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Rationale

Smoking is a major public health issue because it causes or aggravates many serious illnesses. Effective intervention strategies for chronic smokers have been developed using principals of behavioral counseling. These principals are applicable to other risky health behaviors. Health behavior risk assessment and intervention is now an expected physician behavior for the comprehensive care of the adult. Selecting and performing an appropriate smoking cessation intervention is an important training problem for the third year medical student.

Prerequisites

Prior knowledge, skills and attitudes acquired during the pre-clinical (basic science) years should include:

  1. risks of smoking, passive smoke and smokeless tobacco
  2. pharmacology of addictive drugs
  3. attitudes regarding reasons for discontinuing smoking

Specific Learning Objectives

  1. Knowledge: Students should be able to define and describe:
    1. the pharmacological effects of nicotine
    2. nicotine withdrawal symptoms
    3. intervention strategies that physicians can use for their patients
    4. symptoms indicating nicotine dependence
    5. the common barriers preventing patients from undertaking smoking cessation
    6. the principles of at least one theory of behavior modification
    7. the common medical diseases associated with chronic smoking and the effects of stopping on future risk.
    8. the indications for nicotine replacement therapy
    9. the association between smoking cessation and weight gain
  2. Skills: Students should demonstrate specific skills including:
    1. history-taking skills: Students should be able to obtain, document and present an age-appropriate medical history, that differentiates among etiologies of disease, in order to:
      1. determine if a patient has nicotine dependence
      2. assess a patient’s motivation for stopping
      3. assess the patient’s past experiences with smoking cessation
      4. review and determine patient’s barriers to stopping
    2. physical exam skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease including:
      1. identifying nicotine stains on physical exam
      2. identifying lesions with malignant potential on the lips and in the oral cavity
      3. identifying the chest findings consistent with chronic obstructive lung disease
    3. differential diagnosis: None
    4. laboratory interpretation: None
    5. communication skills: Students should be able to:
      1. demonstrate a commitment to administer a non-judgmental “stop smoking” message to every patient who smokes
      2. respond positively and non-judgmentally to patient’s excuses or concerns about cessation
      3. be able to counsel a patient on smoking cessation
      4. promote problem-solving by the patient
      5. get the patient to commit to a specific action plan that can lead to complete cessation.
    6. basic procedural skills: None
    7. management skills: Students should be able to develop an appropriate evaluation and treatment plan for patient including:
      1. design an intervention that matches the stage of behavior change demonstrated by the patient
      2. explain how to use nicotine patch therapy and nicotine gum therapy
      3. negotiate a follow-up plan with the patient
      4. encourage the patient to increase physical activity to lessen weight gain, if medically appropriate.
      5. access and utilize appropriate information systems and resources to help delineate issues related to smoking cessation
  3. Attitudes and Professional Behaviors: Student should be able to:
    1. administer a non-judgmental “stop smoking” message to every patient who smokes