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

被引：33

作者：

Ockene, Judith K. ^{[1
]}

Hayes, Rashelle B. ^{[1
]}

Churchill, Linda C. ^{[1
]}

Crawford, Sybil L. ^{[1
]}

Jolicoeur, Denise G. ^{[1
]}

Murray, David M. ^{[2
]}

Shoben, Abigail B. ^{[3
]}

David, Sean P. ^{[4
]}

Ferguson, Kristi J. ^{[5
]}

Huggett, Kathryn N. ^{[6
]}

Adams, Michael ^{[7
]}

Okuliar, Catherine A. ^{[7
]}

Gross, Robin L. ^{[7
]}

Bass, Pat F., III ^{[8
]}

Greenberg, Ruth B. ^{[9
]}

Leone, Frank T. ^{[10
]}

Okuyemi, Kola S. ^{[11
]}

Rudy, David W. ^{[12
]}

Waugh, Jonathan B. ^{[13
]}

Geller, Alan C. ^{[14
]}

机构：

[1] Univ Massachusetts, Sch Med, Dept Med, Div Prevent & Behav Med, 55 Lake Ave North, Worcester, MA 01655 USA

[2] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Biostat & Bioinformat Branch, Div Intramural Populat Hlth Res, NIH, Bethesda, MD USA

[3] Ohio State Univ, Coll Publ Hlth, Div Biostat, Columbus, OH 43210 USA

[4] Stanford Univ, Sch Med, Dept Med, Ctr Educ & Res Family & Community Med,Div Gen Med, Palo Alto, CA 94304 USA

[5] Univ Iowa, Carver Coll Med, Iowa City, IA USA

[6] Creighton Univ, Sch Med, Dept Med, Omaha, NE USA

[7] Georgetown Univ Hosp, Dept Med, Washington, DC 20007 USA

[8] Louisiana State Univ Hlth Shreveport, Shreveport, LA USA

[9] Univ Louisville, Sch Med, Louisville, KY 40292 USA

[10] Univ Penn, Perelman Sch Med, Div Pulm Allergy & Crit Care Med, Philadelphia, PA 19104 USA

[11] Univ Minnesota, Sch Med, Dept Family & Community Hlth, Minneapolis, MN 55455 USA

[12] Univ Kentucky, Coll Med, Lexington, KY USA

[13] Univ Alabama Birmingham, UAB Lung Hlth Ctr, Sch Hlth Profess, Clin & Diagnost Sci Dept, Birmingham, AL USA

[14] Harvard Univ, Sch Publ Hlth, Dept Social & Behav Sci, 665 Huntington Ave, Boston, MA 02115 USA

来源：

JOURNAL OF GENERAL INTERNAL MEDICINE | 2016年 / 31卷 / 02期

关键词：

tobacco dependence treatment; counseling; medical school curriculum; medical student behaviors; randomized controlled trial; objective structured clinical examination; TOBACCO DEPENDENCE CURRICULA; CESSATION; EDUCATION; SCHOOLS; PROGRAM;

D O I：

10.1007/s11606-015-3508-y

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

BACKGROUND: Early in medical education, physicians must develop competencies needed for tobacco dependence treatment. OBJECTIVE: To assess the effect of amulti-modal tobacco dependence treatment curriculum on medical students' counseling skills. DESIGN: A group-randomized controlled trial (20102014) 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.

引用

页码：172 / 181

页数：10

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