Randomized Controlled Trial

. 2016 Feb;31(2):172-181.

doi: 10.1007/s11606-015-3508-y.

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

Judith K Ockene¹, Rashelle B Hayes², Linda C Churchill², Sybil L Crawford², Denise G Jolicoeur², David M Murray³, Abigail B Shoben⁴, Sean P David⁵, Kristi J Ferguson⁶, Kathryn N Huggett⁷, Michael Adams⁸, Catherine A Okuliar⁸, Robin L Gross⁸, Pat F Bass 3rd⁹, Ruth B Greenberg¹⁰, Frank T Leone¹¹, Kola S Okuyemi¹², David W Rudy¹³, Jonathan B Waugh¹⁴, Alan C Geller¹⁵

Affiliations

¹ Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA. Judith.Ockene@umassmed.edu.
² Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
³ Biostatistics and Bioinformatics Branch; Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
⁴ Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
⁵ Center for Education & Research in Family and Community Medicine, Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
⁶ University of Iowa Carver College of Medicine, Iowa City, IA, USA.
⁷ Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA.
⁸ Department of Medicine, Georgetown University Hospital, Washington, DC, USA.
⁹ Louisiana State University Health Shreveport, Shreveport, LA, USA.
¹⁰ University of Louisville School of Medicine, Louisville, KY, USA.
¹¹ Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹² Department of Family and Community Health, University of Minnesota School of Medicine, Minneapolis, MN, USA.
¹³ University of Kentucky College of Medicine, Lexington, KY, USA.
¹⁴ Clinical and Diagnostics Sciences Department, School of Health Professions, UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁵ Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.

PMID: 26391030
PMCID: PMC4720645
DOI: 10.1007/s11606-015-3508-y

Randomized Controlled Trial

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

Judith K Ockene et al. J Gen Intern Med. 2016 Feb.

. 2016 Feb;31(2):172-181.

doi: 10.1007/s11606-015-3508-y.

Authors

Affiliations

¹ Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA. Judith.Ockene@umassmed.edu.
² Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
³ Biostatistics and Bioinformatics Branch; Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
⁴ Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
⁵ Center for Education & Research in Family and Community Medicine, Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
⁶ University of Iowa Carver College of Medicine, Iowa City, IA, USA.
⁷ Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA.
⁸ Department of Medicine, Georgetown University Hospital, Washington, DC, USA.
⁹ Louisiana State University Health Shreveport, Shreveport, LA, USA.
¹⁰ University of Louisville School of Medicine, Louisville, KY, USA.
¹¹ Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹² Department of Family and Community Health, University of Minnesota School of Medicine, Minneapolis, MN, USA.
¹³ University of Kentucky College of Medicine, Lexington, KY, USA.
¹⁴ Clinical and Diagnostics Sciences Department, School of Health Professions, UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁵ Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.

PMID: 26391030
PMCID: PMC4720645
DOI: 10.1007/s11606-015-3508-y

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.

Keywords: counseling; medical school curriculum; medical student behaviors; objective structured clinical examination; randomized controlled trial; tobacco dependence treatment.

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Figures

**Fig. 1**
Consort diagram/flow diagram. a Primary outcome OSCE data. b 5A self-efficacy survey data

**Fig. 2**
Self-efficacy by randomization assignment

See this image and copyright information in PMC

Comment in

Training Future Physicians to Deliver Tobacco Cessation Treatment.
Rigotti NA. Rigotti NA. J Gen Intern Med. 2016 Feb;31(2):144-146. doi: 10.1007/s11606-015-3560-7. J Gen Intern Med. 2016. PMID: 26747628 Free PMC article. No abstract available.

References

1. Jamal A, Dube S, Malarcher A, Shaw L, Engstrom M, Office on Smoking and Health et al. Tobacco use screening and counseling during physician office visits among adults - national ambulatory medical care survey and national health interview survey, United States, 2005–2009. MMWR Morb Mortal Wkly Rep. 2012;61:38–45. - PubMed
1. U.S. Preventive Services Task Force Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive services task force reaffirmation recommendation statement. Ann Intern Med. 2009;150(8):551–555. doi: 10.7326/0003-4819-150-8-200904210-00009. - DOI - PubMed
1. Task Force on Community Preventive Services Recommendations regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. Am J Prev Med. 2001;20(2):10–15. doi: 10.1016/S0749-3797(00)00300-7. - DOI - PubMed
1. Solberg LI, Asche SE, Boyle RG, Boucher JL, Pronk NP. Frequency of physician-directed assistance for smoking cessation in patients receiving cessation medications. Arch Intern Med. 2005;165(6):656–660. doi: 10.1001/archinte.165.6.656. - DOI - PubMed
1. Association of American Medical Colleges (AAMC). Physician behavior and practice patterns related to smoking cessation. Washington, DC: AAMC2007.

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

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

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