6. Abstract Each year smoking kills 430,000 U.S citizens, exacerbates a myriad of diseases, and costs society approximately $100 billion. Despite the proliferation of information and restrictive smoking policies, adult smoking prevalence has remained relatively stable during the past five years, currently at 21%. Brief physician- delivered tobacco treatment, commonly known as """"""""the 5As"""""""", is an evidence-based intervention demonstrated to double a smoker's likelihood of quitting. Given that 70% of smokers see a physician each year, it is imperative that all clinicians have the appropriate knowledge and skill level to counsel smokers. However, few physicians and physicians-in-training receive adequate training to develop these skills. Using a pair-matched, randomized group-controlled (RGC) design (implemented in 10 medical schools), we will compare two methods of teaching the 5As to medical students: 1) traditional medical education (TE), and 2) multi-modal education (MME) that adds two components to TE: a web-based instructional program for students and preceptor training. The primary outcome is observed tobacco treatment counseling skill as measured by the Objective Structured Clinical Examination (OSCE), the standard method for evaluating medical student skill level at all U.S. medical schools. A secondary outcome is self-reported tobacco treatment counseling skill level. In a nested cohort design, during the second year of the study a cohort of medical students will be followed from early in their first year of medical school (MS1) through the end of their third year (MS3) which occurs in the 4th year of the study. The Primary Aim of this RGC trial is to compare the effectiveness of MME for teaching the 5As counseling skills in medical school against TE. Hypothesis 1: MME will outperform TE on observed 5As counseling skills (OSCE). Hypothesis 2: MME will outperform TE on self-reported 5As counseling skills. Strengths of this study include: 1) the innovative study design that tests common and integrative teaching methods and 2) the potential to disseminate throughout US medical schools effective educational methods that can build physicians'skills to assist the millions of patients who continue to smoke. This is a unique window of opportunity to build on our team's prior research in medical education and tobacco dependence treatment. This study involves close collaboration among researchers, practitioners, educators, and stakeholders at 10 U.S. medical schools. This unique team is comprised of investigators with extensive experience developing and teaching an evidence-based, physician-delivered 5A tobacco treatment model;developing and evaluating a web-based tobacco dependence treatment course;implementation of academic detailing with physician preceptors;and experience in building a large medical school consortium for tobacco curriculum reform.

Public Health Relevance

Each year, smoking kills 430,000 U.S citizens, exacerbates myriad diseases, and costs society approximately $100 billion. Brief physician-delivered tobacco cessation counseling, commonly known as the 5As, is an evidence-based intervention strategy that has been shown to double a smoker's likelihood of quitting. Although 70% of smokers see a physician each year, few physicians are skilled in tobacco cessation treatment, making it imperative that all clinicians and all physicians-in-training have the appropriate knowledge and skill level to counsel their patients who smoke. The goal of this group randomized trial conducted at 10 medical schools is to test the effectiveness of two conditions using different methods for teaching the 5As (Ask, Advise, Assess, Assist, and Arrange) to medical students on their observed and reported counseling behaviors.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA136888-04
Application #
8270519
Study Section
Community-Level Health Promotion Study Section (CLHP)
Program Officer
Hunt, Yvonne M
Project Start
2009-07-06
Project End
2014-05-31
Budget Start
2012-06-01
Budget End
2013-05-31
Support Year
4
Fiscal Year
2012
Total Cost
$784,939
Indirect Cost
$136,893
Name
University of Massachusetts Medical School Worcester
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
603847393
City
Worcester
State
MA
Country
United States
Zip Code
01655
Ockene, Judith K; Hayes, Rashelle B; Churchill, Linda C et al. (2016) Teaching Medical Students to Help Patients Quit Smoking: Outcomes of a 10-School Randomized Controlled Trial. J Gen Intern Med 31:172-81
Leone, Frank T; Evers-Casey, Sarah; Graden, Sarah et al. (2015) Academic Detailing Interventions Improve Tobacco Use Treatment among Physicians Working in Underserved Communities. Ann Am Thorac Soc 12:854-8
Hayes, Rashelle B; Geller, Alan C; Crawford, Sybil L et al. (2015) Medical school curriculum characteristics associated with intentions and frequency of tobacco dependence treatment among 3rd year U.S. medical students. Prev Med 72:56-63
Mazor, Kathleen M; Jolicoeur, Denise; Hayes, Rashelle B et al. (2015) Assessing Medical Students' Tobacco Dependence Treatment Skills Using a Detailed Behavioral Checklist. Teach Learn Med 27:292-8
Xiao, Rui S; Hayes, Rashelle B; Waring, Molly E et al. (2015) Tobacco counseling experience prior to starting medical school, tobacco treatment self-efficacy and knowledge among first-year medical students in the United States. Prev Med 73:119-24
Leone, Frank T; Evers-Casey, Sarah; Graden, Sarah et al. (2015) Behavioral economic insights into physician tobacco treatment decision-making. Ann Am Thorac Soc 12:364-9
Hayes, Rashelle B; Geller, Alan; Churchill, Linda et al. (2014) Teaching tobacco dependence treatment and counseling skills during medical school: rationale and design of the Medical Students helping patients Quit tobacco (MSQuit) group randomized controlled trial. Contemp Clin Trials 37:284-93
Geller, Alan C; Hayes, Rashelle B; Leone, Frank et al. (2013) Tobacco dependence treatment teaching by medical school clerkship preceptors: survey responses from more than 1,000 US medical students. Prev Med 57:81-6
Leone, Frank T; Evers-Casey, Sarah (2012) Developing a Rational Approach to Tobacco Use Treatment in Pulmonary Practice: A Review of the Biological Basis of Nicotine Addiction. Clin Pulm Med 19:53-61
Ockene, Judith K; Schneider, Kristin L; Lemon, Stephenie C et al. (2011) Can we improve adherence to preventive therapies for cardiovascular health? Circulation 124:1276-82

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