May 2007

Grant Results

SUMMARY

Researchers at Morehouse School of Medicine, in collaboration with colleagues at Mercer University School of Medicine, developed and evaluated a computer-based, self-directed curriculum to teach medical students in the early clinical years of training how to counsel patients effectively to quit smoking.

Key Results

  • The Smoking Cessation Clinical Intervention tutorial is available online to the public without charge. It includes a narrative section of 26 modules that addresses steps for counseling patients about smoking cessation and a practicum section of eight videotaped physician-patient counseling scenarios.

Key Findings

  • Students at both Morehouse and Mercer significantly improved their knowledge of tobacco-control issues as a result of using the smoking-cessation tutorial.
  • In an assessment, students at both schools stated that their ability to perform patient counseling activities related to smoking cessation had significantly improved after using the smoking-cessation tutorial.

Funding
The Robert Wood Johnson Foundation (RWJF) supported the project with two unsolicited grants totaling $294,754 to Morehouse School of Medicine between January 1999 and February 2005.

 See Grant Detail & Contact Information
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THE PROBLEM

Lung cancer is the leading cause of cancer death and is the most preventable cancer, according to the American Cancer Society. Studies cited by researchers at Morehouse School of Medicine found that 70 percent of smokers see a physician every year and 60 percent to 70 percent say they would quit smoking if urged to do so by a physician. (See, for example, Fiore et al., Journal of the American Medical Association [JAMA], 271[8]: 624–626, 1994.)

Yet, according to Morehouse researchers, medical students lack confidence in their ability to counsel patients effectively to stop smoking. Part of the reason for this, notes the principal investigator, Daniel S. Blumenthal, M.D., M.P.H., is that "short shrift" is given to training medical students in smoking cessation counseling in an already overcrowded medical school curriculum.

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RWJF STRATEGY

RWJF has been actively engaged in improving and advancing smoking-cessation treatment since 1996. The projects and programs it has funded include:

  • Addressing Tobacco in Managed Care, a program to improve tobacco-cessation systems of care within managed care organizations. See Grant Results on the program.
  • Addressing Tobacco in Health Care, a research network that connects researchers, health care providers and other partners interested in developing and implementing changes to health care systems that will improve the delivery of evidence-based tobacco-dependence treatment.
  • Dissemination of the original Public Health Service guidelines on tobacco-cessation treatment (see Grant Results on ID# 030525 etc.).
  • Development of a primary care practitioners' pocket guide (see Grant Results on ID# 029466).
  • Development of an update to the original guideline (see Grant Results on ID# 034068).

In conjunction with other organizations, RWJF funded the development of a blueprint for adolescent treatment (see Grant Results on ID#s 037525 and 041053 to form the Youth Tobacco Cessation Collaborative).

Also in conjunction with other organizations, RWJF funded the development of a blueprint for pregnant smokers through Smoke-Free Families: Innovations to Stop Smoking During and Beyond Pregnancy, working with the National Partnership to Help Pregnant Smokers Quit (see Grant Results).

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THE PROJECT

Researchers at Morehouse School of Medicine, in collaboration with colleagues at Mercer University School of Medicine, developed and evaluated a computer-based, self-directed curriculum to teach medical students in the early clinical years of training how to counsel patients effectively to quit smoking.

Morehouse School of Medicine, located in Atlanta, Ga., is a predominantly African-American school whose mission is to train physicians for primary care careers in medically underserved communities.

Mercer University School of Medicine, in Macon, Ga., has as its mission the education of primary care physicians for rural and medically underserved areas of Georgia. The majority of its students are white.

Under grant ID# 034237, in April 1999, Morehouse researcher Linda Pederson, Ph.D., began the project by recruiting participants for and facilitating small focus groups at Morehouse (one with two students and one with three) and Mercer (with nine students). The purpose of the focus groups was to learn about:

  • Students' knowledge and attitudes about tobacco control and the health effects of tobacco.
  • Students' views of the role and abilities of the physician in tobacco prevention in a clinical setting.
  • Students' suggestions about the knowledge and skills needed to participate effectively in tobacco control efforts as physicians.
  • Constraints-and ways to overcome the constraints-on medical students in obtaining the needed skills and knowledge to help their patients quit smoking.

Pederson left Morehouse later in 1999 to work for the Office of Smoking and Health at the Centers for Disease Control and Prevention (CDC), and work on this project ceased for a time. Morehouse researcher Daniel S. Blumenthal, M.D., M.P.H., succeeded Pederson as project director in 2001 and continued the project under grant ID# 041057.

Under grant ID# 041057, Morehouse and Mercer researchers:

  • Worked with an electronic media company, CIBER, in Greenwood Village, Colo. (under a subcontract) to create a Web-based tutorial on tobacco-control strategies and techniques for medical students and physicians. Project staff originally planned a CD-ROM version of the tutorial but decided on a Web-based version as more accessible. See Results for more information on the tutorial.
  • Surveyed students in the 2003 entering classes at both Morehouse (45 students) and Mercer (34 students) prior to their use of the tutorial about:
    • Their knowledge of tobacco-control issues.
    • Their self-assessment of their ability to counsel patients regarding smoking.
    • Their confidence related to important tobacco-control activities in the clinical setting.
  • Made the tutorial available to the medical students over a two-week period following the initial survey.
  • Resurveyed students within one week of tutorial use, using the same questionnaire. In addition, researchers surveyed Morehouse students about their exposure to the individual modules of the tutorial.

Morehouse students received course credit for completing the questionnaires and accessing the tutorial. At Mercer, students received $50 for completing the questionnaires and $50 for accessing the tutorial.

