Journal of General Internal Medicine

, Volume 25, Supplement 4, pp 620–626 | Cite as

Linking a Motivational Interviewing Curriculum to the Chronic Care Model

  • Sharone A. AbramowitzEmail author
  • Davida Flattery
  • Karena Franses
  • Lyn Berry
Original Research



Unhealthy lifestyle choices frequently cause or worsen chronic diseases. Many internal medicine residents are inadequately trained to provide effective health behavior counseling, in part, due to prioritization of acute care in the traditional model of medical education and to other systemic barriers to teaching psychosocial aspects of patient care.


To address this gap in training, we developed and piloted a curriculum for a Primary Care Internal Medicine residency program that links a practical form of motivational interviewing (MI) training to the self-management support (SMS) component of the chronic care model.


All 30 primary care residents at Alameda County Medical Center were trained in the curriculum since it was initiated in 2007 during the California Academic Chronic Care Collaborative.


Residents participated in three modules during which the chronic care model was introduced and motivational interviewing skills were linked to the model’s self-management support component. This training was then reinforced in the clinical setting. Case-based interactive instruction, teaching videotapes, group role-plays, faculty demonstration, and observation of resident-patient interactions in the clinical setting were used to teach the curriculum.


A preliminary, qualitative assessment of this curriculum was done from a program standpoint and from the perspective of the learners. Residents reported increased sense of confidence when approaching patients about health behavior change. Faculty directly observed residents during clinical encounters using MI and SMS skills to work more collaboratively with patients and to improve patient readiness for self-management goal setting.


A curriculum that links motivational interviewing skills to the chronic care model’s self-management support component and is reinforced in the clinical setting is feasible to develop and implement. This curriculum may improve residents’ confidence with health behavior counseling and with preparing patients to become active participants in management of their chronic conditions.


chronic care model self-management support motivational interviewing residency training primary care 



This work was partially funded by a Health Resources and Services Administration Grant for Training in Primary Care Medicine and Dentistry.

Conflict of Interests

None disclosed.


