1
|
Moeteke NS, Oyibo P, Ochei O, Ntaji MI, Awunor NS, Adeyemi MO, Enemuwe IM, Agbatutu E, Adesoye OO. Effectiveness of online training in improving primary care doctors' competency in brief tobacco interventions: A cluster-randomized controlled trial of WHO modules in Delta State, Nigeria. PLoS One 2024; 19:e0292027. [PMID: 38386654 PMCID: PMC10883549 DOI: 10.1371/journal.pone.0292027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) strongly recommends that brief tobacco interventions should be routinely offered in primary care. However, medical doctors do not consistently and effectively intervene during their encounters with cigarette smokers. There is a paucity of studies assessing the effect of training on the tobacco intervention competency of primary care doctors in Nigeria. AIM To evaluate the effectiveness of online training in improving competency in brief tobacco interventions among primary care doctors in Delta State, Nigeria. METHODS A cluster-randomized controlled trial was conducted among eligible doctors working in government-owned facilities. The 22 eligible Local Government Areas (LGAs) served as clusters. The intervention group received a WHO six-hour online course on brief tobacco cessation intervention, delivered via Zoom. The control group received no intervention. A structured questionnaire was sent to participants via WhatsApp before and six months after the training. The primary outcome variables were scores for knowledge, attitude, self-efficacy, and practice. Differences in change of scores between intervention and control groups were assessed with t-test. To adjust for clustering, these inter-group differences were further analyzed using linear mixed-effects regression modeling with study condition modeled as a fixed effect, and LGA of practice entered as a random effect. RESULTS The intervention group had a significantly higher mean of change in scores for knowledge (effect size 0.344) and confidence (effect size 0.52). CONCLUSION The study shows that training, even online, positively affects clinician competency in brief tobacco intervention. This is important for primary care systems in developing countries. Mandatory in-service training and promotion of the WHO modules are recommended.
Collapse
Affiliation(s)
- Nnamdi Stephen Moeteke
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
- Center for Primary Care, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Patrick Oyibo
- Department of Health Services Research and Management, City, University of London, London, United Kingdom
- Department of Community Medicine, Delta State University, Abraka, Delta State, Nigeria
| | - Oboratare Ochei
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
- Department of Community Medicine, Delta State University, Abraka, Delta State, Nigeria
| | - Maureen Iru Ntaji
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
- Department of Community Medicine, Delta State University, Abraka, Delta State, Nigeria
| | - Nyemike Simeon Awunor
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
- Department of Community Medicine, Delta State University, Abraka, Delta State, Nigeria
| | | | - Ibobo Mike Enemuwe
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
- Department of Community Medicine, Delta State University, Abraka, Delta State, Nigeria
| | - Eseoghene Agbatutu
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | - Oluwaseun Opeyemi Adesoye
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| |
Collapse
|
2
|
Satish P, Khetan A, Shah D, Srinivasan S, Balakrishnan R, Padmanandan A, Hejjaji V, Hull L, Samuel R, Josephson R. Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial. J Gen Intern Med 2023; 38:3162-3170. [PMID: 37286774 PMCID: PMC10247264 DOI: 10.1007/s11606-023-08243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Low-middle-income countries face an enormous burden of tobacco-related illnesses. Counseling for tobacco cessation increases the chance of achieving quit outcomes, yet it remains underutilized in healthcare settings. OBJECTIVE We tested the hypothesis that utilizing trained medical students to counsel hospitalized patients who use tobacco will lead to an increase in patient quit rates, while also improving medical student knowledge regarding smoking cessation counseling. DESIGN Investigator-initiated, two-armed, multicenter randomized controlled trial conducted in three medical schools in India. PARTICIPANTS Eligibility criteria included age 18-70 years, active admission to the hospital, and current smoking. INTERVENTION A medical student-guided smoking cessation program, initiated in hospitalized patients and continued for 2 months after discharge. MAIN MEASURES The primary outcome was self-reported 7-day point prevalence of smoking cessation at 6 months. Changes in medical student knowledge were assessed using a pre- and post-questionnaire delivered prior to and 12 months after training. KEY RESULTS Among 688 patients randomized across three medical schools, 343 were assigned to the intervention group and 345 to the control group. After 6 months of follow up, the primary outcome occurred in 188 patients (54.8%) in the intervention group, and 145 patients (42.0%) in the control group (absolute difference, 12.8%; relative risk, 1.67; 95% confidence interval, 1.24-2.26; p < 0.001). Among 70 medical students for whom data was available, knowledge increased from a mean score of 14.8 (± 0.8) (out of a maximum score of 25) at baseline to a score of 18.1 (± 0.8) at 12 months, an absolute mean difference of 3.3 (95% CI, 2.3-4.3; p < 0.001). CONCLUSIONS Medical students can be trained to effectively provide smoking cessation counseling to hospitalized patients. Incorporating this program into the medical curriculum can provide experiential training to medical students while improving patient quit rates. TRIAL REGISTRATION URL: http://www. CLINICALTRIALS gov . Unique identifier: NCT03521466.