Communications

Researchers presented their findings at the 2004 Morehouse School of Medicine 4th Annual Primary Care and Prevention Conference.

After the grant period ended, researchers reported findings in two articles published in 2005 in Ethnicity & Disease and in 2006 in Drug and Alcohol Review. Researchers presented findings about the evaluation of the tutorial at the 2005 National Conference on Tobacco or Health. See the Bibliography for details.

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RESULTS

Researchers reported the following results in a report to RWJF:

  • The Smoking Cessation Clinical Intervention tutorial is available online to the public without charge. It uses a curriculum based on the U.S. Public Health Service Clinical Practice Guideline on Treating Tobacco Use and Dependence and on the results of the medical student focus groups.
  • The narrative section of the tutorial includes 26 modules on the following:
    • The 5 A's (Ask, Advise, Assess, Assist, Arrange): steps a physician can take when counseling a patient not to smoke or to stop smoking.
    • The 5 R's (Relevance, Risks, Rewards, Roadblocks, Repetition): categories that help structure a physician's approach to counseling patients who are not yet ready to quit smoking.
    • Links to Web sites of the National Cancer Institute, CDC Office on Smoking and Health, American Lung Association and others for more information.
  • The practicum section of the curriculum includes eight videotaped scenarios in which physicians counsel patients of different ages and ethnicities, demonstrating the strategies and techniques outlined in the narrative section.

Findings

Researchers reported key findings in an article published in 2006 in Drug and Alcohol Review, entitled "A Web-Based Smoking Cessation and Prevention Curriculum for Medical Students: Why, How, and What Next." See the Bibliography for details.

  • Students at both Morehouse and Mercer significantly improved their knowledge of tobacco-control issues as a result of using the smoking cessation tutorial.
  • Students at both schools assessed their ability to perform the five counseling steps, as well as their overall counseling ability, as having significantly improved after using the smoking-cessation tutorial. The only exception was improvement in the "Ask" step among Mercer students, which approached, but did not reach, statistical significance.
  • Among the 36 Morehouse students questioned, those who had viewed one or more modules were significantly more likely to demonstrate improved knowledge. (Mercer students were not questioned on this.) The number of modules viewed was not related to changes in knowledge.
  • As exposure to the modules increased, Morehouse students reported improved:
    • Skill in helping patients quit smoking.
    • Confidence in counseling patients who are not interested in quitting.
    • Confidence in counseling teens.

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CONCLUSIONS

Project staff offered the following conclusions in the 2006 article published in Drug and Alcohol Review:

  • "Given the need for and desire on the part of practitioners for training … the curriculum described here can fill a gap among practitioners. [Its] usefulness … is not limited to medical students; it can be used by practicing physicians, nurses, physician's assistants, health educators, dentists and other healthcare professionals who wish to improve their skills in smoking prevention and cessation."

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LESSONS LEARNED

  1. Plan for adequate funding when producing a Web-based curriculum. It is expensive to develop Web-based products. Without an adequate budget, it may not be possible to reshoot segments or make revisions, if needed. (Project Director)

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AFTER THE GRANT

Since the Smoking Cessation Clinical Intervention tutorial became available on the Internet in October 2003, it has logged more than 600 hits in more than 30 countries. The tutorial will remain on the Web site of the Morehouse School of Medicine.

As of January 2007, the tutorial is also available on MedEdPortal, the online medical education resource center of the Association of American Medical Colleges. From this page, you can access the Daniel Blumenthal tutorial after entering keywords "smoking cessation" and author "Blumenthal."

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GRANT DETAILS & CONTACT INFORMATION

Project

Developing and Evaluating Educational Materials for Medical Students on Smoking Cessation Counseling

Grantee

Morehouse School of Medicine (Atlanta,  GA)

  • Development and Evaluation of Educational Materials for Medical Students on Smoking Cessation Counseling
    Amount: $ 155,338
    Dates: January 1999 to October 2004
    ID#:  034237

  • Developing and Evaluating Educational Materials for Medical Students on Smoking Cessation Counseling
    Amount: $ 139,416
    Dates: October 2001 to February 2005
    ID#:  041057

Contact

Daniel S. Blumenthal, M.D., M.P.H.
(404) 752-1160
dblumenthal@msm.edu

Web Site

http://nosmoking.msm.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Pederson LL and Blumenthal D. "Smoking Cessation: What Works in Primary Care Settings." Ethnicity & Disease, 15(2 Suppl 2): S10–S13, 2005. Abstract available online. Full text requires fee.

Pederson LL, Blumenthal DS, Dever A and McGrady G. "A Web-Based Smoking Cessation and Prevention Curriculum for Medical Students: Why, How, What, and What Next." Drug and Alcohol Review, 25(1): 39–47, 2006. Available online (click on "View Article").

Survey Instruments

"Medical Student Questionnaire on Smoking Cessation Counseling." Morehouse School of Medicine, fielded November–December 2003.

World Wide Web Sites

http://nosmoking.msm.edu. "Smoking Cessation: Clinical Intervention" offers a tutorial to registered physicians and medical students. It also offers an option for nonregistered visitors to browse the site and provides an overview of the tutorial material. Atlanta: Morehouse School of Medicine, October 2003.

Presentations and Testimony

Linda L. Pederson and Daniel Blumenthal. "Web-Based Curriculum: Tobacco Cessation Training for Medical Students," at the National Conference on Tobacco or Health, May 6, 2005, Chicago. Abstract available online.

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Report prepared by: Eve Shapiro
Reviewed by: Mary B. Geisz
Reviewed by: Molly McKaughan
Program Officer: Karen K. Gerlach

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