Motivational Interviewing for Smoking Cessation CME: Event One

"Opening Night" Event #1 of the CS2Day CME Program

Last night was the first of our three-event, Smoking Cessation Continuing Medical Education (CME) workshop program in the virtual world of Second Life.  The program is sponsored by Cease Smoking Today (CS2Day), an educational collaborative made up of nine partner organizations. Intended for healthcare professionals (family medicine doctors, nurse practitioners, etc), this CME program focuses on the technique of motivational interviewing to help HCPs help their patients to stop smoking.

The in-world events, which began last night, will take place on three successive Wednesday evenings (May 18, 25, and June 1).  At last night’s kick-off event, our participants were given an overview of the Motivational Interviewing (MI) technique from the workshop’s facilitators, Dr. Jay Lee and Dr. Suzanne Mitchell.  There were 34 attendees at the session coming into the virtual world from all over the United States (with one attendee from Indonesia, where it was 5:00 a.m.!).  The overview focused on the MI skills of rolling with resistance, expressing empathy, avoiding argumentation, developing discrepancy, and supporting self efficacy.  You can view the session slides here.

How many cigarettes in a year? (effect by Electric Pixels)

Our facilitators enlivened their talk with a few intriguing, virtual world special effects.  In this photo you can see Jay Lee demonstrating how many cigarettes a smoker with a pack-a-day habit would smoke in one year.

Issue and relational resistance. (effect by Mel Primswitch)

And in this photo you can see Suzanne Mitchell demonstrating the significance and impact of issue and relational resistance.  These unique effects demonstrate the high visual impact offered by the virtual world  – seeing what you might only imagine in your mind’s eye as a metaphor or an explanation.

In addition to the special effects, Suzanne and Jay used the local chat function to full advantage. Throughout their talk, they posed questions to the audience, asking them to type their answers in local chat. The HCPs quickly caught onto the value of the local chat stream, not only giving feedback to the speakers but commenting on each other’s thoughts and opinions.

Here is a typical local-chat exchange, excerpted from the transcript, in response to Suzanne giving them a patient scenario (smoking patient with high blood pressure who feels good and doesn’t think their smoking is a problem) and asking them for their thoughts – what questions would they ask this patient:

[17:34] Bronxdoc: It great that you feel good. Do you have any concerns about smoking?

[17:34] rwmorrowmd: what’s your favorite part of smoking?

[17:34] Abigail Mhia: Sounds like your health has been good

[17:34] Mona Willful: well that’s great that you feel fine, but what are your concerns about smoking

[17:35] jbrow0: you have not felt health effects from your smoking yet?

[17:35] Mar Scientist: I undersatnd you feel fine, but do you have … shortness of breath? does your family complain about your smoking?

[17:35] Boggsly: where do you see yourself in 5 years in regard to smoking?

[17:35] Mona Willful: It seems like he’s scared of something and not telling me, I want to dig into that

[17:35] jbrow0: just restating; not meant in ominouis tone

[17:36] jbrow0: you feel ok; no problems now

[17:39] Mona Willful: I see that this pt is very scared, and is in ambivalence. This is good for change

[17:40] rwmorrowmd: yes

[17:41] ttran72: what have you tried….

[17:41] RadhaLew: So on one hand you see some value in quitting but it sounds like you have a lot of stress in your life right now

[17:41] Bronxdoc: sounds like you would like to quit smoking but you feel that there are benefits as well

[17:41] rwmorrowmd: yes, it’s hard

[17:41] Boggsly: how important is it for you to try to quit right now?

[17:41] Mar Scientist: beating themselves up because they’ve not been successful;

[17:41] ttran72: maybe we can look at those failures and turn them into success by working together

[17:41] familydocwonk: you seem stressed about quitting smoking yet feel that smoking helps relieve your stress

[17:41] jbrow0: quitting smoking is important to you, but you are worried it might increase your stress levels

[17:41] Mona Willful: so you have tried quitting. What are some things you’ve tried? Are there any other things to lower your stress?

[17:41] Abigail Mhia: so on one hand, you feel smoking helps manage stress, but on the other, you see that quitting smoking is something you would like to do.