Collapse
Affiliation(s)
- Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
| | - Aditya Khetan
- Division of Cardiology, McMaster University, Hamilton, ON, Canada
| | | | - Shuba Srinivasan
- Department of General Medicine, SMSIMSR, Muddenahalli, Karnataka, India
| | | | - Arun Padmanandan
- Senior Zonal AEFI Consultant, Ministry of Health and Family Welfare, Govt of India, New Delhi, India
| | - Vittal Hejjaji
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Leland Hull
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Reema Samuel
- Department of Psychiatry, Christian Medical College, Vellore, India
| | - Richard Josephson
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
3
|
Elfandi S, Poudyal H. Tobacco Cessation Curriculum in Medical Schools: a Scoping Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1614-1623. [PMID: 37188986 DOI: 10.1007/s13187-023-02309-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Abstract
This scoping review aims to identify interventional training courses on tobacco cessation counseling skills of medical students, identify the most appropriate teaching method, and the ideal stage to provide such training. We retrieved articles published since 2000 from two electronic peer-reviewed databases (PubMed and Scopus) and hand-searched reference lists of selected articles. Articles published in English, with a clearly defined curriculum, reporting knowledge, attitude, cessation counseling skills of medical students post-training, and cessation-related outcomes of patients participating in student-led counseling sessions, were considered for inclusion. We used the York framework to guide this scoping review. First, data from studies meeting the inclusion criteria were charted using a standardized form. Subsequently, related studies were organized under three themes that emerged in the review process-lectured-based, web-based, and multi-modal curriculum. We concluded that a short but focused lecture-based curriculum combined with peer role-play or standardized/real patient interactions effectively develops the necessary knowledge and skills of undergraduate medical students to provide tobacco cessation counseling to patients. However, studies consistently report that the gains in knowledge and skills after cessation training is acute. Therefore, continued participation in cessation counseling and periodic review of cessation-related knowledge and skills post-training is warranted.
Collapse
Affiliation(s)
- Sufian Elfandi
- Population Health and Policy Research Unit, Graduate School of Medicine, Medical Education Center/International Education Section, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Hemant Poudyal
- Population Health and Policy Research Unit, Graduate School of Medicine, Medical Education Center/International Education Section, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| |
Collapse
|
4
|
Gorukanti AL, Kimminau KS, Tindle HA, Klein JD, Gorzkowski J, Kaseeska K, Ali R, Singh L, David SP, Halpern-Felsher B. Cross-sectional online survey of clinicians' knowledge, attitudes and challenges to screening and counselling adolescents and young adults for substance use. BMJ Open 2022; 12:e059019. [PMID: 36414284 PMCID: PMC9685226 DOI: 10.1136/bmjopen-2021-059019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine adolescent healthcare clinicians' self-reported screening practices as well as their knowledge, attitudes, comfort level and challenges with screening and counselling adolescents and young adults (AYA) for cigarette, e-cigarette, alcohol, marijuana, hookah and blunt use. DESIGN A 2016 cross-sectional survey. SETTING Academic departments and community-based internal medicine, family medicine and paediatrics practices. PARTICIPANTS Adolescent healthcare clinicians (N=771) from 12 US medical schools and respondents to national surveys. Of the participants, 36% indicated male, 64% female, mean age was 44 years (SD=12.3); 12.3% of participants identified as Asian, 73.7% as white, 4.8% as black, 4.2% as Hispanic and 3.8% as other. PRIMARY AND SECONDARY OUTCOME MEASURES Survey items queried clinicians about knowledge, attitudes, comfort level, self-efficacy and challenges with screening and counselling AYA patients about marijuana, blunts, cigarettes, e-cigarettes, hookah and alcohol. RESULTS Participants were asked what percentage of their 10-17 years old patients they screened for substance use. The median number of physicians reported screening 100% of their patients for cigarette (1st, 3rd quartiles; 80, 100) and alcohol use (75, 100) and 99.5% for marijuana use (50,100); for e-cigarettes, participants reported screening half of their patients and 0.0% (0, 50), (0, 75)) reported screening for hookah and blunts, respectively. On average (median), clinicians estimated that 15.0% of all 10-17 years old patients smoked cigarettes, 10.0% used e-cigarettes, 20.0% used marijuana, 25.0% drank alcohol and 5.0% used hookah or blunts, respectively; yet they estimated lower than national rates of use of each product for their own patients. Clinicians reported greater comfort discussing cigarettes and alcohol with patients and less comfort discussing e-cigarettes, hookah, marijuana and blunts. CONCLUSIONS This study identified low rates of screening and counselling AYA patients for use of e-cigarettes, hookahs and blunts by adolescent healthcare clinicians and points to potential missed opportunities to improve prevention efforts.
