JDE
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

J Dent Educ. 71(9): 1171-1178 2007
© 2007 American Dental Education Association
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Walsh, S. E.
Right arrow Articles by Mitchell, C. K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Walsh, S. E.
Right arrow Articles by Mitchell, C. K.

Educational Methodologies

Tobacco Cessation Counseling Training with Standardized Patients

Sarah E. Walsh, M.P.H., C.H.E.S.; Jacqueline A. Singleton, R.D.H., M.Ed.; Celeste T. Worth, B.H.S., C.H.E.S.; Jacqueline Krugler, M.B.A.; Regan Moore, D.D.S., M.S.D.; Gina C. Wesley, Ph.D.; Charlene K. Mitchell, M.D., M.S.P.H.

Key words: tobacco use cessation, tobacco counseling, provider training, health care professionals, tobacco intervention, standardized patients, patient simulation

Submitted for publication 10/31/06; accepted 05/15/07


   Abstract
Top
 Abstract
Methods
 Results
 Discussion
 Conclusion
 References
 
A pilot study was conducted to assess clinician receptivity to tobacco cessation counseling training methods using standardized patients. Additionally, the study assessed changes in clinician knowledge and behavioral intentions following the training. Medical and dental residents and dental hygiene students from the University of Louisville attended a one- to two-hour lecture addressing the counseling strategies (the Five As/the Five Rs) and pharmacotherapy recommended in the U.S. Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence. Participants subsequently had three training encounters with standardized patients representing various stages of change including a patient ready to quit, a patient contemplating quitting, and a patient resistant to quitting. Thirty-six participants completed a preprogram survey prior to the lecture and a postprogram evaluation that included questions about their attitudes and beliefs about tobacco, their comfort level with various aspects of tobacco intervention, and eight knowledge questions. Participants demonstrated a statistically significant increase in objective knowledge about the practices recommended in the Clinical Practice Guideline following intervention. Results also indicate a significant increase in subjective measures of participant receptivity, self-reported comfort, and perceived skill with various aspects of tobacco intervention. Overall, participants were found to be very receptive to training sessions on tobacco cessation counseling with standardized patients. In light of the educational gains and positive response from participants, the use of standardized patients is a promising strategy for training on tobacco cessation counseling.

It is evident that health care professionals should provide tobacco cessation counseling (TCC) to their patients and families.1–11 The U.S. Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence (TTUD) recommends that cessation counseling be provided to all tobacco users. This recommendation is considered to be the standard of care.1 Health care professionals have an important role in educating their patients about the negative consequences of tobacco use and providing cessation counseling.1,5,7,8,12–19 Recent studies have indicated that professionals are influential in motivating patients to stop tobacco use.4,10,11,13,17,19–21 Solberg et al. found that when smoking cessation interventions were offered during clinical visits, patient satisfaction increased.22

Although health care professionals believe that TCC should be provided to all patients, studies show they do not routinely offer these therapies.9,11,17,19,23,24 Barriers exist that deter intervention.9,11,13,24,25 Barriers to the counseling process include providers’ lack of relevant knowledge and the failure to understand the chronic nature of tobacco dependence, as well as the lack of time, financial incentive, confidence in ability, clinical and institutional support, and resources.8,11,13,17,24–26 Warnakulasuriya concluded that the most significant barrier for health care providers is the lack of cessation education during the formative years of training.17

Recent research has revealed gaps in health care education in the area of cessation training.9,14,17,26–32 Spangler et al. found a lack of research in effective training methods and the long-term retention rates of TCC skills in medical schools. They also found an inadequate integration of these skills and cultural competency in the school curricula of health care professionals.27 Warnakulasuriya recommended that training modules be introduced into the curriculum at undergraduate levels,17 while Hartmann et al. urged health care systems to provide resources to facilitate intervention.9 Thomas found professional schools in Canada devoted more hours of education to diseases caused by smoking than to counseling interventions.32 The TTUD panel review and the national action plan of the Subcommittee on Cessation of the Interagency Committee on Smoking and Health recommended that health care professionals and those in training should be taught effective strategies to assist all tobacco users in quitting and stated that competency in tobacco dependence interventions should be a core graduation requirement.1,28 The TTUD guideline recommends that professionals help patients willing to quit tobacco use by employing counseling strategies appropriate for a patient’s readiness to quit and first-line pharmacotherapy.1

