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CORK Bibliography: Medical Education

42 citations. January 2009 to present

Prepared: March 2012

[Anonymous]. Addiction medicine and substance abuse care. (editorial). Canadian Family Physician 57(11): e429-e429, 2011. (1 refs.)

Anderson BL; Dang EP; Floyd RL; Sokol R; Mahoney J; Schulkin J. Knowledge, opinions, and practice patterns of obstetrician-gynecologists regarding their patients' use of alcohol. Journal of Addiction Medicine 4(2): 114-121, 2010. (26 refs.)

Objective: To evaluate the evolution of fetal alcohol spectrum disorder prevention practices including awareness and use of recently published tools. Methods: Fellows of the American College of Obstetricians and Gynecologists were asked about their knowledge, opinions, and practice regarding alcohol-related care. Eight hundred obstetrician-gynecologists (ob-gyns) were selected; 48.1% returned the survey. Results: The majority (66.0%) indicated that occasional alcohol consumption is not safe during any period of pregnancy. There was no consensus when asked if alcohol's effect on fetal development is clear (46.9% thought it was clear and 45.9% did not). Most (82.2%) ask all pregnant patients about alcohol use only during patients' initial visit, whereas 10.6% ask during initial and subsequent visits. Most (78.5%) advise abstinence when pregnant women report alcohol use. When asked which validated alcohol risk screening tool they most commonly use with pregnant patients, 57.8% said they use no tool. Although 71.9% felt prepared to screen for risky or hazardous drinking, older ob-gyns indicated feeling significantly more unprepared than younger ob-gyns. "Patient denial or resistance to treatment" was the top issue affecting alcohol screening and "referral resources for patients with alcohol problems" was the resource needed most. Most ob-gyns were not aware of the National Institute on Alcohol Abuse and Alcoholism "Clinician's Guide" or the American College of Obstetricians and Gynecologists "Fetal Alcohol Spectrum Disorder Prevention Tool Kit." Conclusions: There are few changes in the alcohol-related screening and treatment patterns of ob-gyns since 1999; although perceived barriers and needs have changed. Interventions, including referral resources and continuing medical education training, are warranted.

Attas JD; de Pabon EV; Cueva RN. Current challenges and future perspectives in the field of addiction psychiatry in Latin America. International Review of Psychiatry 22(4): 347-354, 2010. (37 refs.)

This paper provides a brief review of the addictions field in Latin America. Epidemiology, legal aspects, dual pathology, treatment, prevention and future directions are discussed. This increasing disease is one of the major contributors for mental health problems in the region. Efforts have been made in treatment and prevention but results and budgets arc scarce. Dual pathology, new modalities such as injected heroin in countries such as Colombia, low coverage of programmes, training resources, research and publications are important challenges. The tendency to liberalize legal terms of use would require more effort for prevention and education. Based on relevant literature and a long and current experience in the area, the authors summarize this important theme.

Balls JE; Price JH; Dake JA; Jordan TR; Khuder S. African American primary care physicians' perceptions and practices regarding smoking cessation therapy. Journal of The National Medical Association 102(7): 579-589, 2010. (39 refs.)

African American smokers (34% of males and 23% of females) need formal interventions to assist them in quitting smoking, a major method of preventing premature mortality from smoking-related illnesses. The purpose of this study was to examine African American primary care physicians' perceptions and practices regarding smoking cessation counseling. A national random sample (n = 202) of primary care physicians was asked about their perceptions and practices regarding smoking cessation therapy. Most (89%) placed themselves in the maintenance stage for asking their patients about their smoking status and regularly documented the smoking status of their patients (70%). Most physicians did not comply with all of the components of the US Public Health Services' smoking cessation guidelines (eg, 5 A's and 5 R's). The component most often implemented of the 5 A's was to "advise" patients to quit (89%), and "arrange" follow-up was the least frequently (60%) used component. Perceived barriers to engaging in smoking cessation interventions were time (38%) and patients not interested in quitting (19%). Although physicians used many of the steps in the 5 A's and 5 R's, they were far less compliant in recommending, nicotine replacement therapy, prescribing pharmacotherapy, and providing support and/or follow-up for patients who were willing to quit smoking. Physicians need more academic preparation in providing smoking cessation counseling since few received such training in medical school (31%) or during their residency programs (18%).

Cape G. Movies as a vehicle to teach addiction medicine. International Review of Psychiatry 21(3, Special Issue): 213-217, 2009. (32 refs.)

