RCT for Smoking Cessation in 10 Medical Schools

6.摘要 每年吸烟导致43万美国公民死亡，加剧了无数疾病，并使社会付出代价。 大约1000亿美元。尽管信息的扩散和限制吸烟的政策，成人 在过去五年，吸烟率保持相对稳定，目前为21%。医生简介- 提供的烟草治疗，通常被称为“5A”，是一种基于证据的干预措施， 使吸烟者戒烟的可能性增加一倍。考虑到70%的吸烟者每年都会去看医生， 所有临床医生都必须具备适当的知识和技能水平来为吸烟者提供咨询。但很少 医生和实习医生接受适当培训，以发展这些技能。使用配对的， 随机分组对照（RGC）设计（在10所医学院实施），我们将比较两个 对医学生进行5A教学的方法：1）传统医学教育（TE）和2）多模式 教育（MME），增加了两个组成部分，TE：一个基于网络的教学计划，为学生和 教师培训主要结果是观察烟草治疗咨询技能， 客观结构化临床考试（OSCE），评价医学生技能的标准方法 在美国所有的医学院。次要结果是自我报告的烟草治疗咨询技能水平。 在嵌套队列设计中，在研究的第二年，将跟踪一组医学生 从医学院第一年（MS 1）开始，到第三年（MS 3）结束， 研究的第四年。这项研究资助委员会试验的主要目的是比较MME对 在医学院教5A咨询技巧来对付TE 假设1：MME在观察到的5A咨询技能（OSCE）方面优于TE。 假设2：MME在自我报告的5A咨询技能方面优于TE。 本研究的优势在于：1）创新性的研究设计，测试了共同性和整合性的教学 方法和2）在整个美国医学院传播有效教育方法的潜力， 可以培养医生的技能，帮助数百万继续吸烟的病人。 这是一个独特的机会之窗，可以建立在我们团队先前在医学教育方面的研究基础上， 烟草依赖治疗这项研究涉及研究人员，从业人员， 美国10所医学院的教育工作者和利益相关者。这个独特的团队由调查人员组成， 在开发和教授基于证据的、由医生提供的5A烟草治疗方面拥有丰富的经验 模型;开发和评估基于网络的烟草依赖治疗课程;实施 学术细节与医生导师;和经验，建立一个大型医学院联盟， 烟草课程改革。

6. Abstract Each year smoking kills 430,000 U.S citizens, exacerbates a myriad of diseases, and costs society approximately $100 billion. Despite the proliferation of information and restrictive smoking policies, adult smoking prevalence has remained relatively stable during the past five years, currently at 21%. Brief physician- delivered tobacco treatment, commonly known as "the 5As", is an evidence-based intervention demonstrated to double a smoker's likelihood of quitting. Given that 70% of smokers see a physician each year, it is imperative that all clinicians have the appropriate knowledge and skill level to counsel smokers. However, few physicians and physicians-in-training receive adequate training to develop these skills. Using a pair-matched, randomized group-controlled (RGC) design (implemented in 10 medical schools), we will compare two methods of teaching the 5As to medical students: 1) traditional medical education (TE), and 2) multi-modal education (MME) that adds two components to TE: a web-based instructional program for students and preceptor training. The primary outcome is observed tobacco treatment counseling skill as measured by the Objective Structured Clinical Examination (OSCE), the standard method for evaluating medical student skill level at all U.S. medical schools. A secondary outcome is self-reported tobacco treatment counseling skill level. In a nested cohort design, during the second year of the study a cohort of medical students will be followed from early in their first year of medical school (MS1) through the end of their third year (MS3) which occurs in the 4th year of the study. The Primary Aim of this RGC trial is to compare the effectiveness of MME for teaching the 5As counseling skills in medical school against TE. Hypothesis 1: MME will outperform TE on observed 5As counseling skills (OSCE). Hypothesis 2: MME will outperform TE on self-reported 5As counseling skills. Strengths of this study include: 1) the innovative study design that tests common and integrative teaching methods and 2) the potential to disseminate throughout US medical schools effective educational methods that can build physicians' skills to assist the millions of patients who continue to smoke. This is a unique window of opportunity to build on our team's prior research in medical education and tobacco dependence treatment. This study involves close collaboration among researchers, practitioners, educators, and stakeholders at 10 U.S. medical schools. This unique team is comprised of investigators with extensive experience developing and teaching an evidence-based, physician-delivered 5A tobacco treatment model; developing and evaluating a web-based tobacco dependence treatment course; implementation of academic detailing with physician preceptors; and experience in building a large medical school consortium for tobacco curriculum reform.