Prochaska and DiClemente’s transtheoretical model outlines the stages of change an individual passes through with tobacco cessation.33 Different intervention strategies are indicated based on each stage of change (precontemplation, contemplation, preparation, action, and maintenance). Individuals in the contemplation and preparation stages should be assisted in making a quit attempt. Patients in the action and maintenance stages require relapse prevention strategies. Individuals in the precontemplation stage should receive a motivational intervention to encourage them to consider quitting in the future. The Five As is a counseling strategy for patients willing to make a quit attempt that includes five components: asking about tobacco use, advising cessation, assessing willingness to quit, assisting the patient in making a quit attempt, and arranging follow-up to prevent relapse. The Five Rs, a counseling strategy for patients not willing to make a quit attempt, includes identifying why quitting is personally relevant, the risks of continued tobacco use, the potential rewards associated with quitting, and roadblocks that may impede potential quit attempts. The fifth R stands for repetition, because the motivational intervention should be repeated at every patient encounter. Assessment of health care provider implementation of TCC indicates that effective training programs are needed to assist professionals in teaching and learning effective strategies like the Five As and Five Rs.4–6,9–11,13,15–24,26,27,29–32,34–39

The effectiveness of using standardized patients (SP) to train professionals in TCC is well documented.6,29,31,35,39,40 SPs are actor/educators trained to portray patients in realistic clinical scenarios. Using SP interactions as a training method is an effective teaching and learning tool that offers a safe and controlled environment in which students can learn and practice interviewing and clinical skills. SPs are trained to evaluate the students’ counseling and clinical skills and then provide them immediate feedback on their strengths and on areas they need to continue to improve. In addition, instructors can observe the interactions and evaluate the students’ progress.41,42 Koerber et al. used SPs in training dental students in TCC and found that motivational interviewing increased patient involvement in counseling sessions.29 Other studies have found that using SPs may40,42–49 or may not be cost-efficient.39 Carter et al. found that student perceptions of the SP encounter can be enhanced if it is immediately preceded by a classic didactic lecture.50 One study found that encounters with SPs provide a valid method of scoring and standard setting for the student assessment and that SPs portray patients realistically and provide a standard of assessing clinical competence.51 Students provide positive evaluations of the SP experience and find it to be valuable.45 In summary, there is a substantial body of research demonstrating that using SPs is an educational, effective, and reliable method of teaching and learning interviewing and clinical skills.39,40,42–53

Although much is known about the benefits of education to increase TCC among health care professionals and the value of training conducted using SPs, their impact in combination is unknown. This study presents a novel approach to TCC training by utilizing SPs. The primary objective of this pilot project was to evaluate participant receptivity to TCC training using SPs. Additionally, the project provided initial assessment of the educational impact and behavior changes resulting from the training.


   Methods
Top
 Abstract
 Methods
Results
 Discussion
 Conclusion
 References
 
Training Methodology
The one-day training program pilot-tested in this study consisted of a preprogram survey, a one- to two-hour lecture on the core components of the TTUD, three interactions with standardized patients, and a postprogram evaluation. After several sessions, a debriefing session was formally added to the training format following the postprogram evaluation. This session afforded participants an opportunity to ask any questions raised by the SP encounter and allowed the instructors to provide additional feedback and clarification as needed.

The lecture emphasized the brief intervention strategies for patients who are willing to quit (the Five As) and for patients who are unwilling to quit (the Five Rs) outlined in the TTUD and FDA-approved first-line pharmacotherapy options. Lectures were given by cancer control specialists with advanced training in TCC strategies and were tailored to participants’ professions and specialties.

