Training for New Technique to Change Patient Behavior

Motivational Interviewing (MI) is an approach practitioners can use to encourage behavior change – helping a patient to devise a plan, stick to it, and feel like a participant in a collaborative relationship.

MI has been proven effective across the spectrum of healthcare disciplines, but adoption is relatively low. So SIMmersion, in collaboration with Medscape and Synergy Enterprises, is using its PeopleSim technology to create a training application allowing primary care physicians to explore how an MI-inspired approach could work in their practice while engaging in role-plays with a realistic, virtual patient.

The lack of widespread use drew the attention of the Blending Initiative, a collaboration between the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMSHA) to accelerate the dissemination of research-based treatment methods into clinical practice. The Blending Initiative wanted a system that would allow users to get hands-on practice with MI in a virtual setting – and that made SIMmersion a prime choice for a contract, since the company has been integrating the spirit of MI into all of our physician training systems since 2007, according to Laura Humm, SIMmersion’s Chief Operating Officer.

“Alcohol Screening and Brief Intervention with Christy Johnson, Prescription Drug and Pain Management with Tom Kramer, and Prevention of Childhood Obesity with Kelly Robinson all have reflective listening, collaborative relationship building, and support for autonomy interwoven into the scripts,” she says. “But this is particularly exciting for us, because we get to make the spirit of MI the focus of the training. Because users will be focusing just on MI, they’ll be able to learn tools like identifying and responding to change talk. Hopefully, they’ll see that it’s effective and that patients like it, so they’ll seek out more training.”

SIMmersion’s contribution to the product will be a role-play conversation with a virtual patient who reveals he is using cocaine. The conversation will show users how effective a collaborative, MI-inspired approach with patients can be.

Since primary care physicians have ongoing relationships with their patients, even brief interventions can have lasting effects on the choices patients make. “A simple principle that emerged from our earliest discussions,” writes William Miller, Ph.D, one of the cofounders of MI, “was to have the client, not the counselor, voice the reasons for change.” This approach builds the motivation of patients to work for change, and has a profound effect on retention in treatment and positive outcomes across a practice.

The PeopleSim conversation engine that powers SIMmersion’s characters will make the virtual patient’s personality change from play to play, giving an array of experiences and increasing the replay value. Dynamic pathways through the conversation let users dig deeper with questions, change topics freely, and even backtrack on their way through the conversation, just like a real encounter with a patient. The patient’s level of engagement with users will change dynamically based on what users say. A collaborative style will encourage openness and participation, while a directive style will make the patient more reserved and passive.

Feedback from the character’s dialogue and an on-screen coach will let users learn from missteps in real-time, and a comprehensive after-action review will allow them to see details of their performance and ways to improve.

What patients appreciate about MI, writes Stephen Rollnick, PhD, the other co-founder of MI, is having “a little space with a professional who lets you wonder aloud what change might be like, and who enjoys with you the easy feeling when you make some progress.”

With this training system, SIMmersion and its partners hope to give healthcare practitioners an introduction to the spirit of motivational interviewing, and the helpful, easy feeling it can give patients.