Collapse
Affiliation(s)
- Anu L Gorukanti
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Kim S Kimminau
- Department of Family and Community Medicine, University of Missouri Columbia, Columbia, Missouri, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Julie Gorzkowski
- Department of Healthy Resilient Children Youth and Families, American Academy of Pediatrics, Itasca, Illinois, USA
| | - Kristen Kaseeska
- Department of Healthy Resilient Children Youth and Families, American Academy of Pediatrics, Itasca, Illinois, USA
| | - Raabiah Ali
- Healthcare Settings Program, Chicago Department of Public Health, Chicago, Illinois, USA
| | - Lavisha Singh
- Department of Biostatistics, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Sean P David
- Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | | |
Collapse
|
5
|
Jiménez-Ruiz CA, Chatkin JM, Morais A, Zabert G, Rosa P, Gea J, Cavalcanti Lundgren FL, Boléo-Tomé JP, Araújo AJD, Borrajo C, Buljubasich D, Garcia Rueda M. Consensus Document on Medical Faculty Education on the Treatment of Smoking. Arch Bronconeumol 2020; 56:806-811. [PMID: 32513588 DOI: 10.1016/j.arbres.2020.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/06/2020] [Accepted: 04/26/2020] [Indexed: 11/23/2022]
Abstract
We report the results of a consensus reached by an expert group of representatives from different medical societies in Latin America on the objectives, competencies (knowledge, and skills), content, and duration of smoking cessation education in Latin American medical schools. The document discusses the following aspects: epidemiology, nicotine dependence, factors for initiation and maintenance of tobacco use, smoking-related disorders, diagnosis, minimal intervention, non-pharmacological and pharmacological interventions for smoking cessation, and prevention of smoking.
Collapse
Affiliation(s)
- Carlos A Jiménez-Ruiz
- Presidente de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR); Unidad Especializada en Tabaquismo, Hospital Clínico San Carlos, Madrid, España.
| | - Jose Miguel Chatkin
- Presidente Sociedade Brasileira Pneumologia e Tisiologia; Medicina Interna/Pneumologia, Escola de Medicina PUCRS, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
| | - Antonio Morais
- Presidente Sociedade Portuguesa Pneumologia; Centro Hospitalar Universitário São João, Oporto, Portugal; Faculdade de Medicina do Porto, Oporto, Portugal; i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Oporto, Portugal
| | - Gustavo Zabert
- Presidente de Asociación Latinoamericana del Tórax; Facultad de Ciencias Médicas, Universidad Nacional de Comahue, Argentina
| | - Paula Rosa
- Serviço de Pneumologia, Hospital Vila França de Xira, Vila Franca de Xira, Portugal
| | - Joaquim Gea
- Facultad de Medicina, Universidad Pompeu Fabra, Barcelona, España
| | | | | | - Alberto José de Araújo
- Departamento de Tabaquismo de la Asociación Latinoamericana de Tórax (ALAT), Montevideo, Uruguay
| | - Cristina Borrajo
- Núcleo de Estudos e Tratamento do Tabagismo, Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Marcos Garcia Rueda
- Servicio de Neumología, Hospital Regional Universitario Carlos Haya, Málaga, España
| |
Collapse
|
6
|
Development and Validation of an Evaluation Tool to Measure the Effectiveness of a Smoking Cessation Training among Healthcare Providers in Malaysia: The Providers' Smoking Cessation Training Evaluation (ProSCiTE). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214297. [PMID: 31694286 PMCID: PMC6862003 DOI: 10.3390/ijerph16214297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 11/17/2022]
Abstract
Background: In line with Article 14 of the Framework Convention for Tobacco Control, we have witnessed vast developments in smoking cessation training for healthcare providers, offering help for smokers. However, there is no specific evaluation tool to monitor and evaluate the effectiveness of these programs for future enhancement and sustainability. Objective: To develop and validate a new tool for evaluating smoking cessation training programs for healthcare providers called the Providers' Smoking Cessation Training Evaluation (ProSCiTE). Methods: The 74-item ProSCiTE tool was developed based on a review of the literature and an expert panel review. The tool was validated in a sample of 403 healthcare providers using a cross-sectional study design from July to December 2016. Content validity was assessed by the Scale-Content Validity Index (S-CVI). The construct validity of the ProSCiTE was analyzed using exploratory factor analysis (EFA) to confirm psychometric properties. Internal consistency reliability was determined using Cronbach's alpha. Results: The content validity showed that the S-CVI ranged from 0.82 to 1.00 for consistency, representativeness, relevancy, and the clarity of each construct, resulting in 67 items for the questionnaire. The construct validity of the ProSCiTE (based on eigenvalues and factor loadings to confirm the four-factor structure (attitude, self-efficacy, behavior, and barriers) with 54.74% total variance) was acceptable (Kaiser-Mayer-Olkin = 0.923; Bartlett's test of sphericity was significant, p < 0.001). The internal consistency reliability of the four-factor structure was very good, with Cronbach's alpha values at 0.89, 0.94, 0.95, and 0.90, respectively. Conclusions: This study showed that 67 items of the ProSCiTE demonstrated good content and construct validity, as well as a high internal consistency reliability for the measurement of knowledge, attitudes, self-efficacy, behavior, and barriers to smoking cessation interventions among healthcare providers. Therefore, the ProSCiTE is a valid and reliable research tool with which to evaluate the effectiveness of smoking cessation training programs.