Following the lecture, each participant had three ten-minute interactions with SPs. Each interaction was immediately followed by five minutes of feedback from the SP. The SPs at the University of Louisville School of Medicine undergo extensive training on provider-patient communication upon hire. They also completed a two-hour training on tobacco cessation and were presented the learning objectives of the pilot TCC program; this was intended to help the SPs tailor the feedback they would provide to participants.

The three SP cases were designed to represent typical patients at different stages of readiness to quit, as outlined by Prochaska and DiClemente.33 The first case was a patient ready to quit (preparation/action stage) who was specifically visiting the clinician for assistance with cessation. The second case represented a patient who had considered quitting (contemplation stage). This patient would agree to make a quit attempt if the clinician offered appropriate assistance during the encounter. The third case represented a patient who was resistant to quitting (precontemplation stage) who could not be persuaded to quit at that time regardless of action by the clinician. Although the core structure of the cases was the same for all participants, as with the lecture, the cases were tailored to participant specialty.

TCC Training Participants
Study participants were recruited from various professional education programs at the University of Louisville Schools of Medicine and Dentistry. Faculty were made aware of the training opportunity and elected to have students participate as determined by curriculum demands and scheduling availability. Pilot participants included thirty second-year dental hygiene students, eighteen first-year obstetrics and gynecology residents, twelve general practice (dental) residents, and six first-year periodontal residents.

Completion of the preprogram survey and postprogram evaluation was voluntary for the training participants. Although participants were informed that their responses would be confidential, a portion of participants failed to provide any identifying information that would allow their surveys to be matched. Participants who did not complete all aspects of the training, or whose preprogram survey and postprogram evaluation could not be matched, were excluded from final analysis. In all, data were available from thirty-six participants for subsequent paired analysis although not all participants answered all questions.

Forty-seven percent of participants were male and 53 percent were female. When asked about their highest degree obtained, five participants had high school diplomas, two indicated they had earned bachelor’s degrees, one had completed a master’s degree, fourteen had earned a D.M.D. or D.D.S., and eleven had earned an M.D. Three participants did not indicate their highest degree. The majority of participants (61 percent) were recent graduates, indicating that they had completed their highest degree within the past three years.

Fifteen of the thirty-six participants included in the final analysis were dentists, with ten participants identifying themselves as general practice dental residents and five identifying themselves as periodontal residents. Eight participants were dental hygiene students and eleven were obstetrics/gynecology residents. Two participants did not indicate their specialty or field of training. One third of participants (34 percent) indicated they planned to pursue a sub-specialty. Subspecialties of medicine or dentistry identified included orthodontics, endodontics, periodontics, reproductive endocrinology, and maternal and fetal medicine.

Participants were also asked about their personal tobacco use and awareness of the TTUD on the preprogram survey. The majority of participants (74 percent) had never used tobacco, 6 percent were current tobacco users, and 20 percent were former tobacco users. Most participants (67 percent) had never heard of the TTUD Clinical Practice Guideline. Twenty percent indicated they had heard of the TTUD but had not read it, 6 percent had read the TTUD, and 6 percent reported that they had read the guideline and planned to follow its recommendations. Despite the differences in their training programs, all participants were routinely treating patients from the greater Louisville community. Their patient populations were assumed to include smokers, yet none of the participants reported that they were currently implementing the counseling strategies recommended in the TTUD.