  1. 1.
    Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238–45.CrossRefPubMedGoogle Scholar
  2. 2.
    Dalle Grave R, Melchionda N, Calugi S, et al. Continuous care in the treatment of obesity: an observational multicentre study. J Intern Med. 2005;258:265–73.CrossRefPubMedGoogle Scholar
  3. 3.
    King DE, Mainous AG 3rd, Carnemolla M, Everett CJ. Adherence to healthy lifestyle habits in US adults, 1988–2006. Am J Med. 2009;122:528–34.CrossRefPubMedGoogle Scholar
  4. 4.
    Park ER, Wolfe TJ, Gokhale M, Winickoff JP, Rigotti NA. Perceived preparedness to provide preventive counseling: reports of graduating primary care residents at academic health centers. J Gen Intern Med. 2005;20:386–91.CrossRefPubMedGoogle Scholar
  5. 5.
    Merkel WT, Margolis RB, Smith RC. Teaching humanistic and psychosocial aspects of care: current practices and attitudes. J Gen Intern Med. 1990;5:34–41.CrossRefPubMedGoogle Scholar
  6. 6.
    Hoppe RB, Farquhar LJ, Henry R, Stoffelmayr B. Residents' attitudes towards and skills in counseling: using undetected standardized patients. J Gen Intern Med. 1990;5:415–20.CrossRefPubMedGoogle Scholar
  7. 7.
    Moulmein JR, Caracas’s GJ. Evaluating the interview performance of internal medicine interns. Accad Med. 1989;64:277–9.CrossRefGoogle Scholar
  8. 8.
    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288:1775–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002;288:1909–14.CrossRefPubMedGoogle Scholar
  10. 10.
    Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288:2469–75.CrossRefPubMedGoogle Scholar
  11. 11.
    Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26:1–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH. Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med. 2004;164:1641–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Dennis SM, Zwar N, Griffiths R, et al. Chronic disease management in primary care: from evidence to policy. Med J Aust. 2008;188(8 Suppl):S53–6.PubMedGoogle Scholar
  14. 14.
    Bodenheimer T, MacGregor K, Shafiri C. Helping Patients Manage Their Chronic Conditions. California HealthCare Foundation; 2005.Google Scholar
  15. 15.
    Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. New York: Guilford Press; 2002.Google Scholar
  16. 16.
    Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71:843–61.CrossRefPubMedGoogle Scholar
  17. 17.
    Martins RK, McNeil DW. Review of motivational interviewing in promoting health behaviors. Clin Psychol Rev. 2009;29:283–93.CrossRefPubMedGoogle Scholar
  18. 18.
    Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55:305–12.PubMedGoogle Scholar
  19. 19.
    MI Bibliography 1983–2009. Available at: Accessed Sept 27, 2009.
  20. 20.
    Rollnick S, Miller WM, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Press; 2008.Google Scholar
  21. 21.
    Rollnick S, Mason P, Butler C. Health Behavior Change: A Guide for Practitioners. Edinburgh: Churchill Livingstone; 1999.Google Scholar
  22. 22.
    Bell K, Cole BA. Improving medical students' success in promoting health behavior change: a curriculum evaluation. J Gen Intern Med. 2008;23:1503–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Poirier MK, Clark MM, Cerhan JH, Pruthi S, Geda YE, Dale LC. Teaching motivational interviewing to first-year medical students to improve counseling skills in health behavior change. Mayo Clin Proc. 2004;79:327–31.CrossRefPubMedGoogle Scholar
  24. 24.
    Rubak S, Sandbaek A, Lauritzen T, Borch-Johnsen K, Christensen B. General practitioners trained in motivational interviewing can positively affect the attitude to behaviour change in people with type 2 diabetes. one year follow-up of an RCT, ADDITION Denmark. Scand J Prim Health Care. 2009;27(3):172–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Scal P, Hennrikus D, Ehrlich L, Ireland M, Borowsky I. Preparing residents to counsel about smoking. Clin Pediatr Phila. 2004;43:703–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Thijs GA. GP's consult and health behaviour change project. Developing a programme to train GPs in communication skills to achieve lifestyle improvements. Patient Educ Couns. 2007;67:267–71.CrossRefPubMedGoogle Scholar
  27. 27.
    White LL, Gazewood JD, Mounsey AL. Teaching students behavior change skills: description and assessment of a new Motivational interviewing curriculum. Med Teach. 2007;29:67–71.CrossRefGoogle Scholar
  28. 28.
    Deming WE. The New Economics for Industry, Government and Education. 2nd ed. Cambridge, MA: MIT Press; 2000.Google Scholar
  29. 29.
    Institute for Healthcare Improvement. Testing Changes. Accessed May 26, 2010.
  30. 30.
    Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol Sep. 1992;47(9):1102–14.CrossRefGoogle Scholar
  31. 31.
    Verheijden MW, Bakx JC, Delemarre IC, et al. GPs' assessment of patients' readiness to change diet, activity and smoking. Br J Gen Pract. 2005;55:452–7.PubMedGoogle Scholar
  32. 32.
    Stott NC, Rees M, Rollnick S, Pill RM, Hackett P. Professional responses to innovation in clinical method: diabetes care and negotiating skills. Patient Educ Couns. 1996;29:67–73.CrossRefPubMedGoogle Scholar
  33. 33.
    Laing B, Ward L, Yeh T, Chen E, Bodenheimer T. Introducing the “Teamlet”: initiating a Primary Care Innovation at San Francisco General Hospital. Perm J. 2008;12:4–9.Google Scholar
  34. 34.
    Bodenheimer T, Laing B. The teamlet model of primary care. Ann Fam Med. 2007;5:457–61.CrossRefPubMedGoogle Scholar
  35. 35.
    Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care. 2005;43:436–44.CrossRefPubMedGoogle Scholar
  36. 36.
    Emmons KM, Rollnick S. Interviewing in health care settings. Opportunities and limitations. Am J Prev Med. 2001;20:68–74.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Sharone A. Abramowitz
    • 1
    • 3
    Email author
  • Davida Flattery
    • 1
    • 3
  • Karena Franses
    • 2
  • Lyn Berry
    • 1
    • 3
  1. 1.Primary Care Internal MedicineAlameda County Medical Center, Highland HospitalOaklandUSA
  2. 2.Positive Health Program (AIDS & AIDS Specialties) San Francisco General HospitalUniversity of California San FranciscoSan FranciscoUSA
  3. 3.University of California San FranciscoSan FranciscoUSA

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