Tobacco intervention training: current efforts and gaps in US medical schools.
BACKGROUND
Research has documented that US medical schools inadequately teach tobacco intervention skills.


OBJECTIVE
To examine effective training methods for tobacco intervention in undergraduate medical education.


METHODS
Using indexing terms related to tobacco intervention and medical education, we searched MEDLINE (1966-June 2002) and the Cochrane Database of Systematic Reviews (through issue 2, 2002). Reference lists of relevant articles were also read to identify additional articles. Because of their importance to tobacco intervention, we also reviewed Ockene and colleagues' tobacco education research and the tobacco treatment guidelines of the United States Public Health Service and the United States Preventive Services Task Force.


METHODS
All study designs that incorporated process or outcome evaluation of tobacco intervention educational methods for medical students were included in this review. Of an initial 1241 articles retrieved, 82 included medical students. Reviewing abstracts and references of these articles identified 13 pertinent studies.


METHODS
Quality criteria for inclusion consisted of explicit evaluation of the educational methods used. Data extraction identified all evaluations and any problems in program implementation.


RESULTS
Enhanced instructional methods (eg, the use of patient-centered counseling, standardized patient instructors, role playing, or a combination of these) are more effective for teaching tobacco intervention than are traditional didactic methods alone and can be effectively inserted into medical school curricula.


CONCLUSIONS
Various educational methods have been used to train medical students in tobacco intervention. Nonetheless, gaps still exist within undergraduate medical education, including a lack of integration of tobacco dependence information throughout all 4 years of medical school curricula, specific training in smokeless tobacco intervention, tobacco intervention training that addresses cultural issues, and long-term studies showing that such training is retained.
Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1084, USA. jspangle@wfubmc.edu
John G
JG
Spangler
Geeta
G
George
Kristie Long
KL
Foley
Sonia J
SJ
Crandall
D003376:Counseling; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D006293:Health Promotion; D006801:Humans; D012577:Schools, Medical; D012907:Smoking; D016540:Smoking Cessation; D013663:Teaching / Q000379:methods*; D014029:Tobacco Use Disorder / Q000517:prevention & control*; D014030:Tobacco, Smokeless; D014481:United States