Collapse
|
7
|
Hasan SI, Mohd Hairi F, Ahmad Tajuddin NA, Amer Nordin AS. Empowering healthcare providers through smoking cessation training in Malaysia: a preintervention and postintervention evaluation on the improvement of knowledge, attitude and self-efficacy. BMJ Open 2019; 9:e030670. [PMID: 31562154 PMCID: PMC6773327 DOI: 10.1136/bmjopen-2019-030670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/15/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Healthcare providers are ideally positioned to advise their patients to quit smoking by providing effective smoking cessation intervention. Thus, we evaluate the effectiveness of a 1-day training programme in changing the knowledge, attitude and self-efficacy of healthcare providers in smoking cessation intervention. METHODS A prepost study design was conducted in 2017. The 8-hour Smoking Cessation Organising, Planning and Execution (SCOPE) training comprised lectures, practical sessions and role-play sessions to 218 healthcare providers. A validated evaluation tool, Providers' Smoking Cessation Training Evaluation, was administered to assess the impact of training on knowledge, attitude and self-efficacy on smoking cessation intervention. RESULTS After SCOPE training, the knowledge score increased significantly from 7.96±2.34 to 10.35±1.57 (p<0.001). Attitude and self-efficacy in smoking cessation intervention also increased significantly from 34.32±4.12 to 37.04±3.92 (p<0.001) and 40.31±8.61 to 54.67±7.45 (p<0.001) respectively. Pretraining and post-training scores improved significantly for all professions, and each measure, particularly self-efficacy. CONCLUSION This study demonstrates that SCOPE training could improve healthcare providers' knowledge, attitude and self-efficacy on smoking cessation intervention. Future training is recommended to equip healthcare providers with current knowledge, positive attitude and high self-efficacy to integrate what they have learned into practice successfully.
Collapse
Affiliation(s)
- Siti Idayu Hasan
- Social & Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Nicotine Addiction Research & Collaboration, UMCAS, University of Malaya, Kuala Lumpur, Malaysia
| | - Farizah Mohd Hairi
- Social & Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Nicotine Addiction Research & Collaboration, UMCAS, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Amani Ahmad Tajuddin
- Nicotine Addiction Research & Collaboration, UMCAS, University of Malaya, Kuala Lumpur, Malaysia
- Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Amer Siddiq Amer Nordin
- Nicotine Addiction Research & Collaboration, UMCAS, University of Malaya, Kuala Lumpur, Malaysia
- Psychological Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
8
|
Ockene JK, Ashe KM, Hayes RB, Churchill LC, Crawford SL, Geller AC, Jolicoeur D, Olendzki BC, Basco MT, Pendharkar JA, Ferguson KJ, Guck TP, Margo KL, Okuliar CA, Shaw MA, Soleymani T, Stadler DD, Warrier SS, Pbert L. Design and rationale of the medical students learning weight management counseling skills (MSWeight) group randomized controlled trial. Contemp Clin Trials 2018; 64:58-66. [PMID: 29128651 PMCID: PMC5745008 DOI: 10.1016/j.cct.2017.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 11/01/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
Physicians have an important role addressing the obesity epidemic. Lack of adequate teaching to provide weight management counseling (WMC) is cited as a reason for limited treatment. National guidelines have not been translated into an evidence-supported, competency-based curriculum in medical schools. Weight Management Counseling in Medical Schools: A Randomized Controlled Trial (MSWeight) is designed to determine if a multi-modal theoretically-guided WMC educational intervention improves observed counseling skills and secondarily improve perceived skills and self-efficacy among medical students compared to traditional education (TE). Eight U.S. medical schools were pair-matched and randomized in a group randomized controlled trial to evaluate whether a multi-modal education (MME) intervention compared to traditional education (TE) improves observed WMC skills. The MME intervention includes innovative components in years 1-3: a structured web-course; a role play exercise, WebPatientEncounter, and an enhanced outpatient internal medicine or family medicine clerkship. This evidence-supported curriculum uses the 5As framework to guide treatment and incorporates patient-centered counseling to engage the patient. The primary outcome is a comparison of scores on an Objective Structured Clinical Examination (OSCE) WMC case among third year medical students. The secondary outcome compares changes in scores of medical students from their first to third year on an assessment of perceived WMC skills and self-efficacy. MSWeight is the first RCT in medical schools to evaluate whether interventions integrated into the curriculum improve medical students' WMC skills. If this educational approach for teaching WMC is effective, feasible and acceptable it can affect how medical schools integrate WMC teaching into their curriculum.
