Group randomized trial of teaching tobacco-cessation counseling to senior medical students: a peer role-play module versus a standardized patient module

Education for Tobacco Use Disorder Treatment: Current State, Evidence, and Unmet Needs

Background

Tobacco use is undertreated in the medical setting. One driver may be inadequate tobacco use disorder treatment (TUDT) training for clinicians in specialties treating tobacco-dependent patients.

Objective

We sought to evaluate the current state of TUDT training for diverse professionals and how these skills are assessed in credentialing exams.

Methods

We performed a focused review of current educational practices, evidence-based strategies, and accreditation exam contents focused on TUDT.

Results

Among medical students, participants in reviewed studies reported anywhere from 45 minutes to 3 hours of TUDT training throughout their 4-year programs, most often in the form of didactic sessions. Similarly, little TUDT training was reported at the post-graduate (residency, fellowship, continuing medical education) levels, and reported training was typically delivered as time-based (expected hours of instruction) rather than competency-based (demonstration of mastery) learning. Multiple studies evaluated effective TUDT curricula at varied stages of training. More effective curricula incorporated longitudinal sessions and active learning, such as standardized patient encounters or proctored patient visits. Knowledge of TUDT is minimally evaluated on certification exams. For example, the American Board of Internal Medicine blueprint lists TUDT as <2% of one subtopic on both the internal medicine and pulmonary exams.

Conclusion

TUDT training for most clinicians is minimal, does not assess competency, and is minimally evaluated on certification exams. Effective, evidence-based TUDT training incorporating active learning should be integrated into medical education at all levels, with attention paid to inclusion on subsequent certifying exams.

Adaptation, implementation, and evaluation of an online health sciences training program for brief smoking intervention: A pre-post study in four European countries

BACKGROUND

Tobacco cessation intervention has a positive impact on quality of care. For health professionals, limited competency in this area may be associated with poor training during their academic programs. There is a clear need to further develop and implement training programs to improve tobacco cessation knowledge, skills, and attitudes among healthcare students.

OBJECTIVES

The aim of this study was to assess the effectiveness of the innovative online training program "Brief Intervention in Smoking Cessation" for healthcare students to improve their knowledge, skills, and attitudes.

DESIGN

A pre-post evaluation study with a satisfaction assessment tool was used.

SETTING

Seven universities from four European countries, including Belgium, Portugal, Spain, and the United Kingdom, participated.

PARTICIPANTS

One thousand and seventy-two (1072) undergraduate students participated, with 851 completing the online program.

METHODS

All participants completed the "Brief Intervention in Smoking Cessation" online program, which consisted of five theoretical modules, five videos, and three virtual simulation cases between January 2020 and June 2022. Knowledge was assessed by a multiple-choice test, and practical skills were assessed by a simulation algorithm, both of which were developed by education and smoking cessation experts. Competency was achieved when students successfully completed both assessments. Satisfaction was measured using an ad hoc 16-item questionnaire. Pre-post changes in knowledge were assessed using a paired Student's t-test.

RESULTS

Eighty-six percent of the students achieved smoking cessation competency. Students significantly improved their knowledge score on a scale of 0 to 10 points, with a mean pre-program score of 3.79 vs a mean post-program score of 7.33 ([-3.7 - -3.4] p < 0.001), acquiring sufficient attitudes and skills (simulation mean of 7.4 out of 10 points). Students were highly satisfied with the program (8.2 out of 10) and recommended it to other students (8.4 out of 10).

CONCLUSIONS

The "Brief Intervention in Smoking Cessation" online training program is effective for the acquisition of smoking cessation competencies among European health profession students.

Effects of a Smoking Cessation Counseling Education Program on Nursing Students

This is a quasi-experimental study applying a nonequivalent control group pre-test-post-test design with the control of exogenous variables to compare the research variables among experimental groups. Participants totaled 67 and were divided into three groups, each participating in a different training program (lecture, online video, and case-based peer role-play). There were significant increases in attitudes toward smoking cessation interventions in Experiment 2 (online video) (t = -2.48, p = .021) and Experiment 3 (case-based peer role-play) (t = -2.69. p = .013), efficacy of smoking cessation interventions in Experiment 2 (-2.06, p = .052), and intention to deliver smoking cessation intervention in all experimental groups (Exp 1 t = -5.54, p < .001; Exp 2 t = -2.83, p = .010; Exp 3 t = -3.50, p = .002). All three programs of smoking cessation counseling education (lecture, online video, and case-based peer role-play) used in this study showed meaningful results on the study variables. In conclusion, all of the approaches of this study were found to be effective on the intention to deliver smoking cessation intervention, and it is important to creatively apply counseling programs that include essential elements of smoking cessation interventions in nursing education settings.