Dependence on a substance and the role of medical practitioners in this health problem can be perceived as an enigma. Movies, as a tool for teaching, can be a powerful means of engaging, clarifying and educating students within the addiction medicine arena. Popular mythologies and stereotypes of drug use (including alcohol) and users in cinema can be explored within a learning environment aiding the understanding of this complex topic, thereby improving the therapeutic commitment to addiction medicine. There is a responsibility of the teacher to use this tool with care so as not to perpetuate the mythologies of addiction as often portrayed within commercial cinema. Tried and tested use of this potent educational aid, with suggestions for further development, are outlined in this article.

Clark MR. Chronic opioid therapy for chronic pain: An e-learning program to develop shared decision-making and communication skills. Current Pain and Headache Reports 15(2): 88-90, 2011. (18 refs.)

Aims: This randomized clinical trial was conducted to determine if an interactive web-based training focusing on shared decision making for chronic opioid therapy improved knowledge and competence compared with exposure to practice guidelines. Methods: The participants in this trial were internal medicine residents from five residencies participating in the Residency Review Committee for Internal Medicine's Educational Innovations Project. The participants were randomized to different modes of training on the use of opioid therapy for CNCP emphasizing a comprehensive plan of care and mutually negotiated goals: 1) Collaborative Opioid Prescribing Education (COPE), an interactive web-based training utilizing case vignettes of real time, simulated clinical interactions; or, 2) the Veterans Affairs (VA)/Department of Defense Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain, a text-based set of management algorithms. The following outcomes were assessed both pre- and postintervention utilizing validated instruments: 1) knowledge of the role of opioids in CNCP; 2) self-rated competence in the management of CNCP and opioid prescribing; 3) physician satisfaction in caring for patients with CNCP; 4) physician patient-centeredness; 5) satisfaction with training; and, 6) the use of four core management strategies (frequency of prescribing opioids, use of urine toxicology screening, patient treatment agreements, and opioid contracts) over a 2-month period. Statistical analyses were conducted using both an intention-to-treat paradigm to investigate main effects, interactions, and influence of time, and then, only the residents who completed the pre- and post-training assessments to determine the measures that differed across training. Results: Initially, 570 residents were eligible to participate and 213 were consented for randomization. Both pre- and post-training tests were completed by 143 residents, and 70 residents were missing one or both tests. No significant group differences were found across interventions or between those with and without missing data. Analyses of the training showed significant differences over time and between the two interventions. The web training group had greater increase in knowledge with training and greater self-rated competence in the management of outpatients with chronic pain, including the use of opioids in this management. While residents in both groups reported more satisfaction with managing chronic pain care after training, the web training was superior regarding concerns about training adequacy and relationship quality. For example, about 30% of the web-trained group reported that they did not feel competent managing outpatients with CNCP compared to over 40% of the guideline-trained group. Both groups of residents reported increased satisfaction as the year of residency training increased. The web-based training produced greater improvements on the subscales of training adequacy and relationship quality, but not on those relating to adequacy of data collection, appropriate use of time, and patient's cooperative nature. Similarly, physician patient-centeredness and information sharing increased with training, but there were no group differences. Both groups reported they were less likely to prescribe opioids when requested by patients and more likely to complete opioid contracts and patient treatment agreements. Discussion: This educational trial demonstrated that exposure to an interactive web-based training focused on shared decision-making and communication skills was more effective than exposure to compatible practice guidelines for knowledge and self-reported competence in the management of chronic pain. Both types of training improved satisfaction with chronic pain clinical encounters, especially in more experienced residents. The web-based training produced greater improvement than the guideline-based training on measures of training adequacy and relationship quality facets of satisfaction. These results were achieved with interactive training that required only a 1- to 2-hour time commitment and included communication skills training beyond just cognitive content. Previous customized face-to-face training produced stronger effects on management practices only, but did not assess knowledge differences. Limitations of this study include the generalizability of results and the focus on resident self-reports about knowledge, competence, and satisfaction instead of the adoption of management practices and patient outcomes.

Correa-Fernandez V; Davila M; Kamrudin SA; Li DH; Noor SW; Oluyomi AO et al. Educating cancer prevention researchers in emerging biobehavioral models: Lessons learned. Journal of Cancer Education 26(4): 633-640, 2011. (17 refs.)

To increase the adoption of transdisciplinary research methods among future cancer prevention investigators, faculty members from The University of Texas MD Anderson Cancer Center developed a graduate-level course in biobehavioral methods in cancer prevention research. Two instructors paired by topic and area of expertise offered an hour-long lecture-based seminar every week for 15 weeks during the spring semester of 2010. Students and presenters both evaluated the overall course content and delivery method, as well as each session. A total of 11 students and 22 presenters participated in the course. In each class session, one presenter was from a behavioral science background,and the other was from a biological sciences background. Both presenters and students expressed overall satisfaction with the content and format of the course. The presentation of topics from a transdisciplinary perspective and interaction with presenters from both biological and behavioral sciences are valuable and can help junior researchers prepare to meet the emerging challenges in cancer prevention research.