[17:44] Mona Willful: empathy, rolling with some resistance, support is definitely there

As you can see, the local chat is a great way to get a bead on audience-thinking, find out what they know, and allow everyone to “hear” each other.  It also becomes a permanent record of the exchange – and there was no problem getting these HCPs to contribute!

Although the overall event went very smoothly we, of course, experienced some technical problems.  For the most part, our attendees were brand new to Second Life and had no formal training in advance of the event. Though we had set up a tutorial web site for them, as busy professionals, most of them did not have time to get up to speed in advance. Anticipating this, we had the absolute best in the business on hand to triage and solve anyone’s challenges – Janalee Redmond (SL=Jennette Forager) and Liz Dorland (SL=Chimera Cosmos). And here, sporting our spiffy CS2Day team t-shirts is our fearless crew:

Left to right: Chimera Cosmos, Spiral Theas, Jenn Forager, Cynthia Kear, and Neil Lastchance.

Here were the most commonly encountered technical issues:

– Basic/Advanced Mode.  The latest version of the SL viewer has a toggle option for “Basic” and “Advanced” modes on the log-in screen.  The Basic mode, which gives limited functionality, is the default.  We needed our avatars in Advanced  mode so that they could hear, control the volume, change their view, etc.  Our most commonly encountered technical issue was “I can’t hear.” and it was typically solved by asking them to re-log and change to “Advanced” mode.

– Invisible Avatar.  We had one participant who could not get his avatar to completely appear.  He was showing up as hair and a pair of shoes only. It was comical to see, but I’m sure, not very fun for him.  Turns out it was the “two monitor problem”.  Once we had him shut down his second monitor, he rezzed in full form.

– Getting messages to new avatars.  As the session began and participant’s needed to solve technical issues (sound problems, view problems) it was difficult to get them to transfer the conversation around their problem from local chat to the less-intrusive IM (instant message)/private chat.  In hindsight, we should have done a mini tutorial on how to send and respond to IMs at the beginning of the event.

In addition to those technical matters, there were a few instructional design items that worked well, in addition to some changes that, in hindsight, we’d make to the instructional design:

– Alter the Landing Point.  All participants were given a SLurl to a landing point just behind the main venue.  We had thought that this would be an unobtrusive point to first appear and had a greeter stationed there to meet the HCPs as they arrived and guide them to the main stage.  Unfortunately, many of them took off running or flying as soon as they arrived.  Not knowing about the map function, they just headed off in any old direction, seeking out their colleagues.  Our poor greeter had to run laps to keep up with them, get their attention and direct them to the location.  It might have been better to position the landing point right near the seating area.

– Instructional Time.  Knowing that our participants were all busy professionals and most likely would not have the time to get up to speed on Second Life, we should have taken a little time at the front-end of the session to show them a few basics.

– Second Life Etiquette.  We spent a bit of time at start of the session, reviewing “SL-etiquette” (try to resist playing with the gestures during the talk, encourage them to use local chat to give feedback and comments) but we could have gone into more detail on this (maybe with some helpful visuals?).

– Technical Help by Color Group.  We divided the participants into two groups (red and blue) and indicated their group membership with color-coded signs.  Jenn and Chimera were each assigned to a group so that they were only (ha!) responsible for the technical issues in that group.  This streamlined the technical support and each HCP knew who to go to for help.

Red and blue signs indicated group assignments

It was a terrific event – great job on the part of the presenters, fulsome participation on the part of all the HCPs, and heroic efforts on the part of the technical crew.  Huzzah!!  And now, onto events 2 and 3 where the HCPs will do role-plays (wth standardized patients) which the amazing Ariella Furman and her crew will video record for evaluation and comment.  Can’t wait to see those!


Filed under Teaching with Technology, Virtual Worlds

4 responses to “Motivational Interviewing for Smoking Cessation CME: Event One

  1. Great writeup! It was stressful at times, but overall went very smoothly. Much fun was had by all. 🙂

    Liz D. / Chimera Cosmos

  2. Pingback: Event #2: Motivational Interviewing for Smoking Cessation in Second Life | Stepping Stones

  3. Pingback: It’s a Wrap! | Stepping Stones

  4. Pingback: Summing it Up with Video | Stepping Stones

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