	5	-	1,5	14	40,5

Teaching language

Suitable for English-speaking students

Objectives

Acquisition and consolidation of knowledge:

1. Theoretical underpinnings of health behaviour models and their modification.
2. Understanding the concepts of motivation; ambivalence and resistance.
3. Motivational interviewing foundations (MI) and its applicability (Miller e Rollnick, 1983, 2009).

Promoting and reinforcing the acquisition of advanced patient centerd interviewing skills, with rehearsal of IM techniques, namely:

1. Identifying ambivalence and resistance to change;
2. Fostering cessation of health harmful behaviours, including addictions, and promoting change;
3. Assisting preparation and maintenance of health behaviours;
4. Understanding and guiding from relapse into harmful behaviours;
5. Improving adherence to treatment plans and screenings programs.

Acquisition and reinforcement of an empathy-based clinical attitude, favourable to the process of change, avoiding confrontation and persuasion.

Learning outcomes and competences

The theoretical knowledge of the general principles and spirit of Motivational Interview and rehearsal of specific strategies (OARS; change talk) will promote the acquisition of change facilitating skills. The identification of the stages of change, in each patient, enhances the tailored application of the MI.

Application of MI to adherence to treatment, monitoring of chronic diseases, promoting health related behaviours and prevention strategies will promote the ability to roll with resistance, to recognize the difficulty of change and to cultivate a nonjudgmental collaborative attitude.

Working method

Presencial

Program

1. Patient centered interviewing advanced skills.


2. Health Behaviours and their change:
   
   
   
   1. Social cognitive models:
      
      
      
      1. Health Belief Model (Rosenstock 1974; Stretcher, 1997)
      
      
      2. Theory of planned behaviour (Ajzen 1988)
      
      
      
      
   
   
   2. Integrationist models
      
      
      
      1. Transteoretical Model (Prochaska & DiClemente 1983)
      
      
      2. PRIME Theory (West 2006)
      
      
      
      
   
   
   
   


3. Understanding the concepts of motivation, ambivalence and resistance,


4. Motivational Interviweing (MI) (Miller e Rollnick 1983,2009):
   
   
   
   1. MI principles:
      
      
      
      1. Express empathy;
      
      
      2. Develop discrepancy;
      
      
      3. “Rolling” with resistance;
      
      
      4. Support self-efficacy
      
      
      
      
   
   
   2. Model of 5 A’s.
   
   
   3. MI applicability.
   
   
   4. MI skills and strategies:
   
   
   
   

1. OARS (Open ended questions, Affirmations; Reflections; Summaries)


2. Change talk;

• Preparatory change talk:
  
  
  
  1. DARN (Desire; Ability, Reason ; Need);
  
  
  
  


• Implementing change talk:
  
  
  
  1. CAT (Commitment; Activation; Taking steps)
  
  
  
  

 

1. To learn and to apply specific skills in early stages of treatment.

To eliminate previous interview attitudes inconsistent with MI style.

Mandatory literature

Rui Mota Cardoso; Competências Clinicas de Comunicação, 2015

Complementary Bibliography

Ayers and de Visser; 2013; pp 99-117.; Psycology for Medicine, Cáp. Health and Behaviour, 2013
Davidoff F, Laine C. ; Patient-Centered Medicine - A Professional Evolution JAMA. 275(2):152-156, 1996
Hettema JU, Steel J, Miller WR. ; “Motivational Interviewing”, Annu Rev Clin Psychol,1:91-11., 2005

Teaching methods and learning activities

Seminars 1.5 hour week (Total 10.5 hours), including:

Theoretical component – Theoretical background on patient centred interview skills and emotion-handling skills. Acquiring the rational for defining Motivational Interviewing, principles, techniques and strategies.

Theoretical-practical component – Videotaped clinical examples visualization and discussion, identification and discussion of communication strategies used in a Motivational approach; role play exercises based on real clinical experiences to train Motivational Interviewing.

Practical component – Interviews with simulated and real patients. Audio and video recording of selected interviews to provide discussion and evaluation of acquired communication skills.

Evaluation          

General principles: Formative and summative, providing continuous feedback and addressing specific behaviors

1. Objective structured examination and integrated clinical skills examination (practical component) (90%). Checklist and process grids of MI strategies, scored by teachers and observers (students)
2. Assiduity, attitudes, professional behaviour, problem solving skills (10%).

14 hours of contact.

Evaluation Type

Distributed evaluation without final exam

Assessment Components

Designation	Weight (%)
Participação presencial	10,00
Trabalho prático ou de projeto	90,00
Total:	100,00

Calculation formula of final grade

General principles: Formative and summative, providing continuous feedback and addressing specific behaviors

1. Objective structured examination and integrated clinical skills examination (practical component) (90%). Checklist and process grids of MI strategies, scored by teachers and observers (students)
2. Assiduity, attitudes, professional behaviour, problem solving skills (10%).