The Appeal of Medical Quackery: A Rhetorical Analysis

Medical quackery has been a pressing issue nearly from the start of the medical profession - whether the nostrums and patent medications of old or the super-foods and miracle supplements of today. Throughout history and into the modern day, the medical establishment has tried to counteract the claims of charlatans in order to protect patients from potentially harmful treatments. Countering today\u27s pseudo-medicine begins with an examination of what makes patients susceptible to the claims of quack medicine. Understanding why patients are susceptible to dubious health claims begins with an examination of the rhetoric used to persuade a demographic toward alternative therapies. This knowledge can then be used to educate patients, and to better demonstrate the benefits of evidence-based medicine while improving patient interactions

Effectiveness of Student Facilitation in Motivational Interviewing Education

Objectives: To determine the impact of student or faculty facilitation on student (1)self-assessed attitudes, confidence, and competence in motivational interviewing (MI) skills, (2)actual competence, and (3)evaluation of facilitator performance. Method: Pharmacy students are often utilized in educational settings to facilitate or assist with courses, but little is known how this impacts outcomes. Four third-year pharmacy students underwent a two-day MI training course as well as small group facilitation training. After IRB approval, second-year pharmacy (P2) students in a Cardiology Module were randomly assigned to a student- or faculty-facilitator for practicing MI skills in small groups over 4 hours. Then, P2s participated in a simulated patient encounter where they had to utilize MI and assessed with the MITI (modified). P2s completed a pre-post, 6-point, Likert-type survey assessing their attitudes and perceived competence (4 and 12 items, agreement), confidence (18 items), and facilitator performance (12 items, post-test only, quality). Differences between student and faculty facilitators were assessed using a Mann-Whitney-U test. Results: Of the 44 P2s (100% response rate), there were no significant differences in (1) attitudes, confidence, or competence, (2)actual competence, and (3)evaluations of facilitator performance between faculty- and student-facilitated groups post-experience (p\u3e0.05). Implications: The use of upper-level pharmacy students as small group facilitators did not impact student perceived and actual performance; they were viewed as equally favorable as faculty members. By using pharmacy students as facilitators, it can lessen faculty workload and provide an outlet for students to develop communication and facilitation skills that will be needed in future practice

Effectiveness of Student Facilitation in Motivational Interviewing Education

Objectives: To determine the impact of student or faculty facilitation on student (1)self-assessed attitudes, confidence, and competence in motivational interviewing (MI) skills, (2)actual competence, and (3)evaluation of facilitator performance. Method: Pharmacy students are often utilized in educational settings to facilitate or assist with courses, but little is known how this impacts outcomes. Four third-year pharmacy students underwent a two-day MI training course as well as small group facilitation training. After IRB approval, second-year pharmacy (P2) students in a Cardiology Module were randomly assigned to a student- or faculty-facilitator for practicing MI skills in small groups over 4 hours. Then, P2s participated in a simulated patient encounter where they had to utilize MI and assessed with the MITI (modified). P2s completed a pre-post, 6-point, Likert-type survey assessing their attitudes and perceived competence (4 and 12 items, agreement), confidence (18 items), and facilitator performance (12 items, post-test only, quality). Differences between student and faculty facilitators were assessed using a Mann-Whitney-U test. Results: Of the 44 P2s (100% response rate), there were no significant differences in (1) attitudes, confidence, or competence, (2)actual competence, and (3)evaluations of facilitator performance between faculty- and student-facilitated groups post-experience (p\u3e0.05). Implications: The use of upper-level pharmacy students as small group facilitators did not impact student perceived and actual performance; they were viewed as equally favorable as faculty members. By using pharmacy students as facilitators, it can lessen faculty workload and provide an outlet for students to develop communication and facilitation skills that will be needed in future practice

