Rotation in a Smoking Cessation Clinic Improves Nicotine Dependence Treatment Provided by First-Year Internal Medicine Trainees.
OBJECTIVE
Over 70% of smokers visit a physician annually, and physicians are well-positioned to assist patients in smoking cessation. Residency offers the ideal setting to train physicians in best practices for treatment of nicotine dependence. We hypothesized that experiential learning during a smoking cessation medical clinic (SCMC) rotation would be associated with an improvement in smoking cessation practice of internal medicine (IM) interns in outpatient primary care and inpatient settings.


METHODS
This was a prospective study performed at a large university-affiliated hospital. Forty IM interns rotated through SCMC. After a lecture on nicotine addiction and treatment, interns treated SCMC patients under direct supervision of an attending pulmonologist. Interns' smoking cessation practices before and after SCMC rotation were evaluated through chart review over 1 year. Upon study completion, a survey to assess confidence was administered. Paired t tests measured changes in rates of identifying smokers, offering pharmacological treatment and counseling.


RESULTS
A total of 5,622 outpatient and 683 inpatient charts of interns' encounters with patients were reviewed. Following SCMC rotation, there was an increase in identifying active smokers (7.1% versus 18.7%), prescribing therapy for smoking cessation (6.5% versus 18.0%), and providing counseling (30.9% versus 42.3%) to outpatients. For inpatients, there was an increase in nicotine replacement during admission (12.9% versus 37.4%) and prescription of therapy upon discharge (5.7% versus 16.1%). Interns reported confidence in providing appropriate counseling and treatment.


CONCLUSIONS
SCMC experience positively impacted smoking cessation treatment by IM interns, causing a measurable change in their practice.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mount Sinai St Luke's and Mount Sinai Roosevelt, New York, NY.
Mary M
MM
O'Sullivan
Sumedh S
SS
Hoskote
Melissa B
MB
Lesko
Cristina M
CM
Mallozzi
Young I
YI
Lee
Oluseyi A
OA
Fayanju
Deborah
D
Haller
Muhammad A
MA
Rashad
Elvina
E
Khusainova
Diandra
D
Fortune
Roshen
R
Mathew
Chloe
C
Van Tassel
Ethan D
ED
Fried
D000554:Ambulatory Care Facilities; D003376:Counseling / Q000379:methods; D006760:Hospitalization; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D010820:Physicians; D011446:Prospective Studies; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000628:therapy*; D014146:Training Support