Training and Evaluating Tobacco-specific

Tobacco use is the leading cause of preventable death in the United States. Despite the well-known health hazards of tobacco, about one fourth of the US popu-lation smokes cigarettes.1,2 In addition, cigarette and smokeless tobacco use may be increasing among cer-tain demographic groups,3-7 and the national per capita consumption of smokeless tobacco has tripled in the past several decades.8 Most smokers would like their health care provider to help them quit smoking, but clinicians often feel inadequately trained to provide the help that addicted tobacco users need.9-12 In fact, research has documented that US medical schools are inadequately preparing graduates to deal with tobacco dependence.9,10 Explicit national guidelines are available to train physicians in tobacco cessation.13 Various methods, such as the traditional didactic approach, patient-cen-tered methods, role playing, and the use of standardized patient instructors (SPIs), have also been developed and used with varying degrees of success in training medical students in tobacco cessation counseling.10 Using SPIs is a method that has proven especially suc-cessful.14-18 SPIs are lay individuals trained to act as patients to teach medical students, residents, and physicians history-taking skills and interviewing and counseling techniques. Few resources are available, however, to train these lay individuals to become tobacco-specific SPIs who can reliably and effectively integrate into medical education. As a result, medical educators rely on their own knowledge and skills to provide such training and evaluation of their SPI program(s). This article describes the training, use, and evaluation of tobacco-intervention SPIs in undergraduate medica