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Objective: To develop an observational coding instrument for evaluating the fidelity and quality of brief behavioral change interventions based on the behavioral theories of the 5 A's, Stages of Change and Motivational Interviewing. Methods: Content and face validity were assessed prior to an intervention where psychometric properties were evaluated with a prospective cohort of 116 medical students. Properties assessed included the inter-rater reliability of the instrument, internal consistency of the full scale and sub-scales and descriptive statistics of the instrument. Construct validity was assessed based on student's scores. Results: Inter-rater reliability for the instrument was 0.82 (intraclass correlation). Internal consistency for the full scale was 0.70 (KR20). Internal consistencies for the sub-scales were as follows: MI intervention component (KR20=.7); stage-appropriate MI-based intervention (KR20=.55); MI spirit (KR20=.5); appropriate assessment (KR20=.45) and appropriate assisting (KR20=.56). Conclusions: The instrument demonstrated good inter-rater reliability and moderate overall internal consistency when used to assess performing brief behavioral change interventions by medical students. Practice implications: This practical instrument can be used with minimal training and demonstrates promising psychometric properties when evaluated with medical students counseling standardized patients. Further testing is required to evaluate its usefulness in clinical settings. [Copyright &y& Elsevier]

Background and Objectives: There is little research on training medical students in smoking cessation counseling (SCC). This study aimed to determine if a personal digital assistant (PDA)-based SCC tool can improve medical student SCC., Methods: We conducted a randomized, controlled trial with third-year medical students. SCC behaviors, comfort, and knowledge were assessed using a validated survey before students attended a workshop on SCC. Student groups were then randomized to receive a paper-based reminder tool or the reminder plus a PDA-based SCC tool. The validated survey was repeated upon clerkship completion, and a videotaped standardized patient interview was assessed by trained reviewers using a 24-item SCC checklist. Focus groups assessed satisfaction with the PDA tool, usability, and barriers to use., Results: SCC behaviors, knowledge, and comfort increased among all participants, with no statistical differences between groups. The PDA tool group performed 62% of key SCC activities during the videotaped interview, while the control group performed 69%. Students reported discomfort using the PDA with patients, lack of time, and lack of training as barriers to use of the tool., Conclusions: We demonstrated improvement of SCC skills by third-year medical students using a workshop combined with a supplemental reference tool. However, a PDA-based tool did not increase key SCC behaviors compared with a paper-based reminder. For a PDA intervention to be effective in this setting, the tool must be simplified and additional training provided.