Student Self-assessment of Motivational Interviewing Skills

Objectives: ACPE standards emphasize developing student ability to accurately self-examine knowledge and skills. This study aimed to determine if students accurately assess motivational interviewing (MI) skills by comparing student 1) perceived baseline competence before and after educational sessions, and 2) self-assessment and faculty evaluation of MI skills. Method: During a secondyear Cardiology module, students reviewed MI concepts previously introduced, practiced skills with a trained facilitator, and completed a videotaped standardized patient encounter. A pre- and retrospective post-test survey (13 items, 6 point Likert-type, agreement) assessed student-perceived ease of performing MI skills. Students and faculty evaluated the videotaped encounter using the modified Motivational Interviewing Treatment Integrity (mMITI) instrument. Students were divided into quartiles based on overall faculty mMITI score. Data was analyzed usingWilcoxon signed-rank test and Spearman’s correlation, as appropriate. Results: Students’ (N532, 100% response rate) retrospective assessment significantly declined on 5 items (showing interest p50.007, reflective listening p50.030, permission to share p50.011, patient control p50.002, and open-ended questions p50.001). Students in the upper quartile rated themselves significantly lower on mMITI total score (p50.024) and the empathy/understanding subscale (p50.026). The lower quartile rated themselves significantly higher on every mMITI measure (Total: p50.012, Empathy/Understanding: American Journal of Pharmaceutical Education 2016; 80 (5) Article S2. 109 p50.033, Spirit and MI Adherence: p50.024) except the open-ended questions subscale. Implications: Pharmacy students may have dif- ficulty self-assessing their MI skills. Students with better skills viewed themselves as less competent than faculty did, whereas students with poorer skills viewed themselves as more MI competent than they actually were. This suggests that self-assessment training should be improve

The Impact of Small Group Facilitation on Student Confidence in Motivational Interviewing Skills

Objectives: To determine if facilitating small group sessions impacts student facilitator confidence in utilizing motivational interviewing (MI) skills and perceived skills. Method: Pharmacy students are often utilized in educational settings to facilitate or assist with courses, but little is known how this impacts outcomes. Six P3 students underwent a two-day MI training course as well as small group facilitation training. After IRB approval, the students were randomly assigned to a small group of P2 pharmacy students in a Cardiology Module and asked to facilitate practice of MI skills over 4 hours. The student facilitators completed a pre-post instrument, which contained 6-point, Likert-type items assessing their confidence (19-items) and perceived (13-items) MI skills. Differences between pre- and post-surveys were assessed using a Wilcoxon test. Results: There were significant increases in facilitator confidence in using silence (p50.038), eliciting change talk (p50.039), helping patients set achievable goals (p50.023), assessing readiness to change (p50.014), and confidence in using MI skills in a case scenario involving hypertension (p50.039). Additionally, there was a statistically significant increase in facilitator assessed ability to use reflective listening (p50.046) and summarize what patients are saying (p50.038). The remaining 25 survey items showed no change between pre-and post-survey. Implications: Participation as a facilitator has a positive impact on student confidence and ability to use some aspects of MI skills. By using pharmacy students as facilitators, it can provide an outlet for students to develop communication and facilitation skills that will be needed in future practice

