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Current Efforts and Gaps in US Medical Schools

John G. Spangler, MD, MPH; Geeta George, MPH; Kristie Long Foley, PhD; Sonia J. Crandall, PhD

JAMA. 2002;288:1102-1109.

Context  Research has documented that US medical schools inadequately teach tobacco intervention skills.

Objective  To examine effective training methods for tobacco intervention in undergraduate medical education.

Data Sources  Using indexing terms related to tobacco intervention and medical education, we searched MEDLINE (1966–June 2002) and the Cochrane Database of Systematic Reviews (through issue 2, 2002). Reference lists of relevant articles were also read to identify additional articles. Because of their importance to tobacco intervention, we also reviewed Ockene and colleagues' tobacco education research and the tobacco treatment guidelines of the United States Public Health Service and the United States Preventive Services Task Force.

Study Selection  All study designs that incorporated process or outcome evaluation of tobacco intervention educational methods for medical students were included in this review. Of an initial 1241 articles retrieved, 82 included medical students. Reviewing abstracts and references of these articles identified 13 pertinent studies.

Data Extraction  Quality criteria for inclusion consisted of explicit evaluation of the educational methods used. Data extraction identified all evaluations and any problems in program implementation.

Data Synthesis  Enhanced instructional methods (eg, the use of patient-centered counseling, standardized patient instructors, role playing, or a combination of these) are more effective for teaching tobacco intervention than are traditional didactic methods alone and can be effectively inserted into medical school curricula.

Conclusions  Various educational methods have been used to train medical students in tobacco intervention. Nonetheless, gaps still exist within undergraduate medical education, including a lack of integration of tobacco dependence information throughout all 4 years of medical school curricula, specific training in smokeless tobacco intervention, tobacco intervention training that addresses cultural issues, and long-term studies showing that such training is retained.

Author Affiliations: Department of Family and Community Medicine (Drs Spangler and Crandall) and Department of Public Health Sciences (Dr Foley), Wake Forest University School of Medicine, Winston-Salem, NC; and Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, Houston (Ms George).

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