Pennsylvania's Tobacco Education Project- Medical School Module

Publication ID Published Volume
1703 September 18, 2009 5


The Pennsylvania Tobacco Education pilot project was developed in order to create a generalizable method of improving students' knowledge, attitudes and behaviors related to tobacco use treatment. This module includes pertinent information and resources necessary to plan, train, implement and evaluate a comprehensive tobacco education curriculum into medical schools. The educational methods and evaluation strategies were successfully implemented in three independent institutions across Pennsylvania.

Planning: The worksheets allowed planners to share ideas, improve communication, anticipate inherent obstacles, and assist in developing plans for overcoming these obstacles in all three institutions.

Training: SP training materials were used to help standardize the students' SP experience by providing a consistent point of reference. We were able to develop a cadre of SPs, each familiar with multiple scenarios, helping to overcome difficulties with SP availability and turnover over time.

Evaluation: Survey- Factor analysis of the Confidential Tobacco Survey responses in a validation sample of third year medical students yielded five independent factors with eigenvalues greater than 1, which accounted for 75 percent of the total variance. The first and largest factor (eigenvalue 7.3, 37% of variance) include six items related to students' self-assessment of knowledge and skills related to tobacco cessation (e.g. "I am comfortable prescribing medications that help in cessation"). Other factors are related to students' perceptions regarding tobacco advertising, the utility of nicotine replacement therapy, the prospects for counseling patients in an ambulatory setting, and their level of frustration with smokers who choose not to quit.

PELS- As an intermediate measure of the effectiveness of our educational program, we monitored the change in the rate of students' self-reported key behaviors over time. Over a two-year period, students reported data for 85,728 encounters with adult and adolescent patients during the study period, of which 62,418 included a clinical history. Of the encounters with a clinical history, 37,023 (59%) included documentation that a smoking history was obtained. The highest rate of collecting the smoking history (86%) was seen during the Medicine clerkship. The lowest rates were reported in Pediatrics (29%) and Surgery (25%). PELS remained responsive across time, rotation type, and location, reflecting anticipated differences between primary versus tertiary care, community versus university settings and pre- versus post-training periods.

Most medical school educators place a high priority on tobacco-use treatment instruction. However, schools are less likely to have a well developed educational strategy, relying instead on the varied interests of faculty to "piecemeal" instruction. An organized approach to structuring tobacco-use instruction ensures a complete exposure over the course of four years, and allows educators to isolate and modify approaches based on evaluated results. In addition, clinical skills training focused on important knowledge, attitudes and skills related to tobacco use treatment can be successfully accomplished by splitting up targeted outcomes across several scenarios, typical of the clerkship experience. Alternating outpatient and inpatient contexts allows students to explore ways of overcoming several predictable obstacles.


Evers-Casey S, Leone F, Kanzleiter L. Pennsylvania's tobacco education project- medical school module. MedEdPORTAL Publications. 2009;5:1703.

Contains Information Suitable for Patient Education

Educational Objectives

  1. To be able to assist educators in the identification and organization of existing institutional resources and ensure standardization of content while allowing for variability between sites.
  2. To be able to provide a basic structure for training SP actors, SP scenarios that represent several stages of change and a rudimentary checklist to assess target outcomes based on USPHS guidelines.
  3. To be able to provide a basis for discussing several treatment related misconceptions and provide SP actors with background necessary to facilitate a credible SP session.
  4. To be able to provide a mechanism for program monitoring and quality improvement and assist educators in assessing the effects of program modifications.
  5. To be able to articulate the educational goals for each tobacco-related SP scenario and provide a method for ongoing evaluation of student effectiveness and effectiveness of program components
  6. To be able to encounter Log System (PELS)- Assist educators in tracking key behaviors among students, assess the effectiveness of an educational intervention and provide regular cues to encourage targeted behaviors
  7. To be able to assess and plan- provide students with a formal structure for assessing tobacco patients' needs and a mechanism to develop and document a treatment plan.


  • Case-Based Reporting, Cognitive Therapy, Tobacco Use Treatment, Smoking Cessation

Prior Scholarly Dissemination


  1. Leone FT, Evers-Casey S, Veloski J, Patkar A, Kanzleiter L for the Pennsylvania Continuum of Tobacco Education workgroup. Short, intermediate, and long-term outcomes of Pennsylvania's Continuum of Tobacco Education Project pilot. Nicotine and Tobacco Research - In Press.
  2. Leone FT, Evers-Casey S, Kanzleiter L, Patkar A, Veloski J. Tobacco training in medical schools: preliminary outcomes of the generalizable curriculum initiative. Proceedings of the Society for Research on Nicotine and Tobacco, 2006; PA2-4: 20.
  3. Mahoney JF, Leone FT, Clifton MS, Evers-Casey S. Tobacco treatment education: strategic planning for successful curricula. Association of American Medical Colleges Northeast Group on Educational Affairs Regional Meeting, Washington, D.C., March 5, 2005.

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ISSN 2374-8265