RCT for Smoking Cessation in 10 Medical Schools

描述（由申请人提供）：每年吸烟导致43万美国公民死亡，使各种疾病恶化，并使社会损失约1000亿美元。尽管信息的扩散和限制吸烟的政策，成人吸烟率在过去五年中保持相对稳定，目前为21%。医生提供的简短烟草治疗，通常被称为“5a”，是一种基于证据的干预措施，被证明可以使吸烟者戒烟的可能性增加一倍。鉴于每年有70%的吸烟者看医生，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。然而，很少有医生和实习医生接受过充分的培训来发展这些技能。采用配对、随机分组对照（RGC）设计（在10所医学院实施），我们将比较两种向医学生教授5a的方法：1)传统医学教育（TE）和2)多模式教育（MME），多模式教育为TE增加了两个组成部分：基于网络的学生教学计划和导师培训。主要结果是观察烟草治疗咨询技能，通过客观结构化临床检查（OSCE）测量，这是评估所有美国医学院医学生技能水平的标准方法。第二个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，一组医科学生将从医学院第一年（MS1）的早期开始，一直跟踪到他们第三年（MS3）的结束，这是在研究的第四年。RGC试验的主要目的是比较MME在医学院教授5a咨询技能和TE的效果。假设1：在观察到的5As咨询技能（OSCE）上，MME将优于TE。假设2:MME在自我报告的5a咨询技巧上优于TE。这项研究的优势包括：1)创新的研究设计，测试了常见的和综合的教学方法；2)在美国医学院传播有效的教育方法的潜力，可以培养医生的技能，以帮助数百万继续吸烟的患者。这是我们团队在医学教育和烟草依赖治疗方面的先前研究基础上的一个独特机会。这项研究涉及美国10所医学院的研究人员、从业人员、教育工作者和利益相关者之间的密切合作。这个独特的团队由具有丰富经验的研究人员组成，他们开发和教授循证、医生提供的5A烟草治疗模式；开发和评估基于网络的烟草依赖治疗课程；与医师导师一起实施学术细节；并有建立大型医学院烟草课程改革联盟的经验。公共卫生相关性：每年，吸烟导致43万美国公民死亡，使各种疾病恶化，并使社会损失约1000亿美元。医生提供的简短戒烟咨询，通常被称为“5a”，是一种基于证据的干预策略，已被证明可使吸烟者戒烟的可能性增加一倍。尽管每年有70%的吸烟者看医生，但很少有医生熟练掌握戒烟治疗，因此所有临床医生和所有在职医生必须具备适当的知识和技能水平，以便为吸烟患者提供咨询。本小组随机试验在10所医学院进行，目的是测试两种情况下使用不同方法对医学生进行5a（询问、建议、评估、协助和安排）教学的有效性，以观察和报告医学生的咨询行为。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Each year, smoking kills 430,000 U.S citizens, exacerbates myriad diseases, and costs society approximately $100 billion. Brief physician-delivered tobacco cessation counseling, commonly known as "the 5As", is an evidence-based intervention strategy that has been shown to double a smoker's likelihood of quitting. Although 70% of smokers see a physician each year, few physicians are skilled in tobacco cessation treatment, making it imperative that all clinicians and all physicians-in-training have the appropriate knowledge and skill level to counsel their patients who smoke. The goal of this group randomized trial conducted at 10 medical schools is to test the effectiveness of two conditions using different methods for teaching the 5As (Ask, Advise, Assess, Assist, and Arrange) to medical students on their observed and reported counseling behaviors.