Can residents be trained to counsel patients about quitting smoking? Results from a randomized trial.
OBJECTIVE
To evaluate the effectiveness of two teaching interventions to increase residents' performance of smoking cessation counseling.


METHODS
Randomized controlled factorial trial.


METHODS
Eleven residency programs, in internal medicine (six), family medicine (three), and pediatrics (two). Programs were located in three university medical centers and four university-affiliated community hospitals.


METHODS
261 residents who saw ambulatory care patients at least one half-day per week, and 937 returning patients aged 17 to 75 years who reported having smoked five or more cigarettes in the preceding seven days. Of the 937, 843 were eligible for follow-up, and 659 (78%) were interviewed by phone at six months.


METHODS
Two interventions (tutorial and prompt) and four groups. The tutorial was a two-hour educational program in minimal-contact smoking cessation counseling for residents. The prompt was a chart-based reminder to assist physician counseling. One group of residents received the tutorial; one, the prompt; and one, both. A fourth group received no intervention.


RESULTS
Six months after the intervention, physician self-reports showed that residents in the tutorial + prompt and tutorial-only groups had used more counseling techniques (1.5-1.9) than had prompt-only or control residents (0.9). Residents in all three intervention groups advised more patients to quit smoking (76-79%) than did control group residents (69%). The tutorial had more effect on counseling practices than did the prompt. Physician confidence, perceived preparedness, and perceived success followed similar patterns. Exit interviews with 937 patients corroborated physician self-reports of counseling practices. Six months later, self-reported and biochemically verified patient quitting rates for residents in the three intervention groups (self-reported: 5.3-8.2%; biochemically verified: 3.4-5.7%) were higher than those for residents in the control group (self-reported: 5.2%; biochemically verified: 1.7%), though the differences were not statistically significant.


CONCLUSIONS
A simple and feasible educational intervention can increase residents' smoking cessation counseling.
Strecher
V J
VJ
Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill 27599-7400.
O'Malley
M S
MS
Villagra
V G
VG
Campbell
E E
EE
Gonzalez
J J
JJ
Irons
T G
TG
Kenney
R D
RD
Turner
R C
RC
Rogers
C S
CS
Lyles
M F
MF
D003376:Counseling / Q000193:education*; D005069:Evaluation Studies as Topic; D005194:Family Practice / Q000193:education; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D010372:Pediatrics / Q000193:education; D010817:Physician-Patient Relations; D000074606:Smoking Prevention; D013663:Teaching / Q000379:methods*