Original Publication
Open Access

Small Changes Counseling

Published: February 13, 2014 | 10.15766/mep_2374-8265.9702

Included in this publication:

  • Instructor's Guide.docx
  • SCC Lab Patient-Centered Counseling.doc
  • SCC Model (Instructor).doc
  • SCC Model (Student).doc
  • SCC Pre-Lab Worksheet Principles of MI.doc

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Introduction: The Small Changes Counseling (SCC) curriculum is an educational module designed to enhance the health coaching ability of first- and second-year medical students. This module first teaches the principles of motivational interviewing (MI) before applying these skills to advise weight loss in a structured framework. This curriculum is minimal and efficiently covers key concepts necessary to advise behavioral modification. Methods: The curriculum is administered in two phases. The first contains a series of self-instructed didactics where students learn the concepts of MI and a conversational model for counseling weight loss. The second phase involves a two-part practice counseling exercise. Students pair up to practice communication skills, then take turns counseling the facilitator, who plays the role of an overweight patient considering a lifestyle alteration. Results: We performed a research study to assess the reception of the curriculum at Chicago Medical School at Rosalind Franklin University of Medicine & Science. The counseling exercise significantly affected the students’ perspective of MI (p < .001) and counseling skills (p < .05). Additionally, 86.59% of the students recommended the inclusion of the SCC lab in future years. Fourth-year medical students and physicians who facilitated the mock counseling exercise unanimously supported the inclusion of SCC. Discussion: These materials give students the important background on the topics of MI and weight loss behavioral counseling. What students discover in the counseling exercise, however, is that despite their best intentions, they often find themselves defaulting to directing patients as opposed to guiding. It is a useful teachable moment, as students become aware of their intrinsic desire to fix in their efforts to help. This humbling moment illustrates the subtle difficulty in becoming a skilled counselor.

Educational Objectives

By the end of this session, learners will be able to:

  1. Recognize and describe the motivational interviewing techniques described by the acronyms RULE (avoiding the Righting reflex, Understanding the patient’s behavior, Listening with increased empathy, Empowering the patient) and OARS (open-ended questions, affirmations, reflective listening, summarizing your joint plan).
  2. Apply the concepts covered in OARS and RULE in the practice counseling exercise.
  3. Demonstrate knowledge of the weight loss advising framework in the exercise.
  4. Recall the suggested small changes modifications in the exercise.

Author Information

  • William Billich, MS: Chicago Medical School at Rosalind Franklin University of Medicine & Science
  • Igor Bussel: Rosalind Franklin University of Medicine and Science
  • Jeffery Felgner: Rosalind Franklin University of Medicine and Science
  • Daniela Berger: Rosalind Franklin University of Medicine and Science
  • Sweta Narasimhan: Rosalind Franklin University of Medicine and Science
  • Cathy Lazarus: Rosalind Franklin University of Medicine and Science

None to report.

None to report.


Billich W, Bussel I, Felgner J, Berger D, Narasimhan S, Lazarus C. Small changes counseling. MedEdPORTAL. 2014;10:9702. https://doi.org/10.15766/mep_2374-8265.9702