Evaluation
Participants completed a preprogram survey prior to the lecture and a postprogram evaluation following the SP encounters and before any debriefing session. The preprogram survey included questions about the participants’ attitudes and beliefs about tobacco, their comfort with and self-reported knowledge of various aspects of tobacco intervention, and eight fact-based objective knowledge questions about tobacco use and cessation strategies. The postprogram evaluation mirrored the preprogram survey; however, items were reworded on the postprogram evaluation to reflect behavioral intentions rather than current practices (e.g., the preprogram survey item "How often do you ask an individual patient about tobacco use?" was changed to "In the future, how often do you intend to ask an individual patient about tobacco use?" on the postprogram evaluation). All questions were presented in a multiple choice format. The preprogram survey also assessed participant demographics and current practices regarding tobacco cessation (the Five As). The postprogram evaluation assessed participant receptivity to the training and their intention to implement a brief intervention for tobacco cessation.

Data from preprogram surveys and postprogram evaluations were entered into an SPSS (12.0) database, which was used to produce descriptive statistics for all participants. Matched data from the preprogram survey and postprogram evaluation were subsequently analyzed using Wilcoxon signed rank tests and McNemar’s test (for dichotomous variables) to determine significant differences in responses.


   Results
Top
 Abstract
 Methods
 Results
Discussion
 Conclusion
 References
 
A major objective of the project was to assess the educational impact of the training. Several statements were used to measure participant attitudes and beliefs about tobacco use and the importance of tobacco cessation counseling. Participants were asked to indicate their level of agreement with the statements using a four-point Likert scale (strongly agree, somewhat agree, somewhat disagree, strongly disagree) with 4 indicating strong agreement. No meaningful change was observed from preprogram survey to postprogram evaluation with statements pertaining to the importance of the issue: "It is important for members of my profession to discuss tobacco use with patients"; "Tobacco use has serious negative health consequences"; and "Tobacco cessation is an effective method of reducing morbidity/mortality." Virtually all participants strongly agreed with these statements prior to the training.

Participants reported a change in their attitudes toward their own skill level and belief in the efficacy of a brief patient intervention that was statistically significant. Participants increased their level of agreement with the statement "I have sufficient skills/knowledge to treat nicotine dependence" from a mean score of 2.50 (sd=0.811) on the preprogram survey to 3.47 (sd=0.506) on the postprogram evaluation (p<0.001). Participants also increased their level of agreement that a brief intervention (three minutes) for tobacco cessation would be effective with their patients from a mean score of 2.91 (sd=0.981) on the preprogram survey to 3.49 (sd=0.781) on the postprogram evaluation (p<0.01).

Participants were asked to rate their comfort level with three aspects of providing a tobacco cessation intervention on a four-point scale ranging from "not at all comfortable" (1) to "very comfortable" (4). Measures included discussing tobacco cessation, helping a patient develop a quit plan, and recommending appropriate pharmacological treatments and advising patients on their proper usage. Wilcoxon signed ranks test results indicate a significant increase in participant comfort in all the areas assessed (Table 1Go).


View this table:
[in this window]
[in a new window]

  		Table 1. Participant comfort with tobacco intervention
 
Participants were also asked to self-assess their level of knowledge regarding pharmacotherapy for tobacco cessation on a five-point scale, with 1 indicating "not very knowledgeable" and 5 indicating "very knowledgeable." Mean subjective pharmacotherapy knowledge scores increased significantly from 2.57 (sd=0.884) on the preprogram survey to 3.80 (sd=0.584) on the postprogram evaluation (p<0.001).

On the preprogram survey, 83 percent of participants reported that they currently identified every patient for tobacco use status, as is recommended in the TTUD. On the postprogram evaluation, 97 percent of participants indicated that they intended to identify every patient for tobacco use status. Although this increase is not statistically significant, it is suggestive of an increased adoption of the TTUD recommendation (p=0.125).

Participants were also asked about the frequency with which they performed certain aspects of a tobacco cessation intervention on the preprogram survey and their corresponding intended behaviors on the postprogram evaluation. Following the training, participants intended to significantly increase the frequency with which they would ask patients about tobacco use, advise patients to quit, and assist patients in various aspects of their quit attempt (Table 2Go).