Tobacco Cessation Curriculum in Medical Schools: a Scoping Review

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.

Strategies to tackle non-communicable diseases in Afghanistan: A scoping review

Non-communicable diseases (NCDs) and their risk factors are the leading cause of death worldwide and contribute to 74.3% of deaths globally in 2019. The burden of NCDs is escalating in Afghanistan. Currently, every seconds, people in Afghanistan are dying of NCDs. Addressing this challenge in Afghanistan needs effective and practical interventions. This study aimed to identify the strategies developed and implemented in countries with low non-communicable premature death. To conduct a scoping review, we followed the six-step Arksey and O'Malley protocol and searched for eligible articles on eight international databases and the gray literature. The study followed the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. The inclusion criteria were English documents and evidence produced up to 30 November 2021 for the control of NCDs. We excluded incomplete texts, duplicates, and dissertations due to lack of access. We used EndNote X9 and MaxQDA software for data management and analysis. We conducted content analysis for this study. A total of 122 documents developed between 1984 and 2021 met the inclusion criteria. We identified 35 strategies from which the most used strategies were related to unhealthy diets and smoking cessation programs. Canada (26.4%), Korea (19.8%), and the United Kingdom (19%) have the most publications on the control and prevention of NCDs among the countries included in the study. Most strategies were implemented over 2 years (41%). This study recommends specific interventions to control and prevent NCDs for the main risk factors of tobacco use, unhealthy diet, physical inactivity, and the main non-communicable diseases such as heart diseases, cancers, diabetes, and chronic obstructive pulmonary diseases. Afghanistan Ministry of Public Health, the WHO country office, and other involved stakeholders can use the findings of this review to design and implement strategies for controlling and preventing NCDs in Afghanistan. International organizations such as the World Health Organization, United Nations Agencies, the World Bank, and other involving communities should invest in strengthening good health governance in Afghanistan. The Afghan Government should focus on promoting and funding health literacy among the public and self-care to control and prevent NCDs.

Perceptions and preparedness toward tobacco cessation counseling amongst clinical medical students in Chongqing, Southwest China: A cross-sectional study

Background

Medical students play an indispensable role in providing smoking cessation counseling. Despite the rapid increase in tobacco use, there is little data on what Chinese medical students know or are taught about it. This study aims to investigate the relationship between medical students' tobacco education level, clinical experience, and tobacco cessation counseling (TCC) provided by medical students.

Methods

This cross-sectional study was carried out among clinical medical students of Chongqing medical university. An anonymous, self-administered questionnaire included items on demographic information, perceptions, and perceived preparedness, clinical medical students' self-reported level of education about alternative tobacco products, and traditional cigarettes. We assessed their perspectives toward TCC using a 5-point Likert scale. Descriptive and binary logistic regression analyses were carried out.

Results

A total of 1,263 medical students completed the questionnaire. The majority of students (85%) expressed a willingness to provide TCC to patients in need. However, only half of the students stated unequivocally that they knew some ways and methods of tobacco cessation, while 18% stated that they did not know methods of tobacco cessation. Tobacco education and clinical experience were significantly associated with the ability to provide TCC. Our findings revealed that students with more clinical experience (undergraduates: B = 0.326, P &lt; 0.001; postgraduates: B = 0.518, P &lt; 0.001) were significantly more likely to have a greater self-reported comprehensive ability to provide TCC.

Conclusion

Tobacco education and clinical experience can enhance the ability of medical students to provide smoking cessation counseling. There is a need to focus on alternative tobacco products with changing times, and curriculum planners should collaborate to incorporate comprehensive tobacco prevention and cessation training into the medical school curriculum.

Firearm Safety Counseling for Patients: An Interactive Curriculum for Trauma Providers

INTRODUCTION

Firearm injuries are a major public health concern. Safe firearm storage is recommended by multiple medical organizations. However, rates of firearm safety counseling are particularly low among trauma providers. Educational initiatives for other provider groups have proven to be effective. We hypothesized that educating trauma providers to offer safety counseling would be similarly effective.

METHODS

We developed a didactic session around safe firearm storage counseling for trauma providers consisting of a lecture followed by an interactive session with standardized patients. Session participants completed pre- and postsurveys evaluating their knowledge about firearm storage, self-efficacy in providing firearm storage counseling, and attitudes towards firearm safety. We compared differences between pre- and postsurvey data using chi-square tests.

RESULTS

The didactic session was delivered to target trauma providers: three trauma nurse practitioners, 42 general surgery residents, and 26 emergency medicine residents. After the session, participants were more likely to know the optimal way to safely store a firearm and to be confident in effectively counseling patients about safe firearm storage. Learners were not more likely to believe that providers have a responsibility to counsel patients on firearm safety.

