Citizens for Clean Air and Clean Lungs

Study: MDs Should Help Smokers Quit

Date: Aug 31, 1999 By Andrew Buchanan Associated Press Writer

CHICAGO (AP) -- U.S. medical school graduates are woefully unprepared to help patients quit smoking, the nation's most deadly preventable health care problem, a study concludes.

The researchers surveyed nearly every accredited medical school in the country and found very little coursework devoted to nicotine dependence.

They called the statistics distressing, given National Cancer Institute recommendations from seven years ago that training in how to kick the habit be made mandatory at every U.S. medical school.

The findings appear in Wednesday's Journal of the American Medical Association.

"The public health community is active and aggressive in anti-smoking efforts, but there's nothing innovative going on" at medical schools, said Dr. Linda Ferry, director of preventive medicine at Loma Linda University School of Medicine in California. "It starts right at the ground level in medical school."

Cigarette smoking kills more than 400,000 Americans each year, according to the Centers for Disease Control and Prevention. One in every five deaths in the United States is smoking-related, CDC figures show.

Ferry cited a 1991 survey showing that few doctors felt their formal medical training prepared them to help patients stop smoking, and another that found few physicians advise their patients about kicking the habit.

Ferry and colleagues looked at responses from 122 of 126 medical schools about course offerings in the 1996-97 school year. Not all schools answered every question.

Thirty-two out of 102 medical schools dedicated an average of less than one hour of classroom time per year in smoking cessation techniques.

There was more tobacco-related instruction in the first two years of medical school. But only three schools reported having a required course devoted to tobacco education in the third and fourth years.

And almost 70 percent of schools -- 83 of 120 -- did not require any smoking cessation training at all in those two years, when students theoretically are learning how to apply their knowledge to patients.

The authors acknowledged that more smoking cessation instruction could be taking place in informal settings in the final years of medical school.

Dr. David Steward, chairman of internal medicine at the Southern Illinois University School of Medicine in Springfield, said that is the case at his school, where third- and fourth-year students are often working directly with patients and practicing physicians.

"That's probably the most powerful teaching tool and it's hard to quantify," Steward said.

The authors recommended that a model tobacco curriculum be developed and put in place in all U.S. medical schools, and said the licensing exam for doctors should pay greater attention to the subject.

Nancy Rigotti, director of a preventive medicine course at Harvard Medical School, suggested a philosophical change may be in order as well. She said too many doctors particularly older ones, may be afraid of alienating patients or feel it's not their place to counsel them.

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