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Title:
Standardized Patient Cases for Teaching Tobacco Cessation
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MedEdPORTAL ID#:
1075
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Version:
1
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Resource Type:
Standardized Patient Case
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Description:
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.
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Author Institution:
University of Pittsburgh School of Medicine
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Primary Author:
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John F. Mahoney, MD
University of Pittsburgh School of Medicine
M-211 Scaife Hall
3550 Terrace St
Pittsburgh,
PA
15261
USA
412.648.8714
mahoney@medschool.pitt.edu
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Other Authors:
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John
Mahoney, MD
University of Pittsburgh School of Medicine
mahoney@medschool.pitt.edu
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Frank
Vitale, MA
University of Pittsburgh School of Medicine
vitalef@pitt.edu
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David
Eibling, MD
University of Pittsburgh School of Medicine
eiblingde@upmc.edu
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Patricia
Campbell
University of Pittsburgh School of Medicine
omed@medschool.pitt.edu
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Maurice
Clifton, MD, Primary Author
University of Pittsburgh School of Medicine
omed@medschool.pitt.edu
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Resource File(s):
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Additional Resource File Information:
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1 .zip file containing the following resources:
Provided in Adobe PDF and Microsoft Word Formats:
1. Standardized_Patient_Cases_for_Teaching_Tobacco_Cessation.pdf
2. Standardized_Patient_Cases_for_Teaching_Tobacco_Cessation.doc
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AAMC Hot Topics:
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Medicine: Communication Skills
Medicine: Substance Abuse
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Content Last Updated:
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| 07/10/2008 |
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Specialty/Discipline:
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Medicine: Graduate Medical Education
Medicine: Preventive Medicine
Medicine: Skills/Doctoring
Medicine: Undergraduate Medical Education
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Educational Objectives:
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1.) To understand the basics of addition theory, physiologic effects of nicotine, and pharmacology of tobacco cessation aides as they relate to tobacco cessation counseling.
2.) To demonstrate the ability to counsel patients in multiple stages of change, using the Centers for Disease Control (CDC) guidelines.
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Resource Keyword/Symptom:
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Patient Health Education
Tobacco Use Cessation
Smoking Cessation
Prevention and Health Maintenance
Tobacco Prevention and Control
Standardized Patient
Substance Abuse
Behavior Modification
Prevention
Stages of Change
Behavioral Counseling
Behavior Therapy (MeSH)
Counseling (MeSH)
Patient Education as Topic (MeSH)
Tobacco Use Cessation (MeSH)
Smoking Cessation (MeSH)
Tobacco Use Disorder (MeSH)
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Accreditation Council for Graduate Medical Education (ACGME) Competencies Addressed:
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Patient Care
Medical Knowledge
Interpersonal and Communication Skills
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Intended Learner Audience:
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2nd Year Medical/Dental Students
3rd Year Medical/Dental Students
4th Year Medical/Dental Students
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Intended Faculty Audience:
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Clinical Science Faculty
Clerkship Director / Clinical Science Course Director
Medical/Dental School Administrators (broadly defined)
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Effectiveness and Significance of Publication:
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| 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. |
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Special Implementation Requirements or Guidelines:
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1.) 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.
2.) 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.
3.) 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.
4.) 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. |
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Lessons Learned:
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1.) Students initially seem not to know what to do. This has been the case even after making various adjustments to the workshop instructions and opening presentation. By the second or third case, they understand the process and proceed without difficulty.
2.) 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.
3.) Agenda setting is important. Beginning the opening lecture by advising the students that at the end of the lecture they will be interviewing and counseling eight patients, captures their attention.
4.) 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.
5.) These cases can readily be used in other health science schools, and can also be used in the GME, CME and staff development settings. |
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Publications, Presentations, and/or Citations For This Publication:
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Mahoney JF, Clifton MS, Tobacco Treatment Education: Strategic Planning for Successful Curricula. Workshop presented at the 2005 Association for Medical Education in Europe Meeting, Amsterdam, Netherlands, September 1, 2005.
Mahoney JF, Leone F, Clifton MS, Evers-Casey S, Tobacco Treatment Education: Strategic Planning for Successful Curricula, presented at the 2005 Association of American Medical Colleges Northeast Group on Educational Affairs Regional Meeting, March 5, 2005, Washington, D.C.. Received Honorable Mention Award for Research Poster Presentation.
Clifton MS, Mahoney JF, Ryan K, Campbell P, Eibling D, Integration of Content on Tobacco Cessation into the Medical School Curriculum. Innovation in Medical Education exhibit at the Association of American Medical Colleges Annual Meeting, November 7, 2004, Boston, MA.
Clifton MS, Mahoney JF, Vacca JL, Vitale F, Eibling DE, Standardized Patients Teaching Tobacco Cessation to Medical Students Using Clinical Practice Guidelines on Smoking Cessation. Poster presentation at the Northeast Group on Educational Affairs Meeting, April 30, 2004, Pittsburgh, PA.
Clifton MS, Campbell PJ, Mahoney JF, Middleton DB, Rogers PL. Integration of a Comprehensive Evaluation of Smoking Cessation Skills into an OSCE. Presented at the Association of Standardized Patient Educators Annual Meeting, July 20, 2003, Virginia Beach, VA. |
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Sponsorship (Funding Source):
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| Funding support was provided for the Tobacco Cessation Curriculum Development Project by the Commonwealth of Pennsylvania Department of Health, Bureau of Chronic Diseases and Injury Prevention, 2002-2006. |
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Citation Formats:
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NLM:
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Mahoney J , Mahoney J, Vitale F, Eibling D, Campbell P, Clifton M,
Standardized Patient Cases for Teaching Tobacco Cessation. MedEdPORTAL;
2008.
Available from: http://services.aamc.org/30/mededportal/servlet/s/segment/mededportal/?subid=1075
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APA:
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Mahoney, J., Mahoney, J., Vitale, F., Eibling, D., Campbell, P., Clifton, M.,
(2008).
Standardized Patient Cases for Teaching Tobacco Cessation. MedEdPORTAL:
http://services.aamc.org/30/mededportal/servlet/s/segment/mededportal/?subid=1075
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