The clinical practice guideline, Treating Tobacco Use and Dependence, emphasizes that tobacco dependence is a chronic disease. Quitting is a continuous process with time spent in consideration, planning, maintenance, and relapse. In order to teach medical students how to provide comprehensive tobacco cessation counseling, they must learn effective strategies for each stage. This submission includes eight standardized patient (SP) cases and instructions on how each was used in a tobacco cessation counseling training workshop for third year clerkship students. There are two in each of the following four stages of change: Pre-Contemplation, Action, Maintenance and Relapse. Additional materials include an evaluation form and a sample student schedule. These documents include ready-to-use SP training materials and case-specific structured feedback forms for use by SPs during the student session. An outline of the opening lecture is also included.
The workshop begins with a didactic lecture on the physiology of nicotine addiction, behavioral modification techniques, and the pharmacology of nicotine cessation aids. Pairs of students then alternate between interviewing and providing feedback about their partner so that each student interviews and facilitates a patient in each stage. Students have nine minutes to conduct the interview and counseling and then receive feedback for three minutes. Feedback consists of self-assessment by the interviewing student about things done well, followed by positive reinforcement by the other student and then the SP. The interviewing student reports on what they would have done differently and the SP provides additional constructive feedback. The SP feedback is "scripted" in the form of a checklist of most important items for that case.
This has been one of the most successful programs during the third year medical school curriculum. In the first cohort of students, they ranked the SP encounters to be very helpful in helping them learn to provide smoking cessation counseling, with 85.5% of students rating the encounters a 6 or 7 on a 1-7 scale (7 = highest). Students also reported comfort in providing smoking cessation counseling in their preceptors' offices, of 83 students, 34 (41%) ranked their comfort as a 6 of 7, 20 (24.1%) a 5 of 7, and 19 (22.9%) a 7 (very comfortable). Students demonstrated a significant increase in the number of tobacco cessation counseling encounters reported in their clerkship learning logs, beginning immediately after the implementation of this module of curriculum. Compared to several years of baseline data in the ambulatory care clerkship where this module was taught, students showed an approximate doubling of the average number of tobacco cessation counseling encounters reported. This increase has led us to sustain this workshop in the curriculum even as the clerkship curriculum and structure has evolved and after the completion of the funded project that supported the development of these materials.
The optimal use of these of these cases requires a working knowledge of standardized patients (SP) including standard training techniques. The SP cases themselves are ready to be printed and used for training and the accompanying feedback forms are also printer-ready. Learners should be trained in basic interviewing techniques. Ideally, the groups of learners should be matched according to their level within an individual small group for the best SP counseling and feedback experience. These cases may be used alone, but were constructed as part of an overall session on tobacco cessation. A suggested outline for a lecture that would be the introduction for this type of workshop is included, as are suggestions for accompanying tobacco cessation teaching materials that are available from government courses. The lecture would include information on tobacco cessation techniques including behavioral modification, addiction physiology, and pharmacology of cessation aids. Faculty who implement these cases should use the latest information from the CDC and other authorities to optimize the accuracy and timeliness of the presentation. The content of this package is current as of November 2007. Having the SPs understand the feedback process (more than simply how to perform it) has improved their enthusiasm for the process and has generally improved their engagement with this step. Also, debriefing the students at the end of the SP encounters is essential to helping them tie up loose ends and complete their assimilation of the material. These cases can readily be used in other health science schools, and can also be used in the GME, CME and staff development settings.
- To understand the basics of addition theory, physiologic effects of nicotine, and pharmacology of tobacco cessation aides as they relate to tobacco cessation counseling.
- To demonstrate the ability to counsel patients in multiple stages of change, using the Centers for Disease Control (CDC) guidelines.
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Blake K, Kutcher M, Murphy J, Wakefield S, Mann K, Vincent N. Structured Communication Adolescent Guide (SCAG) Extension of Reliability and Validity to Physicians. Presented at: Council on Medical Students Education Physicians; 2003.
Blake K, Kutcher M, Murphy J, Wakefield S, Mann K. The Structured Communication Adolescent Guide (SCAG) and its use in medical education. Presented at: Council on Medical Students Education In Pediatrics; 2006.
Blake K, Kutcher M, Murphy J, Wakefield S, Mann K. Reliability of the Structured Communication Adolescent Guide (SCAG) with Untrained Adolescent. Presented at: the Association for Medical Education in Europ; September 2006; Genoa, Italy.
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