Journal of General Internal Medicine

, Volume 19, Issue 5, pp 534–539 | Cite as

Teaching patient-centered tobacco intervention to first-year medical students

  • Richard L. BrownEmail author
  • Judie M. Pfeifer
  • Craig L. Gjerde
  • Christine S. Seibert
  • Cynthia L. Haq
Innovations In Education And Clinical Practice


The University of Wisconsin’s Tobacco Intervention Basic Skills curriculum (TIBS) was inaugurated to begin training 147 first-year medical students in skills for promoting health behavior change. Learning activities included lecture, demonstration, reading, quiz, role-play exercises, and standardized patient interviews. After TIBS, the 69 students who provided pre- and postintervention data exhibited more therapeutic attitudes and increased knowledge and self-confidence in applying TIBS skills. Two months later, 52% of the 109 posttest respondents had applied TIBS in clinical settings, often for behaviors other than tobacco use. We conclude that medical students can gain from early training on promoting behavior change.

Key words

undergraduate medical education competency-based education tobacco use cessation health promotion program evaluation 


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  1. 1.
    McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270:2207–12.PubMedCrossRefGoogle Scholar
  2. 2.
    World Health Organization. World Health Report 2002. Geneva: World Health Organization; 2002.Google Scholar
  3. 3.
    Rigotti NA. Clinical practice. Treatment of tobacco use and dependence. N Engl J Med. 2002;346:506–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Silagy C, Stead LF. Physician advice for smoking cessation [systematic review]. Cochrane Tobacco Addiction Group. Cochrane Database of Systematic Reviews; 2003:3.Google Scholar
  5. 5.
    Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, Md: U.S. Department of Health and Human Services, Public Health Service; 2000.Google Scholar
  6. 6.
    Hughes JR. Motivating and helping smokers to stop smoking. J Gen Intern Med. 2003;18:1053–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Cornuz J, Humair JP, Seematter L, et al. Efficacy of resident training in smoking cessation: a randomized, controlled trial of a program based on application of behavioral theory and practice with standardized patients. Ann Intern Med. 2002;136:429–37.PubMedGoogle Scholar
  8. 8.
    Cornuz J, Zellweger JP, Mounoud C, Decrey H, Pecoud A, Burnand B. Smoking cessation counseling by residents in an out-patient clinic. Prev Med. 1997;26:292–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Hymowitz N, Schwab J, Eckholdt H. Pediatric residency training on tobacco. Pediatrics. 2001;108:E8.Google Scholar
  10. 10.
    Montner P, Bennett G, Brown C. An evaluation of a smoking cessation training program for medical residents in an inner-city hospital. J Natl Med Assoc. 1994;86:671–5.PubMedGoogle Scholar
  11. 11.
    Secker-Walker RH, Solomon LJ, Flynn BS, et al. Training obstetric and family practice residents to give smoking cessation advice during prenatal care. Am J Obstet Gynecol. 1992;166:1356–63.PubMedGoogle Scholar
  12. 12.
    Eyler AE, Dicken LL, Fitzgerald JT, Oh MS, Wolf FM, Zweifler AJ. Teaching smoking-cessation counseling to medical students using simulated patients. Am J Prev Med. 1997;13:153–8.PubMedGoogle Scholar
  13. 13.
    Roche AM, Eccleston P, Sanson-Fisher R. Teaching smoking cessation skills to senior medical students: a block-randomized controlled trial of four different approaches. Prev Med. 1996;25:251–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Spangler JG, George G, Foley KL, Crandall SJ. Tobacco intervention training: current efforts and gaps in US medical schools. JAMA. 2002;288:1102–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Humair JP, Cornuz J. A new curriculum using active learning methods and standardized patients to train residents in smoking cessation. J Gen Intern Med. 2003;18:1023–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Miller WR, Rollnick S. Motivational Interviewing. New York: Guilford Press; 1991.Google Scholar