De Jong C; Luycks L; Delicat JW. The master in addiction medicine program in The Netherlands. Substance Abuse 32(2, special issue): 108- 114, 2011. (15 refs.)

Since 2007 there is a full-time, 2-year professional training in addiction medicine in the Netherlands. The aim of this article is to describe in detail the development and present status of the Dutch Master in Addiction Medicine (MiAM) program. In this competency-based professional training, theoretical courses are integrated with learning in clinical practice under guidance of an experienced clinical teacher. The theoretical courses consist of evidence-based medicine, communication and basic psychotherapeutic skills, neurobiology of addiction, addiction medicine, addiction and psychiatry, and public health. The 7 main competencies are made ready for operation in the personal education plan and are evaluated by different styles of examination.

Desalu OO; Adekoya AO; Elegbede AO; Dosunmu A; Kolawole TF; Nwogu KC. Knowledge of and practices related to smoking cessation among physicians in Nigeria. Jornal Brasileiro de Pneumologia 35(12): 1198-1203, 2009. (27 refs.)

Objective: To evaluate the knowledge and practices of smoking cessation among physicians in Nigeria. Methods: We conducted a cross-sectional survey in Lagos and three geopolitical zones of Nigeria. A self-administered structured questionnaire was used to obtain information on tobacco use and its health effects, as well as on the knowledge and practices of smoking cessation, from 436 physicians. Results: Of the 436 physicians, 292 (67.0%) were aware of smoking cessation, but only 132 (30.3%) showed good knowledge on this topic. The prevalence of smoking among the physicians was 17.7%. In addition, 308 physicians (70.6%) reported that tobacco education in the medical school curriculum was inadequate. Of the 436 physicians, 372 (86.2%) asked their patients whether they smoked, and 172 (39.4%) asked their patients the reasons for using tobacco. As a means of smoking cessation intervention, 268 (61.5%) used brief advice/counseling (2-5 min), 12 (3.7%) prescribed antidepressants, 16 (2.8%) prescribed nicotine replacement therapy (NRT), and 76 (17.4%) arranged follow-up visits. When the physicians were questioned regarding the obstacles to smoking cessation interventions, 289 (66.3%) cited poor knowledge of the issue, 55 (12.6%) cited a lack of time, and 20 (4.6%) cited unavailability of NRT. Conclusions: The results of this study highlight the lack of knowledge among physicians in Nigeria in terms of smoking cessation, as well as their failure to apply appropriate practices. The results of this study can further the evaluation and formulation of guidelines on smoking cessation and smoking education programs for physicians. Our findings also underscore the need to offer smoking cessation programs in all treatment facilities.

el-Guebaly N; Violato C. The international certification of addiction medicine: Validating clinical knowledge across borders. Substance Abuse 32(2, special issue): 77-83, 2011. (12 refs.)

The experience of the International Society of Addiction Medicine in setting up the first international certification of clinical knowledge is reported. The steps followed and the results of a psychometric analysis of the tests from the first 65 candidates are reported. Lessons learned in the first 5 years and challenges for the future are identified.

Faulkner LR; Juul D; Andrade NN; Brooks BA; Colenda CC; Guynn RW et al. Recent trends in American Board of Psychiatry and Neurology Psychiatric subspecialties. Academic Psychiatry 35(1): 35-39, 2011. (18 refs.)

Objective: This article reviews the current status and recent trends in the American Board of Psychiatry and Neurology (ABPN) psychiatric subspecialties and discusses the implications of those trends as well as several key questions whose answers may well determine subspecialty viability. Methods: Data are presented on specialty and subspecialty programs; graduates; and ABPN certification candidates and diplomates drawn from several sources, including the records of the ABPN, the websites of the Accreditation Council for Graduate Medical Education and the American Medical Association, and the annual medical education issues of JAMA. Results: Fewer than half of psychiatry graduates pursue subspecialty training. While most recent specialty graduates attempt to become certified by the ABPN, many subspecialists elect not to do so. There have been recent decreases in the number of fellowship programs and trainees in geriatric psychiatry and addiction psychiatry. The pass rates for fellowship graduates are superior to those for the "grandfathers" in all of the newer psychiatric subspecialties. Lower percentages of subspecialists than specialists participate in maintenance of certification, and maintenance of certification pass rates are high. Conclusion: The initial interest in training and certification in some of the ABPN subspecialties appears to have slowed, and the long-term viability of those subspecialties may well depend on the answers to a number of complicated social, economic, and political questions in the new health care era.

