Effect of a Training Program for Resident Physicians in Improving Success Rate in Helping Patients Quit Smoking

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The summary below is from the full report titled "Efficacy of Resident Training in Smoking Cessation: A Randomized, Controlled Trial of a Program Based on Application of Behavioral Theory and Practice with Standardized Patients." It is in the 19 March 2002 issue of Annals of Internal Medicine (volume 136, pages 429-437). The authors are J Cornuz, J-P Humair, L Seematter, R Stoianov, G van Melle, H Stalder, and A Pécoud. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians–American Society of Internal Medicine.

What is the question and what is known about it so far?

Helping patients to stop smoking is an important activity for physicians. This process begins with counseling, a skill that requires the ability to evaluate the patient's readiness to quit and to motivate patients into effective action. Despite the importance of this activity, physicians usually do not receive training in the best counseling methods. When they do, the programs usually involve lectures rather than active participation in learning. In fact, medical educators have little evidence to guide them in designing programs to teach physicians how to counsel smokers who want to quit.

Why did the researchers do this particular study?

They wanted to see whether an educational program that used active learning methods could improve the rate of success in sustained avoidance of smoking.

Who was studied?

Thirty-five physicians-in-training (residents) at the University Hospitals of Lausanne and Geneva, Switzerland, took part in the training program; 251 patients in two different outpatient clinics took part in the evaluation program.

How was the study done?

Residents were randomly assigned to two learning groups. One group received training in smoking cessation techniques. The other received training in another, unrelated subject. The smoking cessation group had two half-day sessions on strategies to motivate smokers to quit, techniques to support smokers who were trying to quit, and appropriate prescription of nicotine replacement therapy. They then practiced these techniques on four "standardized patients," who played the roles of smokers who were thinking about quitting. The researchers then interviewed clinic patients cared for by both groups of residents to learn how well the residents actually used the counseling skills. They also asked whether the patient had quit smoking. Patients were interviewed twice: soon after the course and 1 year later.

What did the researchers find?

Trained residents used good counseling techniques significantly more often than untrained residents. One year after the counseling sessions, 13% of patients of the trained residents but only 5% of patients of untrained residents had stopped smoking.

What were the limitations of the study?

The patients' report on abstinence from smoking was checked by chemical tests at only one clinic, so an overestimate of the effectiveness of the training was possible. Furthermore, only 71% of the patients returned the questionnaire 1 year after they received counseling. Because most residents left the university after they completed training, the researchers could not evaluate the long-term effectiveness of the training program.

What are the implications of the study?

Active participation and role-playing by residents appear to be an effective method to learn counseling skills that increases success in helping patients quit smoking.