View this table:
[in this window]
[in a new window]

  		Table 2. Participant-reported frequency of tobacco intervention practices and future behavioral intentions (N=36)
 
Eight multiple choice questions covering factual information were used to assess objective knowledge about tobacco use and cessation strategies. Aggregate scores ranged from 1 to 7 on the preprogram survey and 3 to 8 on the postprogram evaluation. Performance on individual questions varied considerably, and comparisons between preprogram survey and postprogram evaluation results using McNemar’s test are detailed in Table 3Go. Overall, mean scores on the knowledge assessment increased significantly by more than two points from a mean of 3.8 correct responses on the preprogram survey to 6.0 correct responses on the postprogram evaluation (p<0.001). Four participants did not complete all eight questions, and their responses were excluded from this analysis.


View this table:
[in this window]
[in a new window]

  		Table 3. Change in proportion of correct responses to objective knowledge questions on tobacco use and cessation information (N=32)
 
Three questions on the postprogram evaluation were designed to assess the primary research question regarding participant receptivity to the program. A five-point Likert scale, with 5 indicating strong agreement and 1 indicating strong disagreement, was used to assess three statements about the program. Participants indicated that the practice sessions increased their confidence in providing cessation advice (mean=4.47, sd=0.634), that the feedback from the SP was helpful (mean=4.69, sd=0.491), and that they would recommend the training to others interested in improving their skills in smoking cessation counseling (mean=4.63, sd=0.766).


   Discussion
Top
 Abstract
 Methods
 Results
 Discussion
Conclusion
 References
 
Prior to the TCC training, none of the participants reported following the counseling strategies recommended by the TTUD although all were treating patients. As a result of participating in the study, participants felt more knowledgeable and confident in following the recommended practices of the TTUD and offering cessation counseling therapies to their patients. Overall, the participants of this study were receptive to the TCC training methodology with SPs.

Although the results from this study are promising, there are several limitations to these preliminary findings. Participants were recruited based on the willingness of program faculty and, as such, the participants differed widely in their level of training and chosen profession. The data available for analysis were limited by participant attrition as necessitated by their call rotations, scheduling conflicts, and willingness to provide identifying information. Future research is warranted to explore profession-specific performance and relative impact on clinician practices.

The primary objective for this pilot study was to evaluate participant receptivity to the training methodology. The secondary objective was to assess changes in knowledge and behavior intentions. At this stage, our results establish that participants benefit from the TCC training with SPs and respond positively to the training format. The absence of a control group hinders our ability to more specifically assess the magnitude of the changes in knowledge. Future studies are planned to assess the long-term impact of the training on participant behavior and intervention practices, rather than intended behavior. Additionally, this study did not explore if these educational benefits could have been achieved through lecture alone. Further research is needed to assess the impact of the combined educational methodology versus lecture or SP interaction alone.


   Conclusion
Top
 Abstract
 Methods
 Results
 Discussion
 Conclusion
References
 
Health care professionals have an important role in educating and informing their patients of the serious health consequences of tobacco use, but they often feel ill prepared to provide TCC. Training health professionals, especially in their formative training years, increases their tobacco intervention activities. The U.S. Public Health Service, congressional committees, and national health care organizations recommend that health care providers receive cessation education in their formative educational years and propose that TCC training should be a core educational requirement. Research on implementation of TCC indicates that it is critical for providers to have the knowledge, tools, and support systems to increase tobacco interventions. Utilizing effective training methods, including using SPs, reducing the counseling barriers, and offering cessation education in the professionals’ formative years of training are likely to increase tobacco interventions in the professionals’ health care setting. This would ultimately reduce tobacco use and save lives.


   Acknowledgments
 
This research was supported by the Jefferson County Smoke Free Coalition, the Louisville Metro Department of Public Health and Wellness, and the University of Louisville Kentucky Cancer Program and Schools of Medicine and Dentistry. The authors would like to thank Pat F. Bass III, M.D., M.S., Jamie Studts, Ph.D., and James Scheetz, Ph.D., for their technical assistance on this project.


