Healthy Discussions for Physiotherapy

Module overview

The success of physiotherapy treatment is often influenced by the degree to which patients engage with it and adhere to recommended behavioural changes. This usually requires a high degree of effort and motivation on the part of the patient and poor adherence is common. A key task for physiotherapists therefore, is enhancing motivation for behaviour change. Traditional approaches to promoting change involve the provision of ‘expert advice’. Whilst this can work some of the time, particularly for acute problems, not all patients are ready, willing or confident in their ability to change and may not be receptive to it (Rollnick, Miller & Butler 2023). Conversations can therefore easily descend into dysfunctional dialogue which can be frustrating for both physiotherapist and patient. Healthy discussions will teach students how to have constructive, meaningful conversations about change, ultimately leading to better patient outcomes. The module draws heavily on motivational interviewing (MI) as a method for guiding these challenging conversations. Students will also learn how the skills and ‘way of being’ that is central to MI may be used to complete the other aspects of their clinical practice.

Syllabus

The main focus of Healthy discussions is having constructive and meaningful conversations with patients about engagement with therapy and sustained behaviour change. We will draw on the method of motivational interviewing to guide practice. The content covered is as follows: - Why do patients resist our good advice? - Underlying style, tasks and principles of helpful conversations - A helpful mindset – attitudes, beliefs and assumptions that underpin helpful conversations - Core micro-skills that underpin conversations about change – open-ended questions, affirmations, reflective listening and summarising. - Giving advice - blending your own expertise with the patient’s own insights and wisdom - Getting started with conversations about change - Evoking the patient's own motivations for change (recognising, eliciting and strengthening change talk) - Building confidence when patients doubt their abilities to change - Responding to arguments against change (sustain talk) and tension within the relationship (discord) - Developing a plan that patients commit to (exploring change expectations, outcome expectations, behavioural plan including relapse prevention, strengthening commitment). Another key focus of the module is to help learners see how components of motivational interviewing (specific skills/style of working) may be helpful in broader clinical practice, that is beyond conversations about change. Examples include: - Raising difficult subjects - Empathic listening when patients express anger or are distressed after receiving bad news - Building engagement whilst gathering information as part of a subjective ‘assessment’ - Summarising to show understanding and to reinforce key points about what matters most - Sensitively refocusing a conversation when patients digress without being rude or disruptive - Identifying what matters most to patients and helping them to identify realistic goals they are committed to

Learning and Teaching

Teaching and learning methods

MI is a talking intervention, and as such, the emphasis of the module is 'learning through doing', which means a focus on purposeful practice, coaching and feedback, and reflection. Included teaching and learning methods are: - Short lectures - Video analysis - Experiential and skills building exercises with opportunities for feedback and coaching - Simulation: Pre module as an engagement exercise; Tag team/team consult for skill development through the module - Blackboard based directed study tasks (video response exercises, skills-building exercises, quizzes and personal learning journal reflections) - Assessment briefing Simulations are used prior to the taught component of the module to promote engagement and at strategic points through the module for skill development. Another key aspect is the use of a ‘parallel process’, whereby the same supportive, non-judgmental interpersonal style that underpins MI is used to teach and coach students. This enhances leaning as students experience MI on a personal level. The non-judgmental tone also encourages them to be open and honest about the difficulties they are experiencing and motivates them to experiment with new skills despite feeling awkward. This supportive, encouraging environment also leads to students persisting in the face of difficulties.

Study time
Type	Hours
Guided independent study	119
Seminar	10
Practical classes and workshops	20
Completion of assessment task	1
Total study time	150

Resources & Reading list

Textbooks

Rollnick, S., Miller, W.R. & Butler, C (2023). Motivational interviewing in healthcare: Helping patients change behaviour. New York: Guilford.

Miller, W.R. (2018). Listening well: The art of empathic understanding. Eugene: Wipf and Stock .

Miller, W.R. & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow. New York: Guilford.

Assessment

Formative

This is how we’ll give you feedback as you are learning. It is not a formal test or exam.

Simulation

Assessment Type: Formative
Feedback: Facilitated verbal peer feedback
Final Assessment:
Group Work: No

Summative

This is how we’ll formally assess what you have learned in this module.

Breakdown
Method	Percentage contribution
Simulated Examination	100%

Referral

This is how we’ll assess you if you don’t meet the criteria to pass this module.

Breakdown
Method	Percentage contribution
Simulated Examination	100%

Repeat Information

Repeat type: External