Teaching patient-centered tobacco intervention to first-year medical students

Abstract

Skills curriculum (TIBS) was inaugurated to begin training 147 firstyear medical students in skills for promoting health behavior change. Learning activities included lecture, demonstration, reading, quiz, role-play exercises, and standardized patient interviews. After TIBS, the 69 students who provided pre-and postintervention data exhibited more therapeutic attitudes and increased knowledge and self-confidence in applying TIBS skills. Two months later, 52% of the 109 posttest respondents had applied TIBS in clinical settings, often for behaviors other than tobacco use. We conclude that medical students can gain from early training on promoting behavior change. Previous studies have shown that resident physicians 7-11 and advanced medical students 12-14 can learn smoking cessation counseling techniques and improve patients' smoking outcomes. 15 Teaching on therapeutics has typically been reserved until the third year of the medical school curriculum. Earlier training on promoting behavior change might be advantageous. Earlier acquisition and application of skills in promoting behavior change might enhance firstand second-year medical students' sense of belonging and usefulness in clinical environments. Training on such skills might reinforce the importance of fundamental communication skills, such as building rapport, attending to affective issues, and cross-cultural communication. It also might help instill in trainees whose professional identities are still emerging the ethic that promoting behavior change is central to medical practice.These advantages could only be realized if teaching these skills earlier were feasible and acceptable to medical students. This study aimed to determine whether a curriculum on tobacco intervention could garner student acceptance; improve relevant knowledge, attitudes, and self-confidence; and be applied in students' early clinical experience. This paper describes the design and evaluation of the Wisconsin Tobacco Intervention Basic Skills curriculum (TIBS), the first experience in a new longitudinal curriculum on promoting behavior change. PROGRAM DESCRIPTION Target AudienceThe targeted learners were the 147 first-year medical students in the class of 2005 at the University of WisconsinMadison. Eighty-three (56.5%) of the students were female; 64 (43.5%) were male. Mean age and standard deviation were 22.6 ± 3.1 years; 7 (5%) of the students were age 30 or above. Behavior Change ModelWe selected motivational interviewing 16 Curriculum DevelopmentSeveral principles guided curriculum development. The greatest instructional emphasis should be skills development. The intervention model should be structured yet flexible to respond to patients' needs and clinicians' time constraints. Practicing physicians should provide role modeling on the importance of these skills in clinical practice. Sequential learning steps should include knowledge acquisition, skills demonstration, skills practice and feedback, and reinforcement by application in clinical settings. Scarce instructional tim...

Tobacco intervention practices of licensed psychologists

“…A number of other professional health care organizations have already issued position statements encouraging their members to intervene with tobacco, including physician assistants (American Academy, 2005), chiropractors (American Chiropractic, 1997), dentists (Benson, Christen, Crews, Madden, & Mecklenberg, 2000), and nurses (American Nurses Association, 1995). Further, training efforts are documented in the literature for a number of health professions, including dental students (Gordon, Severson, Seeley, & Christianson, 2004), medical students (Brown, Pfeifer, Gjerde, Seibert, & Haq, 2004;Fiore, Epps, & Manley, 1994), and pharmacists (Hudmon et al, 2004). The statement by Phillips and Brandon (2004) that "given the likely advantages that psychologists have, they are missing an opportunity to make a cumulatively large public health impact through tobacco-related interventions (p. 284)" appears very consistent given the current findings.…”

Improving Medical Students’ Success in Promoting Health Behavior Change: A Curriculum Evaluation

“…3 Previous efforts to evaluate behavior change counseling curricula have been aimed at determining immediate gains in knowledge or confidence, but not necessarily in skill development. [4][5][6] The need exists to establish the effectiveness of a course that impacts knowledge, confidence, and skill development within an instructionally sound framework.…”

Teaching students behavior change skills: description and assessment of a new Motivational interviewing curriculum

“…confidence some medical schools and residency programs have implemented motivational interviewing (MI) curricula as described by Humair & Cornuz (2003) and Brown et al (2004). Motivational interviewing is a patient-centered yet directive style of behavior change counseling first described by Miller (1983).…”