   Footnotes
 
Ms. Walsh is a Cancer Control Specialist, Kentucky Cancer Program, James Graham Brown Cancer Center, University of Louisville; Ms. Singleton is Assistant Professor, Dental Hygiene Program, Department of Periodontics, Endodontics, and Dental Hygiene, University of Louisville School of Dentistry; Ms. Worth is Professional Education Program Manager, Kentucky Cancer Program, James Graham Brown Cancer Center, University of Louisville; Ms. Krugler is Assistant Director, Standardized Patient Program, University of Louisville School of Medicine; Dr. Moore is Associate Professor and Director of Undergraduate Periodontics, Department of Periodontics, Endodontics, and Dental Hygiene, University of Louisville School of Dentistry; Dr. Wesley is Assistant Professor, Medicine Dean’s Office, Director of the Standardized Patient Program, and Director of Clinical Assessment Programs, University of Louisville School of Medicine; and Dr. Mitchell is Associate Professor, Internal Medicine and Pediatrics, University of Louisville School of Medicine. Direct correspondence and requests for reprints to Ms. Sarah E. Walsh, Kentucky Cancer Program, James Graham Brown Cancer Center, University of Louisville, 529 S. Jackson Street, Louisville, KY 40202; 502-852-6318 phone; 502-852-4554 fax; sarah.walsh{at}louisville.edu.


