Medical students' use of the stages of change model in tobacco cessation counseling

BACKGROUND: Many medical schools have incorpo-rated the Stages of Change Model into their curricula with specific application to tobacco cessation. OBJECTIVE: This study examined the extent to which medical students were prepared to provide stage-based interventions to treat nicotine dependence. DESIGN: Using a quasi-experimental design, medical students ’ counseling interactions were evaluated with a standardized patient portraying a smoker in either the precontemplation or preparation stage of change. PARTICIPANTS: Participants were 147 third-year med-ical students at the University of California, San Francisco. MEASUREMENTS: Checklists completed by standard-ized patients evaluated students ’ clinical performance. Surveys administered before and after the encounters assessed students ’ knowledge, attitudes, confidence and previous experience with treating smoking. RESULTS: Most students asked about tobacco use (89%), advised patients of the health benefits of quitting (74%), and assessed the patient’s readiness to quit (76%). The students were more likely to prescribe medications and offer referrals to patients in the preparation than in the precontemplation stage of change (P <0.001); however, many students had diffi-culty identifying patients ready to quit, and few encour-aged patients to set a quit date or arranged follow-up to assess progress. Students ’ tobacco-related knowledge, but not their attitudes, confidence, or previous experi-ence predicted their clinical performance. CONCLUSIONS: The findings indicated evidence of students tailoring their counseling strategies to the patients ’ stage of change; however, they still could do more to assist their patients in quitting. Additional training and integration of cessation counseling into clinical rotations are needed. KEY WORDS: tobacco treatment; smoking cessation; medical education; training; standardized patients; stages of change model