Impact of Small-Group Sessions on Motivational Interviewing Outcomes

Objectives: To assess the impact of integrating motivational interviewing (MI) training on student (1) attitudes, confidence, and perceived competence and (2) measured competence. Method: MI is a patient-centered approach that facilitates communication and health behavior change, essential skills for pharmacy practice. Students were introduced to MI during year 1 and reinforced in a second-year Cardiology module. IRB approval was obtained; students were broken into small groups (5-6 students) and for 4 hours to practice MI skills with a trained facilitator. Students then were assessed in a simulated MI patient encounter using the MITI (modified). Students completed a pre-post survey assessing their attitudes and perceived competence (4 items and 12 items, 6-point Likert-type, Strongly Disagree to Strongly Agree) and confidence (18 questions, 6-point Likert-type, Very Unconfident to Very Confident). The post-survey also contained retrospective pre-test items (i.e., before Cardiology, how confident ...). Changes were assessed using a Wilcoxon signed-rank test. Results: Students’ (N 5 44, 100% response rate) pre-post attitudes toward MI significantly improved on 1 item (effectiveness of MI in eliciting behavior changes, p 5 0.024), confidence on 9 items (p,0.05), and perceived competence on 3 items (p,0.05). Retrospective pre-post changes significantly improved on 3 attitude, all confidence, and 9 perceived competence items. The median MITI score was 22.5 (maximum 5 30). Implications: Incorporating additional content on MI was beneficial in reinforcing and improving student perceptions of their MI skills. However, pharmacy students believed that they were more competent in MI prior to the reinforcement than they actually were, indicating the importance of reinforcing curricular content

Qualitative Analysis of Motivational Interviewing Outcomes After Small Group Sessions

Objectives: To qualitatively describe student perceptions of small group motivational interviewing (MI) training facilitated by either faculty or students. Method: Patient counseling skills are becoming increasingly important for pharmacists, and MI can be effective in promoting positive and reducing maladaptive health behaviors. Second-year professional pharmacy students (N 5 44) engaged in small group MI educational sessions facilitated by a trained third-year pharmacy student or faculty member. Students (N 5 9, 7 from student-facilitated 2 from faculty-facilitated) were randomly selected to participate in a focus group session regarding their experience. Guiding questions were created for the session after an extensive review of the literature and discussion amongst researchers. Follow-up questions were asked based on participant responses. Discussions were moderated by trained research assistants who took notes and recorded the sessions using LiveScribe pens. Data were transcribed verbatim, and QSR NVivo 10 was used to perform content analysis and identify grounded themes in student responses. Results: Predominant themes that emerged included: MI seemed more accessible, providing feedback to peers reinforced their own knowledge, and small groups provided a more open environment to make mistakes. Students also reported that MI techniques still felt somewhat unnatural, they were unsure how to practically fit MI into practice, and that they would like to self-evaluate footage of themselves participating in an MI interview. Implications: This research suggests that peer review focused, small group settings can increase student confidence in MI and health behavior change counseling skills, but work is still needed to reinforce the utility of MI in practice

Impact of Small-Group Sessions on Motivational Interviewing Outcomes

Objectives: To assess the impact of integrating motivational interviewing (MI) training on student (1) attitudes, confidence, and perceived competence and (2) measured competence. Method: MI is a patient-centered approach that facilitates communication and health behavior change, essential skills for pharmacy practice. Students were introduced to MI during year 1 and reinforced in a second-year Cardiology module. IRB approval was obtained; students were broken into small groups (5-6 students) and for 4 hours to practice MI skills with a trained facilitator. Students then were assessed in a simulated MI patient encounter using the MITI (modified). Students completed a pre-post survey assessing their attitudes and perceived competence (4 items and 12 items, 6-point Likert-type, Strongly Disagree to Strongly Agree) and confidence (18 questions, 6-point Likert-type, Very Unconfident to Very Confident). The post-survey also contained retrospective pre-test items (i.e., before Cardiology, how confident ...). Changes were assessed using a Wilcoxon signed-rank test. Results: Students’ (N 5 44, 100% response rate) pre-post attitudes toward MI significantly improved on 1 item (effectiveness of MI in eliciting behavior changes, p 5 0.024), confidence on 9 items (p,0.05), and perceived competence on 3 items (p,0.05). Retrospective pre-post changes significantly improved on 3 attitude, all confidence, and 9 perceived competence items. The median MITI score was 22.5 (maximum 5 30). Implications: Incorporating additional content on MI was beneficial in reinforcing and improving student perceptions of their MI skills. However, pharmacy students believed that they were more competent in MI prior to the reinforcement than they actually were, indicating the importance of reinforcing curricular content