Collapse
Affiliation(s)
- Judith K Ockene
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| | - Karen M Ashe
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| | - Rashelle B Hayes
- Department of Psychiatry, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, United States.
| | - Linda C Churchill
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| | - Sybil L Crawford
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States.
| | - Denise Jolicoeur
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| | - Barbara C Olendzki
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| | - Maria Theresa Basco
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Jyothi A Pendharkar
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| | - Kristi J Ferguson
- University of Iowa Carver College of Medicine, OCRME, 1204 MEB, Iowa City, IA 52242, United States.
| | - Thomas P Guck
- Creighton University School of Medicine, Department of Family Medicine, 2412 Cuming Street, Omaha, NE 68131, United States.
| | - Katherine L Margo
- Perelman School of Medicine at University of Pennsylvania, 3451 Walnut St, Philadelphia, PA 19104, United States.
| | - Catherine A Okuliar
- Medstar Georgetown University Hospital, Department of Internal Medicine, 3800 Reservoir Road N.W., PHC 5, Washington, DC 20007, United States.
| | - Monica A Shaw
- University of Louisville School of Medicine, 500 S Preston St, Louisville, KY 40202, United States.
| | - Taraneh Soleymani
- University of Alabama at Birmingham, 1720 2nd Ave South, Webb 646, Birmingham, AL 35294-3360, United States.
| | - Diane D Stadler
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR110, Portland, OR 97239, United States.
| | - Sarita S Warrier
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, United States.
| | - Lori Pbert
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| |
Collapse
|
9
|
Zhou C, Wu L, Liu Q, An H, Jiang B, Zuo F, Zhang L, He Y. Evaluation of smoking cessation intervention in patients with chronic diseases in smoking cessation clinics. Medicine (Baltimore) 2017; 96:e7459. [PMID: 29049178 PMCID: PMC5662344 DOI: 10.1097/md.0000000000007459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to evaluate the effects of psychological intervention and psychological plus drug intervention on smoking cessation among male smokers with single chronic diseases.A total of 509 male smokers were divided into psychological group (n = 290) and psychological plus drugs (n = 219) groups according to their will. The physicians provided free individual counseling and follow-up interviews with brief counseling for all the subjects. In addition to mental intervention, patients in psychological plus drug group also received bupropion hydrochloride or varenicline tartrate to quit smoking. Outcomes were self-reported, regarding the 7-day point prevalence on abstinence rate and continuous abstinence rates at 1-, 3-, and 6-month follow-up period. Data analyses were performed using intention-to-treat analysis and per protocol analysis.With regards to the 3 follow-up time points, 7-day point-prevalence abstinence rate in psychological plus drugs group was all higher than that in the psychological intervention group. Additionally, the 3-month continuous abstinence rate (21.4%) of the 6-month follow-up in the psychological group was not significantly higher than that (26.9%) in the psychological plus drugs group (P >.05 for all). Fagerström test score, stage of quitting smoking, perceived confidence or difficulty in quitting, and chronic disease types were independently correlated with 3-month continuous abstinence in the 6-month follow up (P <.05 for all). The results were similar between intentional analysis and protocol analysis.The psychological intervention and psychological plus drugs intervention exerted good effects on smoking cessation in a short time (1 month). Nevertheless, the advantages did not appear during long-time (6 months) follow-up.
