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Teaching Medical Students to Help Patients Quit Smoking: Outcomes of a 10-School Randomized Controlled Trial
University of Massachusetts Medical School Faculty Publications
  • Judith K. Ockene, University of Massachusetts Medical School
  • Rashelle B. Hayes, University of Massachusetts Medical School
  • Linda C. Churchill, University of Massachusetts Medical School
  • Sybil Crawford, University of Massachusetts Medical School
  • Denise Jolicoeur, University of Massachusetts Medical School
  • David M. Murray, Eunice Kennedy Shriver National Institute of Child Health and Human Development
  • Abigail Shobend, Ohio State University
  • Sean P. David, Stanford University
  • Kristi J. Ferguson, University of Iowa
  • Kathryn N. Huggett, Creighton University
  • Michael Adams, Georgetown University
  • Catherine Okuliar, Georgetown University
  • Robin L. Gross, Georgetown University
  • Pat F. Bass, 3rd, Louisiana State University
  • Ruth B. Greenberg, University of Louisville
  • Frank Leone, University of Pennsylvania
  • Kola Okuyemi, University of Minnesota
  • David W. Rudy, University of Kentucky
  • Jonathan B. Waugh, University of Alabama at Birmingham
  • Alan C. Geller, Harvard School of Public Health
UMMS Affiliation
Department of Medicine, Division of Preventive and Behavioral Medicine
Document Type

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.

Rights and Permissions
Citation: J Gen Intern Med. 2016 Feb;31(2):172-81. doi: 10.1007/s11606-015-3508-y. Link to article on publisher's site
Related Resources
Link to Article in PubMed
  • counseling,
  • medical school curriculum,
  • medical student behaviors,
  • objective structured clinical examination,
  • randomized controlled trial,
  • tobacco dependence treatment
PubMed ID
Citation Information
Judith K. Ockene, Rashelle B. Hayes, Linda C. Churchill, Sybil Crawford, et al.. "Teaching Medical Students to Help Patients Quit Smoking: Outcomes of a 10-School Randomized Controlled Trial" Vol. 31 Iss. 2 (2016) ISSN: 0884-8734 (Linking)
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