title: Teaching Medical Students to Help Patients Quit Smoking: Outcomes of a 10-School Randomized Controlled Trial.
abstract: BACKGROUND
  Early in medical education, physicians must develop competencies needed for tobacco dependence treatment.
  
  
  OBJECTIVE
  To assess the effect of a multi-modal tobacco dependence treatment curriculum on medical students' counseling skills.
  
  
  METHODS
  A group-randomized controlled trial (2010-2014) included ten U.S. medical schools that were randomized to receive either multi-modal tobacco treatment education (MME) or traditional tobacco treatment education (TE).
  
  
  METHODS
  Students from the classes of 2012 and 2014 at ten medical schools participated. Students from the class of 2012 (N = 1345) completed objective structured clinical examinations (OSCEs), and 50 % (N = 660) were randomly selected for pre-intervention evaluation. A total of 72.9 % of eligible students (N = 1096) from the class of 2014 completed an OSCE and 69.7 % (N = 1047) completed pre and post surveys.
  
  
  METHODS
  The MME included a Web-based course, a role-play classroom demonstration, and a clerkship booster session. Clerkship preceptors in MME schools participated in an academic detailing module and were encouraged to be role models for third-year students.
  
  
  METHODS
  The primary outcome was student tobacco treatment skills using the 5As measured by an objective structured clinical examination (OSCE) scored on a 33-item behavior checklist. Secondary outcomes were student self-reported skills for performing 5As and pharmacotherapy counseling.
  
  
  RESULTS
  Although the difference was not statistically significant, MME students completed more tobacco counseling behaviors on the OSCE checklist (mean 8.7 [SE 0.6] vs. mean 8.0 [SE 0.6], p = 0.52) than TE students. Several of the individual Assist and Arrange items were significantly more likely to have been completed by MME students, including suggesting behavioral strategies (11.8 % vs. 4.5 %, p < 0.001) and providing information regarding quitline (21.0 % vs. 3.8 %, p < 0.001). MME students reported higher self-efficacy for Assist, Arrange, and Pharmacotherapy counseling items (ps ≤0.05).
  
  
  CONCLUSIONS
  Inclusion of only ten schools limits generalizability.
  
  
  CONCLUSIONS
  Subsequent interventions should incorporate lessons learned from this first randomized controlled trial of a multi-modal longitudinal tobacco treatment curriculum in multiple U.S. medical schools. NIH Trial Registry Number: NCT01905618.
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA. Judith.Ockene@umassmed.edu.
authors.forename: Judith K
authors.initials: JK
authors.lastname: Ockene
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Rashelle B
authors.initials: RB
authors.lastname: Hayes
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Churchill
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Sybil L
authors.initials: SL
authors.lastname: Crawford
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Denise G
authors.initials: DG
authors.lastname: Jolicoeur
authors.affiliation: Biostatistics and Bioinformatics Branch; Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Murray
authors.affiliation: Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
authors.forename: Abigail B
authors.initials: AB
authors.lastname: Shoben
authors.affiliation: Center for Education & Research in Family and Community Medicine, Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: David
authors.affiliation: University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Kristi J
authors.initials: KJ
authors.lastname: Ferguson
authors.affiliation: Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Kathryn N
authors.initials: KN
authors.lastname: Huggett
authors.affiliation: Department of Medicine, Georgetown University Hospital, Washington, DC, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Adams
authors.affiliation: Department of Medicine, Georgetown University Hospital, Washington, DC, USA.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Okuliar
authors.affiliation: Department of Medicine, Georgetown University Hospital, Washington, DC, USA.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Gross
authors.affiliation: Louisiana State University Health Shreveport, Shreveport, LA, USA.
authors.forename: Pat F
authors.initials: PF
authors.lastname: Bass
authors.affiliation: University of Louisville School of Medicine, Louisville, KY, USA.
authors.forename: Ruth B
authors.initials: RB
authors.lastname: Greenberg
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Frank T
authors.initials: FT
authors.lastname: Leone
authors.affiliation: Department of Family and Community Health, University of Minnesota School of Medicine, Minneapolis, MN, USA.
authors.forename: Kola S
authors.initials: KS
authors.lastname: Okuyemi
authors.affiliation: University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Rudy
authors.affiliation: Clinical and Diagnostics Sciences Department, School of Health Professions, UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Waugh
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Geller
mesh_terms: D002982:Clinical Clerkship; D002983:Clinical Competence; D003194:Computer-Assisted Instruction / Q000379:methods; D003376:Counseling / Q000193:education; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006801:Humans; D017063:Outcome Assessment, Health Care; D020377:Self Efficacy; D016540:Smoking Cessation / Q000379:methods*; D013337:Students, Medical; D014029:Tobacco Use Disorder / Q000534:rehabilitation*; D014481:United States
keywords: counseling; medical school curriculum; medical student behaviors; objective structured clinical examination; randomized controlled trial; tobacco dependence treatment