   REFERENCES
Top
 Abstract
 Methods
 Results
 Discussion
 Conclusion
 References
 

  1. Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Gritz ER, et al. Treating tobacco use and dependence: clinical practice guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, 2000.
  2. Reducing tobacco use: a report of the surgeon general—executive summary. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000.
  3. Tobacco research implementation plan: priorities for tobacco research beyond the year 2000. Bethesda, MD:The National Cancer Institute, National Institutes of Health, November 1998.
  4. Gelskey SC. Impact of a dental/dental hygiene tobacco-use cessation curriculum on practice. J Dent Educ 2002; 66: 1074–8.[Abstract]
  5. Greene JC. Tobacco use, prevention, and cessation: introduction to the special section. J Dent Educ 2002; 66:1049–50.[Medline]
  6. Keefe CW, Thompson ME, Wadland WC. A comprehensive approach to teaching smoking-cessation strategies. Acad Med 2001; 76:520–1.[Medline]
  7. Mecklenburg RE. Tobacco: addiction, oral health, and cessation. Quintessence Int 1998; 29:250–2.[Medline]
  8. Geboy MJ. Dental school-based continuing education in tobacco use cessation counseling for oral health care providers. J Dent Educ 1990; 54:736–8.[Abstract]
  9. Hartmann KE, Espy A, McPheeters M, Kinsinger LS. Physicians taught as residents to conduct smoking cessation intervention: a follow-up study. Prev Med 2004; 39:344–50.[Medline]
  10. Manley M, Epps RP, Husten C, Glynn T, Shopland D. Clinical interventions in tobacco control: a National Cancer Institute training program for physicians. JAMA 1991; 266(22):3172–3.[Abstract/Free Full Text]
  11. Dolan TA, McGorray SP, Grinstead-Skigen CL, Mecklenburg R. Tobacco control activities in U.S. dental practices. J Am Dent Assoc 1997; 128:1669–79.[Abstract/Free Full Text]
  12. Johnson GK, Hill M. Cigarette smoking and the periodontal patient. J Periodontol 2004; 75:196–209.[Medline]
  13. Monson AL. Barriers to tobacco cessation counseling and effectiveness of training. J Dent Hyg 2004; 78:1–7.[Medline]
  14. Geller AC, Zapka J, Brooks KR, Dube C, Powers CA, Rigotti N, et al. Tobacco control competencies for U.S. medical students. Am J Public Health 2005; 95:950–5.[Abstract/Free Full Text]
  15. Adsit R, Fraser D, Redmond L, Smith S, Fiore M. Changing clinical practice, helping people quit: the Wisconsin cessation outreach model. WMJ 2005; 104:32–6.[Medline]
  16. Kotlyar M, Hatsukami DK. Managing nicotine addiction. J Dent Educ 2002; 66:1061–73.[Abstract]
  17. Warnakulasuriya S. Effectiveness of tobacco counseling in the dental office. J Dent Educ 2002; 66:1079–87.[Abstract]
  18. Severson HH. Tobacco cessation in the dental office: a brief intervention for spit tobacco users. Quintessence Int 1998; 29:262–5.[Medline]
  19. Smith SS, Beckley T, Fiore MC. Health care provider use of guideline-based smoking cessation interventions: results from the 2003 Wisconsin tobacco survey. WMJ 2005; 104:28–31.[Medline]
  20. Burns DM. Reducing tobacco use: what works in the population? J Dent Educ 2002; 66:1051–60.[Abstract]
  21. Gansky SA, Ellison JA, Kavanagh C, Hilton JF, Walsh MM. Oral screening and brief spit tobacco cessation counseling: a review and findings. J Dent Educ 2002; 66: 1088–98.[Abstract]
  22. Solberg LI, Boyle RG, Davidson G, Magnan SJ, Carlson LC. Patient satisfaction and discussion of smoking cessation. Mayo Clin Proc 2001; 76:138–43.[Abstract]
  23. Thorndike AN, Rigotti NA, Stafford RS, Singer DE. National patterns in the treatment of smokers by physicians. JAMA 1998; 279:604–8.[Abstract/Free Full Text]
  24. Monson AL, Engeswick LM. Promotion of tobacco cessation through dental hygiene education: a pilot study. J Dent Educ 2005; 69:901–11.[Abstract/Free Full Text]
  25. Cook PA. Smoking cessation. Quintessence Int 1998; 29:259–62.[Medline]
  26. Hudmon KS, Corelli RL, Chung E, Gundersen B, Kroon LA, Sakamoto LM, et al. Development and implementation of a tobacco cessation training program for students in the health professions. J Cancer Educ 2003; 18:142–9.[Medline]
  27. Spangler JG, George G, Foley KL, Crandall SJ. Tobacco intervention training: current efforts and gaps in U.S. medical schools. JAMA 2002; 288:1102–9.[Abstract/Free Full Text]
  28. Fiore MC, Croyle RT, Curry SJ, Cutler CM, Davis RM, Gordon C, et al. Preventing 3 million premature deaths and helping 5 million smokers quit: a national action plan for tobacco cessation. Am J Public Health 2004; 94(2): 205–10.[Abstract/Free Full Text]