Collapse
Affiliation(s)
- Changxi Zhou
- Department of Respiration, Chinese PLA General Hospital
| | - Lei Wu
- Department of Epidemiology, Institute of Geriatrics
| | - Qinghui Liu
- Department of Respiration, Chinese PLA General Hospital
| | - Huaijie An
- Central Laboratory of Navy General Hospital
| | | | | | - Li Zhang
- Department of Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Yao He
- Department of Epidemiology, Institute of Geriatrics
| |
Collapse
|
10
|
Lucas NCC, Walker N, Bullen C. Using a videotaped objective structured clinical examination to assess Knowledge In Smoking cessation amongst medical Students (the K.I.S.S. Study). MEDICAL TEACHER 2016; 38:1256-1261. [PMID: 27590001 DOI: 10.1080/0142159x.2016.1210116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Brief smoking cessation advice from physicians is an effective smoking cessation intervention and is therefore an important skill medical students should master. We sought to assess the ability of medical students at the University of Auckland, New Zealand at different stages of their clinical education to provide accurate smoking cessation advice. METHODS Seventy-five medical students participated in a five-minute videotaped objective structured clinical examination (VOSCE) with a standardized patient. We marked them using a 10-point scale based on the "5As" of smoking cessation, with a score of 7/10 or more considered a pass. We used the general inductive method to analyze student feedback for key themes. RESULTS The mean score was 5.81/10, with only 15 (20%) students reaching the pass mark. Qualitative analysis revealed three themes: students had breadth of knowledge but lacked depth; their preference was to prescribe medications; and students were unable to identify where further smoking cessation support could be sourced. DISCUSSION AND CONCLUSION University of Auckland medical students performed poorly when giving smoking cessation advice. Inclusion of smoking cessation education in the undergraduate curriculum is required to ensure all graduates are capable of providing evidence-based and accurate cessation advice.
Collapse
Affiliation(s)
- Nathanael C C Lucas
- a National Institute of Health Innovation, School of Population Health , The University of Auckland , Auckland , New Zealand
| | - Natalie Walker
- a National Institute of Health Innovation, School of Population Health , The University of Auckland , Auckland , New Zealand
| | - Chris Bullen
- a National Institute of Health Innovation, School of Population Health , The University of Auckland , Auckland , New Zealand
| |
Collapse
|
11
|
Bayefsky SD, Shah HH, Jhaveri KD. Nephrology education for medical students: a narrative review. Ren Fail 2016; 38:1151-9. [PMID: 27197981 DOI: 10.1080/0886022x.2016.1185352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Strategies used to teach nephrology to medical students are not well studied. This study assesses the published literature on medical student education in nephrology. METHODS A review of the published literature on nephrology education for medical students was conducted on two major online search engines (PubMed and ERIC). In addition, references of the manuscripts discovered in these searches were reviewed. The empirical studies were categorized by subject within nephrology and research design. RESULTS We found 26 original studies in which a method of teaching nephrology to medical students was described. The studies dated from 1977 to 2015. The focus of these nephrology teaching experiences was as follows: anatomy (6.5%), physiology (22.6%), pathophysiology (29.0%), pathology (6.5%), treatment (25.8%), and general nephrology (9.7%). The studies were also categorized into various types of research design. 6.9% had either no assessment of the educational experience or had a description too vague to categorize it; 3.4% involved a survey about the existing educational approach before a curriculum change was implemented; 55.2% used surveys or tests after an educational course was carried out; 10.3% sought feedback from students before and after the educational experience; 13.8% were case studies; and 10.3% included a randomized controlled trial. The randomized controlled trials involved teaching techniques focused on the pathophysiology of renal disease. CONCLUSIONS Rigor was lacking in most empirical studies on medical student education in nephrology. Well-designed randomized controlled studies are needed to accurately assess the effectiveness of the educational techniques introduced into medical school curricula.
Collapse
Affiliation(s)
| | - Hitesh H Shah
- a Hofstra Northwell School of Medicine , Hempstead , NY , USA ;,b Division of Kidney Diseases and Hypertension, Department of Medicine , North Shore University Hospital and Long Island Jewish Medical Center, Northwell Health , Great Neck , NY , USA
| | - Kenar D Jhaveri
- a Hofstra Northwell School of Medicine , Hempstead , NY , USA ;,b Division of Kidney Diseases and Hypertension, Department of Medicine , North Shore University Hospital and Long Island Jewish Medical Center, Northwell Health , Great Neck , NY , USA
| |
Collapse
|
12
|
A Call to Formalize Training in Tobacco Dependence Treatment for Pulmonologists. Ann Am Thorac Soc 2016; 13:460-1. [PMID: 27058182 DOI: 10.1513/annalsats.201512-815le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
13
|
Ockene JK, Hayes RB, Churchill LC, Crawford SL, Jolicoeur DG, Murray DM, Shoben AB, David SP, Ferguson KJ, Huggett KN, Adams M, Okuliar CA, Gross RL, Bass PF, Greenberg RB, Leone FT, Okuyemi KS, Rudy DW, Waugh JB, Geller AC. Teaching Medical Students to Help Patients Quit Smoking: Outcomes of a 10-School Randomized Controlled Trial. J Gen Intern Med 2016; 31:172-181. [PMID: 26391030 PMCID: PMC4720645 DOI: 10.1007/s11606-015-3508-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Early in medical education, physicians must develop competencies needed for tobacco dependence treatment. OBJECTIVE To assess the effect of a multi-modal tobacco dependence treatment curriculum on medical students' counseling skills. DESIGN A group-randomized controlled trial (2010-2014) included ten U.S. medical schools that were randomized to receive either multi-modal tobacco treatment education (MME) or traditional tobacco treatment education (TE). SETTING/PARTICIPANTS Students from the classes of 2012 and 2014 at ten medical schools participated. Students from the class of 2012 (N = 1345) completed objective structured clinical examinations (OSCEs), and 50 % (N = 660) were randomly selected for pre-intervention evaluation. A total of 72.9 % of eligible students (N = 1096) from the class of 2014 completed an OSCE and 69.7 % (N = 1047) completed pre and post surveys. INTERVENTIONS The MME included a Web-based course, a role-play classroom demonstration, and a clerkship booster session. Clerkship preceptors in MME schools participated in an academic detailing module and were encouraged to be role models for third-year students. MEASUREMENTS The primary outcome was student tobacco treatment skills using the 5As measured by an objective structured clinical examination (OSCE) scored on a 33-item behavior checklist. Secondary outcomes were student self-reported skills for performing 5As and pharmacotherapy counseling. RESULTS Although the difference was not statistically significant, MME students completed more tobacco counseling behaviors on the OSCE checklist (mean 8.7 [SE 0.6] vs. mean 8.0 [SE 0.6], p = 0.52) than TE students. Several of the individual Assist and Arrange items were significantly more likely to have been completed by MME students, including suggesting behavioral strategies (11.8 % vs. 4.5 %, p < 0.001) and providing information regarding quitline (21.0 % vs. 3.8 %, p < 0.001). MME students reported higher self-efficacy for Assist, Arrange, and Pharmacotherapy counseling items (ps ≤0.05). LIMITATIONS Inclusion of only ten schools limits generalizability. CONCLUSIONS Subsequent interventions should incorporate lessons learned from this first randomized controlled trial of a multi-modal longitudinal tobacco treatment curriculum in multiple U.S. medical schools. NIH Trial Registry Number: NCT01905618.
Collapse
Affiliation(s)
- Judith K Ockene
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Rashelle B Hayes
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Linda C Churchill
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Sybil L Crawford
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Denise G Jolicoeur
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - David M Murray
- Biostatistics and Bioinformatics Branch; Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Abigail B Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Sean P David
- Center for Education & Research in Family and Community Medicine, Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Kathryn N Huggett
- Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Michael Adams
- Department of Medicine, Georgetown University Hospital, Washington, DC, USA
| | | | - Robin L Gross
- Department of Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Pat F Bass
- Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Ruth B Greenberg
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Frank T Leone
- Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kola S Okuyemi
- Department of Family and Community Health, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - David W Rudy
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jonathan B Waugh
- Clinical and Diagnostics Sciences Department, School of Health Professions, UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| |
Collapse
|
14
|
Improving Tobacco Dependence Treatment Delivery: Medical Student Training and Assessment. Am J Prev Med 2015; 49:e9-e12. [PMID: 26091923 DOI: 10.1016/j.amepre.2015.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/23/2015] [Accepted: 04/15/2015] [Indexed: 11/21/2022]
Abstract
Tobacco dependence is a chronic condition, with cigarette smoking considered the leading cause of preventable death, disease, and disability in the U.S. Currently, the U.S. adult smoking rate is 17.8%. National surveys reveal that approximately half of all smokers who have been treated by a healthcare provider in the last 12 months received Public Health Service-recommended guideline-concordant tobacco dependence treatment. Although smoking prevalence has been declining, several disparate groups continue to smoke at rates significantly higher than the national average, including those with low income, low educational attainment, or mental health disorders. To address these disparities and more effectively address tobacco use, provision of guideline-concordant tobacco dependence treatment within the healthcare system must improve. We discuss changes to the medical licensing examination that may result in enhanced tobacco dependence treatment education and skills training for students in medical school.
Collapse
|
15
|
Xiao RS, Hayes RB, Waring ME, Geller AC, Churchill LC, Okuyemi KS, Adams M, Huggett KN, Ockene JK. Tobacco counseling experience prior to starting medical school, tobacco treatment self-efficacy and knowledge among first-year medical students in the United States. Prev Med 2015; 73:119-24. [PMID: 25666737 PMCID: PMC4378235 DOI: 10.1016/j.ypmed.2015.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/30/2014] [Accepted: 02/01/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To explore students' tobacco dependence counseling experiences prior to medical school and their associations with tobacco counseling self-efficacy, and familiarity with and perceived effectiveness of tobacco dependence treatment among first-year medical students in the United States. METHOD In 2010, 1266 first-year medical students from 10 US medical schools completed a survey reporting their clinical experiences with specific tobacco counseling skills (e.g., 5As) prior to medical school. The survey also included questions on tobacco counseling self-efficacy, perceived physician impact on smokers, and familiarity and effectiveness of tobacco-related treatments. RESULTS Half (50.4%) reported some tobacco counseling experiences prior to medical school (i.e. at least one 5A). Students with prior counseling experiences were more likely to have higher tobacco counseling self-efficacy, and greater familiarity with medication treatment, nicotine replacement treatment, and behavioral counseling for smoking cessation, compared to those with no prior experiences. Perceived physician impact on patient smoking outcomes did not differ by prior tobacco counseling experiences. CONCLUSIONS Many first-year medical students may already be primed to learn tobacco dependence counseling skills. Enhancing early exposure to learning these skills in medical school is likely to be beneficial to the skillset of our future physicians.
Collapse
Affiliation(s)
- Rui S Xiao
- Clinical and Population Health Research Program, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA; Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA.
| | - Rashelle B Hayes
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, USA
| | - Molly E Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Linda C Churchill
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, USA
| | - Kolawole S Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michael Adams
- Division of General Internal Medicine, Department of Medicine, Georgetown University Hospital, USA
| | | | - Judith K Ockene
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, USA
| |
Collapse
|
16
|
Hayes RB, Geller AC, Crawford SL, Jolicoeur DG, Churchill LC, Okuyemi KS, David SP, Adams M, Waugh J, Allen SS, Leone FT, Fauver R, Leung K, Liu Q, Ockene JK. Medical school curriculum characteristics associated with intentions and frequency of tobacco dependence treatment among 3rd year U.S. medical students. Prev Med 2015; 72:56-63. [PMID: 25572623 PMCID: PMC4562320 DOI: 10.1016/j.ypmed.2014.12.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/20/2014] [Accepted: 12/26/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Physicians play a critical role in addressing tobacco dependence, yet report limited training. Tobacco dependence treatment curricula for medical students could improve performance in this area. This study identified student and medical school tobacco treatment curricula characteristics associated with intentions and use of the 5As for tobacco treatment among 3rd year U.S. medical students. METHODS Third year medical students (N=1065, 49.3% male) from 10 U.S. medical schools completed a survey in 2009-2010 assessing student characteristics, including demographics, tobacco treatment knowledge, and self-efficacy. Tobacco curricula characteristics assessed included amount and type of classroom instruction, frequency of tobacco treatment observation, instruction, and perception of preceptors as role models. RESULTS Greater tobacco treatment knowledge, self-efficacy, and curriculum-specific variables were associated with 5A intentions, while younger age, tobacco treatment self-efficacy, intentions, and each curriculum-specific variable were associated with greater 5A behaviors. When controlling for important student variables, greater frequency of receiving 5A instruction (OR=1.07; 95%CI 1.01-1.12) and perception of preceptors as excellent role models in tobacco treatment (OR=1.35; 95%CI 1.04-1.75) were significant curriculum predictors of 5A intentions. Greater 5A instruction (B=.06 (.03); p<.05) and observation of tobacco treatment (B=.35 (.02); p<.001) were significant curriculum predictors of greater 5A behaviors. CONCLUSIONS Greater exposure to tobacco treatment teaching during medical school is associated with both greater intentions to use and practice tobacco 5As. Clerkship preceptors, or those physicians who provide training to medical students, may be particularly influential when they personally model and instruct students in tobacco dependence treatment.
Collapse
Affiliation(s)
- Rashelle B Hayes
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States
| | - Sybil L Crawford
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Denise G Jolicoeur
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Linda C Churchill
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kolawole S Okuyemi
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Sean P David
- Center for Education & Research in Family and Community Medicine, Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Michael Adams
- Division of General Internal Medicine, Department of Medicine, Georgetown University Hospital, United States
| | - Jonathan Waugh
- Department of Clinical and Diagnostics Sciences/UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sharon S Allen
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Frank T Leone
- Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Randy Fauver
- Center for Education & Research in Family and Community Medicine, Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Katherine Leung
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Qin Liu
- Wistar Institute, Philadelphia, PA, United States
| | - Judith K Ockene
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| |
Collapse
|