DISCUSSION

A didactic session on safe firearm storage counseling was associated with increased rates of knowledge and self-efficacy. The session did not change attitudes among trauma providers, although, prior to the session, most providers already believed they had a responsibility to counsel patients on safe firearm storage. Similar curricula should be piloted at other trauma centers.

Assessment of an intensive education program for pharmacists on treatment of tobacco use disorder using an objective structured clinical examination: a randomized controlled trial

BACKGROUND

Tobacco use is one of the major public health threats globally. Community pharmacists are uniquely positioned to offer tobacco cessation services owing to their easy accessibility by the public. To prepare Qatar community pharmacists to develop the competencies and skills required to offer smoking cessation services, an intensive tobacco control education program was designed and implemented. The study aimed to assess the impact of the tobacco education program on the pharmacists' skills and competence.

METHODS

A random sample of community pharmacists in Qatar was chosen for participation in the program. Consenting participants were randomly assigned to either intervention or control groups. The intervention group received an intensive education program on treatment of tobacco-use disorder, while a short didactic session on a non-tobacco-related topic was delivered to the control group. The pharmacists' tobacco cessation skills and competencies were assessed using an Objective Structured Clinical Examination (OSCE).

RESULTS

A total of 54 and 32 community pharmacists in the intervention group and the control group, respectively, completed the OSCE. The intensive tobacco education group achieved significantly higher total scores than the control group in all the OSCE cases. Specifically, the mean total scores for the intervention group were 15.2, 15.3, 14.2, 14.6, 16.3, and 15.2 compared to 8.8, 6.2, 7.7, 9.2, 8.3, and 11.3 for the control group (p < 0.001) for cases one to six respectively.

CONCLUSION

The study demonstrated that an intensive tobacco cessation education program can improve pharmacists' tobacco cessation skills and increase their tobacco cessation counseling abilities.

TRIAL REGISTRATION

Clinical Trials NCT03518476 ( https://clinicaltrials.gov/ct2/show/NCT03518476 ) Registration date: May 8, 2018.

Educational effectiveness of simulation in teaching health science students Smoking cessation: A Systematic Review

BACKGROUND

Simulation is one of the educational tools that can be used in the learning process to help with smoking cessation.

AIM

To synthesize all the publications studying the contribution of simulation as an educational tool in the acquisition of skills to help with smoking cessation.

METHODS

We performed a systematic review of the Francophone and Anglophone literature over the past 24 years (1997 to 2020) using the PubMed, Science Direct and Cochrane Library databases.

RESULTS

A total of 14 articles were included. The most used methods were thestandardized patient, role play and video projection with discussion. The simulation hasnot only proved its effectiveness in terms of acquiring knowledge and self-confidencein the management of the smoking patient in the short term, but also in the acquisition of verbal and non-verbal skills in the long term.

CONCLUSION

This review highlighted the interest of simulation as an educational tool to acquire skills to help with smoking cessation regardless of the method used.

Understanding Patient Evaluation of Abnormal Uterine Bleeding (AUB): A Standardized Patient Case on AUB for OB/GYN Clerkship Students

INTRODUCTION

The differential diagnosis for abnormal uterine bleeding (AUB) among reproductive-age women is broad and includes common and life-threatening conditions. Recognition and accurate diagnosis of AUB are important but can be challenging for medical students. We developed a standardized patient (SP) encounter for medical students during their OB/GYN clerkship.

METHODS

We implemented two SP encounters, on AUB and dyspareunia, that included a postencounter note and SP evaluations. Here, we describe the implementation of the SP encounter on AUB. Students received formative feedback on their interpersonal and history-taking skills, differential diagnosis, and management plan from the SP as well as OB/GYN residents and faculty. Student cumulative feedback was obtained mid-clerkship and following the clerkship. Summary statistics and qualitative data for students' experiences are reported.

RESULTS

SP cases were implemented at the Duke University School of Medicine with 101 second-year medical students who completed the encounter from September 2018 to July 2019. Regarding the AUB case, SPs identified students as adequate history takers, with a mean evaluation score of 3.45 (SD = 0.15) out of 5. Most students (94%) correctly identified at least one diagnosis and provided evidence. Endometrial cancer/hyperplasia (63%) and uterine leiomyoma (60%) were most likely to be identified. Regarding both SP encounters, of the 82 students (81%) completing the end-of-clerkship survey, 57% indicated that the experience enhanced their overall learning at least adequately well or better.

DISCUSSION

The AUB case provided students with the opportunity to exercise their diagnostic and management skills.

Effects of education methods on self-efficacy of smoking cessation counseling among medical students

Background

Medical students need to receive training in providing smoking cessation counseling to provide effective smoking cessation interventions to smokers when they become doctors. This study examined the smoking cessation education curricula and factors affecting counseling self-efficacy (CSE) in smoking cessation treatment among medical students.