  29. Koerber A, Crawford J, O’Connell K. The effects of teaching dental students brief motivational interviewing for smoking-cessation counseling: a pilot study. J Dent Educ 2003; 67:439–47.[Abstract]
  30. Scal P, Hennrikus D, Ehrlich L, Ireland M, Borowsky I. Preparing residents to counsel about smoking. Clin Pediatr 2004; 43:703–8.[Abstract/Free Full Text]
  31. Spangler JG, Enarson C, Elfridge C. An integrated approach to a tobacco-dependence curriculum. Acad Med 2001; 76:521–2.[Medline]
  32. Thomas R. A survey of the training of Canadian health professionals to counsel against smoking. Chronic Dis Can 1997; 18:120–9.[Medline]
  33. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 1983; 51:390–5.[Medline]
  34. Collins RL, D’Angelo S, Stearns SD, Campbell LR. Training pediatric residents to provide smoking cessation counseling to parents. Sci World J 2005; 5:410–9.
  35. Brown RL, Pfeifer JM, Gjerde CL, Seibert CK, Haq CL. Teaching patient-centered tobacco intervention to first-year medical students. J Gen Intern Med 2004; 19: 534–9.[Medline]
  36. Barker GJ, Williams KB, Taylor TS, Barker BF. Practice behaviors of alumni trained as students in tobacco use cessation interventions. J Dent Hyg 2001; 75:165–9.[Medline]
  37. Christen AG. Helping patients quit smoking: lessons learned in the trenches. Quintessence Int 1998; 29:253–9.[Medline]
  38. Kosower E, Ernst A, Taub B, Berman N, Andrews J, Seidel J. Tobacco prevention education in a pediatric residency program. Arch Pediatr Adolesc Med 1995; 149:430–5.[Abstract/Free Full Text]
  39. Papadakis MA, Croughan-Minihane M, Fromm LJ, Wilkie HA, Ernster VL. A comparison of two methods to teach smoking-cessation techniques to medical students. Acad Med 1997; 72:725–7.[Medline]
  40. Foley KL, George G, Crandall SJ, Walker KH, Marion GS, Spangler JG. Training and evaluating tobacco-specific standardized patient instructors. Fam Med 2006; 38:28–37.[Medline]
  41. Brender E, Burke A, Glass RM. Standardized patients. JAMA 2005; 294:1172.[Free Full Text]
  42. Barrows HS. An overview of the uses of standardized patients for teaching and evaluating clinical skills. Acad Med 1993; 68:443–53.[Medline]
  43. Vu NV, Marcy MM, Colliver JA, Verhulst SJ, Travis TA, Barrows HS. Standardized (simulated) patients’ accuracy in recording clinical performance check-list items. Med Educ 1992; 26:99–104.[Medline]
  44. Kissela B, Harris S, Kleindorfer D, Lindsell C, Pascuzzi R, Woo D, et al. The use of standardized patients for mock oral board exams in neurology: a pilot study. BMC Med Educ 2006; 6:22.[Medline]
  45. Mavis B, Turner J, Lovell K, Wagner D. Faculty, students, and actors as standardized patients: expanding opportunities for performance assessment. Teach Learn Med 2006; 18:130–6.[Medline]
  46. Davidson R, Duerson M, Rathe R, Pauly R, Watson RT. Using standardized patients as teachers: a concurrent controlled trial. Acad Med 2001; 76:840–3.[Medline]
  47. McGraw RC, O’Connor HM. Standardized patients in the early acquisition of clinical skills. Med Educ 1999; 33: 572–8.[Medline]
  48. Vannatta JB, Smith KR, Crandall S, Fischer PC, Williams K. Comparison of standardized patients and faculty in teaching medical interviewing. Acad Med 1996; 71: 1360–2.[Medline]
  49. Vu NV, Barrows HS, Marcy ML, Verhulst SJ, Colliver JA, Travis T. Six years of comprehensive, clinical, performance-based assessment using standardized patients at the Southern Illinois University School of Medicine. Acad Med 1992; 67:42–50.[Medline]
  50. Carter MB, Wesley G, Larson GM. Lecture versus standardized patient interaction in the surgical clerkship: a randomized prospective crossover study. Am J Surg 2006; 191:262–7.[Medline]
  51. Travis TA, Colliver JA, Robbs RS, Barnhart AJ, Barrows HS, Giannone L, et al. Validity of a simple approach to scoring and standard setting for standardized-patient cases in an examination. Acad Med 1996; 71:S84–6.[Medline]
  52. Triola M, Feldman H, Kalet AL, Zabar S, Kachur EK, Gillespie C, et al. A randomized trial of teaching clinical skills using virtual and live standardized patients. J Gen Intern Med 2006; 21:424–9.[Medline]
  53. Stillman PL, Regan MB, Philbin M, Haley HL. Results of a survey on the use of standardized patients to teach and evaluate clinical skills. Acad Med 1990; 65:288–92.[Medline]




This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Walsh, S. E.
Right arrow Articles by Mitchell, C. K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Walsh, S. E.
Right arrow Articles by Mitchell, C. K.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS