Teaching Medical Students to Help Patients Quit Smoking: Outcomes of a 10-School Randomized Controlled Trial

Judith K. Ockene, Rashelle B. Hayes, Linda C. Churchill, Sybil L. Crawford, Denise G. Jolicoeur, David M. Murray, Abigail B. Shoben, Sean P. David, Kristi J. Ferguson, Kathryn N. Huggett, Michael Adams, Catherine A. Okuliar, Robin L. Gross, Pat F. Bass, Ruth B. Greenberg, Frank T. Leone, Kola S. Okuyemi, David W. Rudy, Jonathan B. Waugh, Alan C. Geller

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Background: Early in medical education, physicians must develop competencies needed for tobacco dependence treatment. Objective: To assess the effect of a multi-modal tobacco dependence treatment curriculum on medical students’ counseling skills. Design: A group-randomized controlled trial (2010–2014) included ten U.S. medical schools that were randomized to receive either multi-modal tobacco treatment education (MME) or traditional tobacco treatment education (TE). Setting/Participants: Students from the classes of 2012 and 2014 at ten medical schools participated. Students from the class of 2012 (N = 1345) completed objective structured clinical examinations (OSCEs), and 50 % (N = 660) were randomly selected for pre-intervention evaluation. A total of 72.9 % of eligible students (N = 1096) from the class of 2014 completed an OSCE and 69.7 % (N = 1047) completed pre and post surveys. Interventions: The MME included a Web-based course, a role-play classroom demonstration, and a clerkship booster session. Clerkship preceptors in MME schools participated in an academic detailing module and were encouraged to be role models for third-year students. Measurements: The primary outcome was student tobacco treatment skills using the 5As measured by an objective structured clinical examination (OSCE) scored on a 33-item behavior checklist. Secondary outcomes were student self-reported skills for performing 5As and pharmacotherapy counseling. Results: Although the difference was not statistically significant, MME students completed more tobacco counseling behaviors on the OSCE checklist (mean 8.7 [SE 0.6] vs. mean 8.0 [SE 0.6], p = 0.52) than TE students. Several of the individual Assist and Arrange items were significantly more likely to have been completed by MME students, including suggesting behavioral strategies (11.8 % vs. 4.5 %, p < 0.001) and providing information regarding quitline (21.0 % vs. 3.8 %, p < 0.001). MME students reported higher self-efficacy for Assist, Arrange, and Pharmacotherapy counseling items (ps ≤0.05). Limitations: Inclusion of only ten schools limits generalizability. Conclusions: Subsequent interventions should incorporate lessons learned from this first randomized controlled trial of a multi-modal longitudinal tobacco treatment curriculum in multiple U.S. medical schools. NIH Trial Registry Number: NCT01905618

Original languageEnglish (US)
Pages (from-to)172-181
Number of pages10
JournalJournal of general internal medicine
Volume31
Issue number2
DOIs
StatePublished - Feb 1 2016

Bibliographical note

Funding Information:
The study was supported by an investigator-initiated grant from the National Cancer Institute (NCI) 5 R01 CA136888.

Keywords

  • counseling
  • medical school curriculum
  • medical student behaviors
  • objective structured clinical examination
  • randomized controlled trial
  • tobacco dependence treatment

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