Methods

In a multicenter cross-sectional study, we obtained demographic information, personal history of tobacco use and intention to quit smoking, exposure to secondhand smoke in the school premises during the past week, the experience of learning about tobacco in each medical school, tobacco-related medical knowledge, and self-efficacy in smoking cessation counseling on medical students of four Korean medical schools.

Results

Among 1,416 medical students eligible, 313 (22.1%) students completed a self-administered questionnaire. Only 20.3% of the students reported positive CSE on smoking cessation. The factors affecting positive CSE were scores of ≥ 60 on tobacco-related medical knowledge, smoking experience, and blended learning (p = 0.014, 0.005, and 0.015, respectively).

Conclusion

This study shows that high scores in tobacco-related medical knowledge and blended learning are correlated with positive CSE for smoking cessation counseling.

Can smoking cessation be taught online? A prospective study comparing e-learning and role-playing in medical education

OBJECTIVES

We compared the effect of different didactic formats - e - learning and role-playing - on medical students' knowledge and counselling skills in smoking cessation training.

METHODS

At a German medical school, 145 third-year students were randomly allocated to attend an online course with video examples or an attendance course with role-playing. Students were trained in smoking cessation counselling according to the 5A's (ask, advise, assess, assist, arrange) for approximately 90 minutes. Practical skills were measured in an objective structured clinical examination (OSCE) and represent the primary endpoint of this prospective comparative study. Additionally, changes in theoretic knowledge were assessed by pre - and post - interventional questionnaires and a final written exam.

RESULTS

In the OSCE, overall scores were higher in the attendance group (Mdn=70.8 % vs. 62.8 %; U=119; p=.087, n=36), but a statistical advantage was only found in one single counselling sequence ("Assist": Mdn=66.7 % vs. 51.4 %; p = .049) and the rating of the standardised patients (M=4.7 vs. 4.2 out of 5 points, t_(27.836)=2.0, p=.028). Students' results (n=130) from self-assessment and written exams suggest that both approaches are equally well suited to increase theoretical knowledge. The online course was more time efficient (90 vs. 73 minutes).

CONCLUSIONS

Seminar and web-based training seem equally well suited for transferring knowledge and skills on tobacco cessation counselling. Considering their particular strengths, these two teaching approaches could be combined.

Consensus Document on Medical Faculty Education on the Treatment of Smoking

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.

‘It’s the ultimate observer role…you’re feeling and seeing what’s happening to you’: students’ experiences of peer simulation

Introduction

Simulation-based education (SBE) benefits learners, but multiple barriers limit curriculum integration. Peer simulation, where students are formally educated to portray patient roles in simulated interactions with their peers, might maintain the educational benefits of SBE, be cost-effective, and enable additional learning. Our research question was: ‘What are the perspectives and experiences of physiotherapy students who participated in peer simulation?’.

Methods

Second-year physiotherapy students (n=16) participated in a blended peer simulation programme that included preparation for patient role portrayal and simulated clinical interactions with peers. Using an interpretivist approach, students’ experiences and perspectives were explored in two focus groups. Inductive thematic analysis was completed by two researchers.

Results

Three primary themes were identified that characterised the experiences and perspectives of physiotherapy students: peer simulation is a valuable learning experience, specific design features enable effective peer simulation, and portraying a patient provides unique insight. Peer simulation was unexpectedly realistic, revealed knowledge and skill deficits, and improved their clinical skills. Specific design features included consistent engagement, repetitive, individualised practice, multiple forms of feedback, and detailed role preparation. Being the patient in peer simulation gave students unique and valuable insight into patients’ experiences of and feelings about health issues and healthcare interactions.

Conclusion

Physiotherapy students acquire new insights during peer simulation that may enrich their capabilities for practice through understanding healthcare interactions from patients’ perspectives. Physiotherapy students’ learning in peer simulation appears to align with the powerful learning experiences of health professional students in other immersive simulation modalities.

Adverse Event Disclosure Training for Nursing Students: Peer Role-Play and Simulated Patients

Background Simulation has proven valuable in nursing communication training, but there are limited studies comparing the effectiveness of different training methods, especially in the area of adverse event disclosure (AED) training. Therefore, this study aimed to examine the impact of two training methods, peer role-play (PRP) and simulated patients (SP) on the self-efficacy and performance of nursing students in AED in a simulated environment. Methods Forty-four nursing students participated. Students' self-efficacy toward AED was assessed using the pre/post-test method. Also, students' performance was evaluated after the simulation encounter. Results It showed a significant difference in self-efficacy between the groups. However, no significant difference emerged between the groups in performance. Conclusion This study provides a basis for comparison of these two methods in patient communication training. Educators should consider their resources and expected learning outcomes in designing the emotionally draining adverse event disclosure training.