Abstract
Background
Tobacco dependence counseling is recommended to be included as core curriculum for US medical students. To date, there has been little information on students’ self-reported skills and practice opportunities to provide 5A’s (Ask, Advise, Assess, Assist, and Arrange) counseling for tobacco cessation.
Methods
We conducted anonymous surveys of second year and fourth year students at multiple US medical schools between February 2004 and March 2005 (overall response rate 70%). We report on the tobacco control practices of the 860 second year and 827 fourth year students completing the survey.
Measurements and Main Results
Fourth year students reported multiple opportunities to learn tobacco counseling in case-based discussions, simulated patient encounters, and clinical skills courses. They reported more instruction in family medicine (79%) and Internal Medicine (70%) than Pediatrics (54%), Obstetrics/Gynecology (41%), and Surgery clerkships (16%). Compared with asking patients about smoking, advising smokers to quit, and assessing patient willingness to quit, fourth year students were less likely to have multiple practice opportunities to assist the patient with a quit plan and arrange follow-up contact. More than half of second year students reported multiple opportunities for asking patients about smoking but far fewer opportunities for practicing the other 4 As.
Conclusions
By the beginning of their fourth year, most students in this group of medical schools reported multiple opportunities for training and practicing basic 5A counseling, although clear deficits for assisting patients with a quit plan and arranging follow-up care exist. Addressing these deficits and integrating tobacco teaching through tailored specific instruction across all clerkships, particularly in Surgery, Pediatrics, and Obstetrics/Gynecology is a challenge for medical school education.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238–45.
Centers for Disease Control and Prevention Office of Smoking and Health, 2007.
Fiore MC, Bailey WC, Cohen SJ, et al. A clinical practice guideline for treating tobacco use and dependence: a US Public Health Service report. JAMA. 2000;283:3244–54.
Jordan T, Dake J, Price JH. Best practices for smoking cessation in pregnancy: do obstetrician/gynecologists use them in practice? J Women’s Health. 2006;15:400–41.
Stevens VJ, Solberg LI, Quinn VP et al. Relationship between tobacco control policies and the delivery of smoking cessation services in nonprofit HMOs. JNCI Monographs. 2005;75–80.
Ferketich AK, Khan Y, Wewers ME. Are physicians asking about tobacco use and assisting with cessation? Results from the 2001–2004 national ambulatory medical care survey (NAMCS). Prev Med. 2006;43:472–6.
Fiore MC, Epps RP, Manley MW. A missed opportunity: teaching medical students to help their patients to successfully quit smoking. JAMA. 1994;271:624–6.
Ferry LH, Grissino LM, Runfola PS. Tobacco dependence curricula in US undergraduate medical education. JAMA. 1999;282:825–9.
Spangler JG, George G, Long Foley K, Crandall SJ. Tobacco intervention efforts and gaps in US medical schools. JAMA. 2002;288:1102–7.
Fiore MC, Croyle RT, Curry SJ, et al.. Preventing 3 million premature deaths and helping 5 million smokers quit: a national action plan for tobacco cessation. Am J Pub Health. 2004;94:205–11.
Powers C, Zapka J, Bognar B, et al.. Evaluation of current tobacco curriculum at 12 US medical schools. J Cancer Educ. 2004;19:212–9.
Geller AC, Zapka J, Brooks K, et al.. Tobacco competencies for US medical students. Am J Pub Health. 2005;9:5:950–5.
Geller AC, Prout MN, Miller D, Sun T, Koh HK, Ockene J. Evaluation of a cancer prevention and control curriculum. Prev Med. 2002;35:78–86.
Zapka J, Luckmann, Sulsky SI, et al.. Cancer control knowledge, attitudes and perceived skills among medical students. J Cancer Educ. 2000;15:73–8.
Dake JA, Price JH, Jordan TR. Pediatricians’ practices regarding smoking cessation among parents of their patients. Am J Health Behavior. 2006;30:503–12.
Heaton PC, Frede SM. Patients’ need for more counseling on diet, exercise, and smoking cessation: results from the National Ambulatory Medical Care Survey. J Am Pharm Assoc. 2006;46:364–9.
Kaplan CP, Perez-Stable EJ, Fuentes-Afflick E, Gildengorin V, Millstein S, Juarez-Reyes M. Smoking cessation counseling with young patients: the practices of family physicians and pediatricians. Arch Pediatr Adolesc Med. 2004;158:83–90.
Woerdeman LA, Hage JJ, Hofland MM, Rutgers EJ. A prospective assessment of surgical risk factors in 400 cases of skin-sparing mastectomy and immediate breast reconstruction with implants to establish selection criteria. Plast Reconstr Surg. 2007;119:455–63.
Kuijpers DI, Smeets NW, Lapiere K, Thissen M, Krekels GA, Neumann HA. Do systemic antibiotics increase the survival of a full thickness graft on the nose? JEADV. 2006;20:1296–301.
Sorenson LC, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg. 2003;238:1–5.
Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence study. JAMA. 2000;284:2606–10.
Nicholson JM, Hennrikus DJ, Lando HA, McCarty MC, Vessey J. Patient recall versus physician documentation in report of smoking cessation counselling performed in the inpatient setting. Tob Control. 2000;9:382–8.
Pederson LL, Blumenthal DS, Dever A, McGrady G. A web-based smoking cessation and prevention curriculum for medical students: Why, how, what, and what next. Drug Alcohol Rev. 2006;25:39–47.
Prochaska JJ, Teherani A, Hauer KE. Medical students’ use of the stages of change model in tobacco cessation counseling. J Gen Intern Med. 2007;22:223–7.
Kosowicz LY, Pfeiffer CA, Vargas M. Long-term retention of smoking cessation counseling skills learned in the first year of medical school. J Gen Intern Med. 2007;22:1161–5.
Acknowledgments
National Cancer Institute Grant 1-R25-CA91958-05.
Conflict of Interest
None disclosed.
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
Rights and permissions
About this article
Cite this article
Geller, A.C., Brooks, D.R., Powers, C.A. et al. Tobacco Cessation and Prevention Practices Reported by Second and Fourth Year Students at US Medical Schools. J GEN INTERN MED 23, 1071–1076 (2008). https://doi.org/10.1007/s11606-008-0526-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-008-0526-z