  17. 17.
    Miller WR nel chair. Enhancing Motivation for Change in Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series 35, DHHS Publication No. (SMA) 99-3354. Rockville, Md: Substance Abuse and Mental Health Services Administration; 1999.Google Scholar
  18. 18.
    Rogers C. On Becoming a Person: A Therapist’s View of Psychotherapy. Boston: Houghton Mifflin Company; 1995.Google Scholar
  19. 19.
    Prochaska JO, DiClemente CC. Stages of change in the modification of problem behaviors. Prog Behav Modif. 1992;28:183–218.PubMedGoogle Scholar
  20. 20.
    Spencer L, Pagell F, Hallion ME, Adams TB. Applying the transtheoretical model to tobacco cessation and prevention: a review of literature. Am J Health Promot. 2002;17:7–71.PubMedGoogle Scholar
  21. 21.
    Anonymous. Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH posttreatment drinking outcomes. J Stud Alcohol. 1997;58:7–29.Google Scholar
  22. 22.
    Burke B, Arkowitz H, Dunn C. The efficacy of motivational interviewing. In: Miller WR, Rollnick S. Motivational Interviewing. 2nd ed. New York: Guilford Press; 2001:217–50.Google Scholar
  23. 23.
    Resnicow K, DiIorio C, Soet JE, Ernst D, Borrelli B, Hecht J. Motivational interviewing in health promotion: it sounds like something is changing. Health Psychol. 2002;21:444–51.PubMedCrossRefGoogle Scholar
  24. 24.
    Boehlecke B, Sperber AD, Kowlowitz V, Becker M, Contreras A, McGaghie WC. Smoking history-taking skills: a simple guide to teach medical students. Med Educ. 1996;30:283–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Brown RL. Motivational Interviewing: A Web-based Course. Providence: New England Addiction Technology Transfer Center; 2002.Google Scholar
  26. 26.
    Arizona Cessation Training and Evaluation Management Team. Basic Tobacco Cessation Skills Certification Guidebook. Tucson: University of Arizona; 1999.Google Scholar
  27. 27.
    Brown RL, Pfeifer JM. Wisconsin Tobacco Intervention Basic (TIBS) Skills Manual. Madison, Wis. Unpublished; 2002. Available at: Accessed March 30, 2004.Google Scholar
  28. 28.
    Skochelak S, Thaler S, Gjerde C. The Interdisciplinary Generalist Curriculum Project at the University of Wisconsin Medical School: the Generalist Partners Program. Acad Med. 2001;76(4 suppl):S131-S133.PubMedCrossRefGoogle Scholar
  29. 29.
    Brown RL, Oriel K. Teaching motivational interviewing to first-year students. Acad Med. 1998;73:589–90.PubMedCrossRefGoogle Scholar
  30. 30.
    Cohen J. Statistical Power Analysis for the Behavioral Sciences, 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Association; 1988.Google Scholar
  31. 31.
    MINITAB, Inc. MINITAB Release 12.1. State College, Pa: MINITAB, Inc.; 1998.Google Scholar
  32. 32.
    Festinger L. A Theory of Cognitive Dissonance. Stanford: Stanford University Press; 1957.Google Scholar
  33. 33.
    Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice-Hall; 1986.Google Scholar
  34. 34.
    Papadakis MA, Croughan-Minihane M, Fromm LJ, Wilkie HA, Ernster VL. A comparison of two methods to teach smoking-cessation techniques to medical students. Acad Med. 1997;72:725–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Ajzen I, Fishbein M. Understanding Attitudes and Predicting Social Behavior. Upper Saddle River, NJ: Pearson Education; 1980.Google Scholar
  36. 36.
    Center for Advancement of Health. Integration of Health Behavior Counseling in Routine Medical Care. Washington, DC: Center for Advancement of Health; 2001.Google Scholar

Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  • Richard L. Brown
    • 2
    Email author
  • Judie M. Pfeifer
    • 2
  • Craig L. Gjerde
    • 2
  • Christine S. Seibert
    • 1
  • Cynthia L. Haq
    • 2
  1. 1.Division of General Internal MedicineUniversity of Wisconsin-Madison Medical SchoolMadison
  2. 2.Department of Family MedicineUniversity of Wisconsin-Madison Medical SchoolMadison

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