Journal Club

Mounsey, AL, Bovbjerg, V, White, L and Gazewood, J. Do students develop better motivational interviewing skills through role-play with standardized patients or with student colleagues? Medical Education 2006; 40: 775-750

Reviewed by Margaret Golden MD MPH, SUNY Downstate

How often do we hear students report "The parent was counseled about car seat use/childproofing/proper feeding…."? When I observe students, I find that "counseling" usually means lecturing, admonishing or even badgering. Hence I was intrigued by this article on developing better motivational interviewing skills, since motivational interviewing is a well developed, well accepted clinical technique for promoting behavior change. Standardized patients are the gold standard-both in terms of reliability and unfortunately, also cost-for teaching and assessing communication skills. If role-plays with student colleagues are just as effective as exercises with standardized patients, then we (my school/most schools) could offer more training than we now do in this critical set of communication skills.

This study comparing standardized patient or student role-plays for the formative assessments in a unit on motivational interviewing is meticulously done. It is a randomized controlled trail using a previously validated instrument, the MITI (Motivational Interviewing Treatment Integrity) scoring system, in which faculty scorers of the final taped interviews were extensively trained. The subjects were third year students on a family practice clerkship, who had already had extensive exposure to motivational interview-ing as first years.

The finding of "no difference" between students who practiced with each other and students who practiced with standardized patients is heartening for money-strapped schools that want to expand their teaching and assessment of communication skills.

I have one reservation about the study's results. As the authors mention, they did not do a pre-intervention assessment of these students' skills. Hence we cannot tell if this particular third year intervention did anything to increase the skills of either group-(and did their skills reach a minimal level known to be clinically useful?)

(Editorial comment: Because of the variability of teaching and learning in the physician's office, many schools have turned to standardized patients both to teach and assess medical student skills. This study is intriguing in that it shows that "non-standardized patients", e.g. fellow medical students, can play an effective role in teaching. It may be that merely being forced to practice the skill of counseling is what is critical. Bill Raszka)