title: Developing a fully integrated tobacco curriculum in medical colleges in India.
abstract: BACKGROUND
  This paper describes a pioneering effort to introduce tobacco cessation into India's undergraduate medical college curriculum. This is the first ever attempt to fully integrate tobacco control across all years of medical college in any low and middle income country. The development, pretesting, and piloting of an innovative modular tobacco curriculum are discussed as well as challenges that face implementation and steps taken to address them and to advocate for adoption by the Medical Council of India.
  
  
  METHODS
  In-depth interviews were conducted with administrators and faculty in five medical colleges to determine interest in and willingness to fully integrate smoking cessation into the college curriculum. Current curriculum was reviewed for present exposure to information about tobacco and cessation skill training. A modular tobacco curriculum was developed, pretested, modified, piloted, and evaluated by faculty and students. Qualitative research was conducted to identify challenges to future curriculum implementation.
  
  
  RESULTS
  Fifteen modules were successfully developed focusing on the public health importance of tobacco control, the relationship between tobacco and specific organ systems, diseases related to smoking and chewing tobacco, and the impact of tobacco on medication effectiveness. Culturally sensitive illness specific cessation training videos were developed. Faculty and students positively evaluated the curriculum as increasing their competency to support cessation during illness as a teachable moment. Students conducted illness centered cessation interviews with patients as a mandated part of their coursework. Systemic challenges to implementing the curriculum were identified and addressed.
  
  
  CONCLUSIONS
  A fully integrated tobacco curriculum for medical colleges was piloted in 5 colleges and is now freely available online. The curriculum has been adopted by the state of Kerala as a first step to gaining Medical Council of India review and possible recognition.
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India. yaminiganesh@gmail.com.
authors.forename: T R
authors.initials: TR
authors.lastname: Yamini
authors.affiliation: University of Arizona, School of Anthropology, 85721, Tucson, AZ, USA. nichtermark@gmail.com.|Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA. nichtermark@gmail.com.
authors.forename: Mark
authors.initials: M
authors.lastname: Nichter
authors.affiliation: University of Arizona, School of Anthropology, 85721, Tucson, AZ, USA. mimi.nichter@gmail.com.
authors.forename: Mimi
authors.initials: M
authors.lastname: Nichter
authors.affiliation: Department of Community Medicine, T.D. Medical College, Alappuzha, Kerala, India. sairuphilip09@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Sairu
authors.affiliation: Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India. draswathygopan@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Aswathy
authors.affiliation: Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India. kleelamoni@aims.amrita.edu.
authors.forename: K
authors.initials: K
authors.lastname: Leelamoni
authors.affiliation: Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India. unnikrishnan.b@manipal.edu.
authors.forename: B
authors.initials: B
authors.lastname: Unnikrishnan
authors.affiliation: Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India. ppmithra@gmail.com.
authors.forename: Prasanna Mithra
authors.initials: PM
authors.lastname: P
authors.affiliation: Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India. rekha.apar@manipal.edu.
authors.forename: Rekha
authors.initials: R
authors.lastname: Thapar
authors.affiliation: Department of Community Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India. drriyaz@gmail.com.
authors.forename: S R
authors.initials: SR
authors.lastname: Basha
authors.affiliation: Department of Community Medicine, Academy of Medical Sciences, Pariyaram, Kannur, Kerala, India. akjayasree@gmail.com.
authors.forename: A K
authors.initials: AK
authors.lastname: Jayasree
authors.affiliation: Department of Community Medicine, Academy of Medical Sciences, Pariyaram, Kannur, Kerala, India. pradeepmayamol@gmail.com.
authors.forename: T R
authors.initials: TR
authors.lastname: Mayamol
authors.affiliation: Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA. myram@email.arizona.edu.
authors.forename: Myra
authors.initials: M
authors.lastname: Muramoto
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India. minisureshkumar@yahoo.com.
authors.forename: G K
authors.initials: GK
authors.lastname: Mini
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India. kavumpurathu@yahoo.com.
authors.forename: K R
authors.initials: KR
authors.lastname: Thankappan
mesh_terms: D003479:Curriculum; D003906:Developing Countries; D004504:Education, Medical, Undergraduate; D006292:Health Priorities; D006801:Humans; D007194:India; D017145:Models, Educational; D010865:Pilot Projects; D016540:Smoking Cessation; D020340:Tobacco Use Cessation