Tuesday, May 31, 2016

A Refresher on Motivational Interviewing

Throughout our lives, we may often find ourselves trying to help someone make a change.  At times like these all of us hope to have a positive impact and support others in achieving their goals.

But how? What is the best way to show our support?

In 1991, Miller and Rollnick wrote the first of many books on a new way of talking to people about change:  Motivational Interviewing (MI).1 MI involves techniques for discussion with those who are ambivalent, to elicit and strengthen their personal motivation for change. 2

To guide an interaction based on MI theory, the situation must first be assessed.  How does the person themselves feel about changing? For this assessment, Rollnick created the readiness ruler a simple method for determining readiness to change by asking where a person falls on a scale of 1 to 10.3,4

Figure 1: Readiness rulers (adapted from Miller & Rollnick 1991; Keller & White 1997)

The readiness rulers are a useful tool to initiate any discussion surrounding change. With information on conviction and confidence, we can then apply appropriate strategies for different degrees of readiness.3

Keller and White (1997) found readiness involves two distinct scales: conviction and confidence.5

Figure 2: Factors influencing ambivalence (adapted from Keller & White 1997)

Is the person skeptical? 
Help them explore the pros and cons of change! 

Are they frustrated? 
Guide them to discover their personal strengths!   

Always tailor the discussion to the individual!

Our goal as healthcare professionals is to evoke change talk, to help others recognize the need for change and to help them believe it is possible. 1  That being said, the most important point to remember is that MI is a partnership – two people working in a respectful, collaborative way.  

While there may be little time for pharmacists to have long discussion, we are still the most accessible health profession. As such it is imperative to communicate effectively in the time we have – I hope this helps!


1.           Miller, W. & Rollnick, S. Motivational interviewing: preparing people to change addictive behavior. (New York : Guilford Press, 1991).
2.           Foxcroft, D. & Al., E. Motivational interviewing for alcohol misuse in young adults. Cochrane Database Syst. Rev. 8, CD007025 (2014).
3.           Najavits, L. M. Treatment Improvement Protocol Series: Enhancing Motivation for Change in Substance Abuse Treatment. Subst. Abus. Ment. Heal. Serv. Adm. Cent. Subst. Abus. Treat. 1–27 (1999).
4.           Hesse, M. The Readiness Ruler as a measure of readiness to change poly-drug use in drug abusers. Harm Reduct. J. 3, 3 (2006).
5.           Keller, V. F. & White, M. K. Choices and changes: A new model for influencing patient health behavior. J. Clin. Outcomes Manag. 4, 33–36 (1997).

Thursday, May 12, 2016

A Career of Lifelong Learning

Hello rxBriefCase! As a big fan of continuing education (CE) programs, I am grateful for this type of unique pharmacy experience.  The importance of continuing education is unquestionable; as healthcare professionals we are accountable to provide competent care to our patients throughout our careers.

To accomplish this, we must maintain and continuously develop our knowledge, skills and attitudes in the ever-changing healthcare system.1

Over the next 5 weeks, I will be reviewing a current CE program available for pharmacists as well as producing an e-Newsletter for rxPassport and a mini-module in medSchool For You’s Pharmacy Corner. I hope they will be as enriching to read as they will be to create!  

It is pretty incredible to see all the various roles and components that contribute to the launch of a CE program.   Understanding the foundation upon which continuing education is based really helps you appreciate the time and effort that goes into building these modules. Learning to write continuing education content while simultaneously being a user of these programs enhances all aspects of the learning experience. 

In fact, practicing these different tasks – such as writing continuing education content and participating in continuing education - in a random order has been shown to result in better retention of concepts than practicing them in a blocked order: this is known as the contextual interference (CI) effect.2  Where blocking involves practicing one skill at a time, contextual interference mixes practice on several related skills together.3  This technique produces enhanced performance across disciplines, spanning from athletic training to problem solving in academia.3,4
This approach to learning is increasingly applicable when noticing features among a list of competing alternatives is part of the task; contextual interference helps learners to more quickly estimate the impact of ideas on a case, which I know will absolutely be an asset in pharmacy practice! 4, 5

Again, I am so fortunate for this rotation – good luck to all you lifelong learners!!

1.   Canadian Nurses Association. Professional Development. (2016). at https://www.cna-aiic.ca/en/professional-development. Accessed May 11, 2016.
2.   Lin, C.-H. J., Wu, A. D., Udompholkul, P. & Knowlton, B. J. Contextual interference effects in sequence learning for young and older adults. Psychol. Aging 25, 929–939 (2010).
3.   Pan, S. The Interleaving Effect: Mixing It Up Boosts Learning. Sci. Am. (2015). at http://www.scientificamerican.com/article/the-interleaving-effect-mixing-it-up-boosts-learning. Accessed May 11, 2016.
4.   Helsdingen, A. S., van Gog, T. & Merrie, Vannboer, J. J. G. The effects of practice schedule and critical thinking prompts on learning and transfer of a complex judgment task. J. Educ. Psychol. 103, 383–398 (2011).
5.   Hatala, R. M., Brooks, L. R. & Norman, G. R. Practice Makes Perfect: The Critical Role of Mixed Practice in the Acquisition of ECG Interpretation Skills. Adv. Heal. Sci. Educ. 8, 17–26 (2003).