This is the second in a series of collaborative blog posts between the Collaborative Family Healthcare Association and the Society of Teachers of Family Medicine.
Corey Smith, PsyD
I believe that behavioral education in family medicine is the domain of the courageous and resilient. Behavioral scientists, the “Lone Wolf” of medical education, are asked to educate residents (often with little support) in areas sometimes antithetical to their students’ previous 4 years of medical school.
Example: Motivational Interviewing (MI). Teaching a group of intelligent overachievers, who recently finished training aimed at increasing their comfort with giving orders, that giving orders might be the worst choice they could make? Bring it on.
On my first day in my current position, I participated in a 3-hour didactic involving the placement of first-year residents into groups, with name tags labeled Stars, Champions, and Winners, competing to properly identify OARS statements. What courage to attempt such a novel approach! Three years, and many frustrating didactics later, I see how an experienced and effective psychologist might come to the conclusion, “You know what? Let’s put name tags on these yahoos and see what happens.”
Over the last 3 years I have faced resistance to the concept of MI, the likes of which would rival the 300 Spartans at the battle of Thermopylae. I began with my own resistance and maintenance of a strict adherence to teaching the concepts of MI in a way more suited to those attending a day-long workshop. My first clue that the car had gone off the rails occurred when, during a group meeting, a first-year resident flatly refused to participate in a role play. Awkward. Resilience points: check. Next, I enlisted the assistance of the most behaviorally friendly physician faculty member I could find because, “sometimes doctors think they can only learn from other doctors.” The first statement from the residents upon seeing one of their own in our behavioral meeting: “What are YOU doing here, checking up on us?” Hmm.
Finally, a revelation: “Why don’t we ask the residents how they want to learn this?” Brilliant! (I really wish I could take credit for this.) The residents wanted to have a free-form discussion of common problems and how they might address them (ie, smoking cessation, weight loss, leaving an abusive partner, etc). “But that’s not MI!” I protested. Knowing my colleague was better suited for this task than I, it has taken courage to give up the reins. However, watching her execute her wisdom and skill as a teacher made the development of resilience from constant tongue biting to avoid the over-insertion of MI terminology more palatable. (I’m barely even allowed to speak its name!)
At the time of publication, we have met four times with each cohort of residents and our wonderfully helpful “Physician Mole.” I find the conversations helpful in building rapport and camaraderie surrounding difficult areas of potential change and see hope for the future. In true MI form, I rolled with the resistance and sought opportunities to model and educate residents on the Spirit of MI. It is far too early to evaluate the effectiveness of our modality, nor have I found the method of teaching this important skill that will define our curriculum, but we have become more resilient teachers and maintained the courage of our convictions.
We can’t go back now anyway; I lost the name tags.
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