Motivational Interviewing: Your Own Motivation Matters

by M. Kate Probst, PharmD, BCACP, BCGP

My Own Motivation Background

Over ten years serving as a mentor and trainer for students, residents, and pharmacists has left me hopefully optimistic. Working with students and pharmacists at all stages of readiness to accept new clinical services has been rewarding, but has not been without its challenges. Not all pharmacists and students are instantly ready to embrace all aspects of provider status. Much like our patients facing a new diagnosis, many pharmacists have resisted advanced practice roles. The “I won’t” or the “I might” mentality seems to persist, despite the evidence that a pharmacist’s job description is shifting. After realizing the similarities that exist between patients and pharmacists, both who are hesitant to change, I decided to try using motivational interviewing (MI) when training new pharmacists and students. If motivational interviewing is described by Rollnick and Miller as an “individual-centered counseling style for eliciting behavior change by helping individuals to explore and resolve ambivalence”1, aren’t there implications for its use in eliciting change in practice during training, advising and precepting? There are many instances described in the literature that detail the training of health profession students to deliver MI and the benefit of health professionals utilizing MI to improve patient outcomes. There are fewer articles that describe using MI principles in an advising and precepting role to elicit change from students.2,3 I want to share my own strategy for incorporating MI into training health care professionals. My ultimate goal is to help pharmacists and students realize that building a trusting relationship with patients is just as essential to our role as the clinical knowledge we provide.

Using MI to Train Students and Pharmacists

I have begun by employing MI techniques with my students over the past year. Just as with our patients, we need to understand what the student knows, understands, and believes at the onset.4 In my approach, this is usually attained through a first day interview. The APhA reference “Motivational Interviewing for Health Care Professionals: A Sensible Approach” lists a series of tenets that can be considered when using MI. I have adjusted the wording to better facilitate student-centered thinking.

When using MI, the practitioner or preceptor should:

  • Respect the student/pharmacist as a person
  • Individualize the learning experience
  • Consider previous experience the student may have had in this area (previous years of experience should not be undermined)
  • Take time to recognize that students/pharmacists have differing levels of expertise
  • Personalize the experience
  • Discuss what is important to the student/pharmacist
  • Consider their individual goals when possible to help overcome barriers to learning
  • Act with genuineness and congruence
    • Reflect on when words don’t match actions and motivations
    • If you have ever been a recipient of false empathy, you know when someone’s words don’t match their true feelings, and so you must ensure you are authentic while providing training
  • Be transparent by letting the student/pharmacist know intentions from the onset
  • Share your motivations and provide clear guidance, goals, and objectives established from the beginning of the rotation

The tenets described could also be applied when training practicing pharmacists with limited experience delivering a new clinical service. As adult learners, student pharmacists and practicing pharmacists often want to know why the information presented is useful. The use of MI in this context may lead to stronger interpersonal relationships with your students, colleagues, and patients. MI is a tool and it requires practice. However, it also requires authenticity. You can memorize small talk and information gathering techniques that will improve your process, but if faced with a challenging patient or student, your patience as a provider or as a preceptor will be tested. Part of my job as a faculty member is to create a judgment free zone for students to practice these skills, recognizing that building this authentic motivation takes time. Training with MI the same way we practice with our patients may address barriers to changing pharmacist roles and improve successful utilization of our professional responsibilities for student pharmacists and new pharmacists alike.

Have any of you had success using MI in the training of student pharmacists?

Acknowledgements: Daniel Malcolm for his input and encouragement.

References

1. Rollnick, S., & Miller, W. (1995). What is Motivational Interviewing? Behavioural and Cognitive Psychotherapy,23(4), 325-334. doi:10.1017/S135246580001643X

2. Sheldon, L. (2010). Using Motivational Interviewing to Help Your Students. NEA Higher Education Journal Thought and Action, p153-158.

3. Pettay, R.F. (2009, June). Motivational interviewing in advising: Working with students to change. Academic Advising Today, 32(2). Retrieved from http://www.nacada.ksu.edu/Resources/Academic-Advising-Today/View-Articles/Motivational-Interviewing-in-Advising-Working-with-Students-to-Change.aspx. Accessed June 10, 2018.

4. Berger BA, Villaume WA. Motivational Interviewing for Health Care Professionals: A Sensible Approach. 1st ed. Washington, DC: American Pharmacists Association; 2013. https://doi-org.suscorp.idm.oclc.org/10.21019/9781582121802.fm. Accessed March 22, 2018.


M. Kate Probst is an Associate Professor at Sullivan College of Pharmacy in Louisville Kentucky. Educational scholarship interests include practical applications in lab, preparing student pharmacists for provider status, aging gracefully, and motivational interviewing. In her free time, she enjoys watching her daughters grow up too quickly, amateur gardening and running and playing outside.


Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning

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