目的：探讨针对医学实习生开展“动机性访谈（motivational interviewing，MI）”课程的必要性和效果。方法以帮助冠心病患者戒烟为预设目标，采用理论讲座、知识测验、小组讨论和角色扮演摄像记录相结合的教学方式，教授学生MI的基本知识和技巧，帮助学生应用MI劝诫冠心病标准化病人戒烟。通过分析学生对标准化病人的访谈摄像记录，应用“动机性访谈整合性量表（motivational interviewing treatment integrity，MITI）”评估教学效果。通过问卷调查学生对MI课程质量和有效性的看法。采用SPSS 13.0对计量资料行t检验。结果 MITI评估结果显示，学生对MI课程知识有一定掌握，但未达到量表推荐的专业化熟练水平。“整体评估”中的“共情和MI理念”分数分别为（4.11±0.32）和（5.82±0.17）（推荐水平6分）。“行为计数”评估显示，学生遵从MI理念的行为占（70.96%±24.34%）（推荐水平90%），开放性问题的使用率为（31.42%±8.51%）（推荐水平70%），学生对病人的平均总体反馈为（7.84±3.22）次（推荐水平10次/全程）。访谈中学生对推荐的行为转变标准化问题应用良好，93.75%和87.50%的学生使用了戒烟重要性和自信心的量化评估问题，但对深层次原因探究不足。问卷调查显示，83.33%的学生认为MI课程学习对自身有帮助，能够增强与患者交流的自信心和技巧；97.91%的学生认为掌握MI方法是内科医生必备的重要技能。结论针对医学生开展MI课程是必要和可行的；现行MI教学良好效果；MI在指导不健康行为转变中具有重要价值。%Objective To explore the necessity and effect of the "motivational interviewing/MI"curriculum in medical school students. Methods Helping smoking cessation in standard patients with coronary heart disease was assumed as the expected goal. MI was carried out for medical school students to master basal knowledge and skills of MI and help using MI methods in persuading smoking quitting. The teaching mode of MI curriculum was comprised of a lecture series and small group dis-cussion with videotaped practice in role plays. Motivational Interviewing Treatment Integrity (MITI) scoring tool was applied to assess the teaching effect of MI curriculum with students' performance videotapes. Questionnaire was used to evaluate the quality and efficacy of the MI curriculum, and SPSS 13.0 was used to t test measurement data. Results Analysis of the MITI scores showed students had general mastery of MI knowledge. Nevertheless, they did not reach recommended professional profi-ciency level. The scores of "empathy and MI spirit" in global ratings were (4.11 ±0.32) and (5.82 ± 0.17), respectively (recommended level, 6 score). In the videotape evaluation of "behavior counts", "MI adherent"reached (70.96%±24.34%) (recommended level, 90%). Open question reached (31.42%±8.51%) (recommended level, 70%). Total refection counts were (7.84±3.22) counts per video (recom-mended level, 10). The standard questions recommended in MI for behavior change were better used by students. 93.75%and 87.50%students used ranking questions to evaluate the importance and con-fidence of smoking quitting. Nevertheless, the exploration questions about importance and confidence were less used to know the reason behind their ranking . The results of questionnaire showed that 83.33%students felt MI curriculum effective to help them improve confidence and skills in counseling with patients. 97.91%students thought the mastery of MI methods as an important skill for physicians to have. Conclusion The teaching practice of MI curriculum in medical school students is necessary and feasible with good teaching results. It is worth for professional counseling regarding unhealthy be-havior change in patients.
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