Motivational Interviewing - a core competency or an elective skill?

This past Thursday, I attended a seminar on motivational interviewing. After 3.5 years of medical school focused primarily on the science of medicine, it was a refreshing change. As I progress through medical school, I've been increasingly frustrated by my inability to influence behavior changes in patients - most, if not all, of my patients know that smoking is bad, that fast foods lead to obesity, that exercise can help prevent cardiac disease... the list goes on. As clinicians, we sound like a droning tape recorder when we ask (once again) if our patients are exercising (they're not), if they're still drinking (they are) and if they're still smoking (they're still doing that too).

I've spent countless hours learning about things like Kreb's cycle, IL-1, APO-B and Fabry's Disease, all of which I am unlikely to ever use in my professional career. But, in my medical school training, I have not had a single hour devoted to behavioral change in patients.

Motivational interviewing is "a collaborative, person-centered form of guiding to elicit and strengthen motivation for change." It is a method of empowering our patients to take responsibility for their health and accompanying them on the journey towards that change. It is a method that views each patient as a person with a story and a background and not as the "diabetic in room 2" or "the non-compliant patient."

OARS is often used as an acronym in approaching motivational interviewing:

• Open-ended questions
• Affirmation
• Reflection
• Summarizing

Science tells us that prevention decreases morbidity, increases quality of life and decreases cost. Motivational interviewing provides a systematic approach to prevention.


To better serve our patients, medical schools and residencies across the country need to focus more on teaching the art of medicine, which includes behavioral change methods. Strategies like motivational interviewing should be listed as core clinical competencies and students need to be evaluated on these skills in addition to their clinical knowledge. Learning medicine is daunting - the continuously increasing body of knowledge requires that schools pick and choose what they can teach. But if schools continue to focus on teaching the science of medicine at the expense of the art of medicine, it can only be to the detriment of those we aim to serve.

Motivational Interviewing Resources:
http://www.motivationalinterview.org/
http://motivationalinterview.net/clinical/interaction.html
"A 'Stages of Change' Approach to Helping Patients Change Behavior." http://www.aafp.org/afp/2000/0301/p1409.html