Fox HB; McManus MA; Klein JD; Diaz A; Elster AB; Felice ME et al. Adolescent medicine training in pediatric residency programs. Pediatrics 125(1): 165-172, 2010. (20 refs.)

OBJECTIVES: The aim of this study was to provide an assessment of pediatric residency training in adolescent medicine. METHODS: We conducted 2 national surveys: 1 of pediatric residency program directors and the other of faculty who are responsible for the adolescent medicine block rotation for pediatric residents to elicit descriptive and qualitative information concerning the nature of residents' ambulatory care training experience in adolescent medicine and the workforce issues that affect the experience. RESULTS: Required adolescent medicine topics that are well covered pertain to normal development, interviewing, and sexual issues. Those least well covered concern the effects of violence, motor vehicle safety, sports medicine, and chronic illness. Shortages of adolescent medicine specialists, addictions counselors, psychiatrists, and other health professionals who are knowledgeable about adolescents frequently limit pediatric residency training in adolescent medicine. Considerable variation exists in the timing of the mandatory adolescent medicine block rotation, the clinic sites used for ambulatory care training, and the range of services offered at the predominant training sites. In addition, residents' continuity clinic experience often does not include adolescent patients; thus, pediatric residents do not have opportunities to establish ongoing therapeutic relationships with adolescents over time. Both program and rotation directors had similar opinions about adolescent medicine training. CONCLUSIONS: Significant variation and gaps exist in adolescent medicine ambulatory care training in pediatric residency programs throughout the United States. For addressing the shortcomings in many programs, the quality of the block rotation should be improved and efforts should be made to teach adolescent medicine in continuity, general pediatric, and specialty clinics. In addition, renewed attention should be given to articulating the core competencies needed to care for adolescents.

Goodie JL; Williams PM; Kurzweil D; Marcellas KB. Can blended classroom and distributed learning approaches be used to teach medical students how to initiate behavior change counseling during a clinical clerkship? Journal of Clinical Psychology In Medical Settings 18(4): 353-360, 2011. (40 refs.)

Medical school curricula often provide insufficient time and instruction for health behavior change counseling. We examined the feasibility of blending classroom and distributed learning experiences to teach medical students how to initiate health behavior change counseling and analyzed the impact of this approach on their attitudes, knowledge, and skills. Usage patterns and pre- to post-class attitude and knowledge changes were assessed with self-report questions among 153 third year family medicine clerkship students. Most students viewed at least 90% of the online written content and took an average of 41 min (SD = 24 min 35 s) to view all of the content. Students' confidence in their ability to help patients change unhealthy behaviors significantly improved (p < .01). The blended learning curriculum facilitated learning of behavior change skills, encouraged interaction with course materials, and improved medical students' self confidence for using health behavior change skills.

Gunderson EW; Coffin PO; Chang N; Polydorou S; Levin FR. The interface between substance abuse and chronic pain management in primary care: A curriculum for medical residents. Substance Abuse 30(3): 253-260, 2009. (34 refs.)

Objectives: To develop and assess a housestaff curriculum on opioid and other substance abuse among patients with chronic noncancer pain (CNCP). Methods: The two-hour, case-based curriculum delivered to small groups of medical housestaff sought to improve assessment and management of opioid-treated CNCP patients, including those with a substance use disorder. A two-page pre-post survey was administered to assess self-efficacy change on a scale from 1 (strongly disagree) to 5 (strongly agree). Results: Of 47/50 (94%) respondents, self-efficacy significantly improved across all items (mean pre vs. post ratings, P < .001). Housestaff were more prepared to manage patients on chronic opioid medication (2.8 vs. 3.8), including those with substance use disorders (2.3 vs. 3.4). They felt more prepared to identify opioid dependence (2.8 vs. 3.9) and overall rated the curriculum favorably (4.2). Conclusions: The brief curriculum was well received and appears effective. Further study is needed to determine practice impact.

Haber PS. International perspectives in postgraduate medical training in addiction medicine. (editorial). Substance Abuse 32(2, special issue): 75-76, 2011. (6 refs.)

Haber PS; Murnion BP. Training in addiction medicine in Australia. Substance Abuse 32(2, special issue): 115-119, 2011. (0 refs.)

Barriers to entering addiction medicine (AM) have led to a persisting workforce shortage. To address this problem, the Chapter of Addiction Medicine (AChAM) was formed in 2001 as a subdivision of the Royal Australasian College of Physicians (RACP). Through consultation, AChAM has identified the scope of practice and offered fellowship to suitable established practitioners. The Chapter successfully applied to the Australian Government for recognition of AM as a medical specialty, which was finalized in November 2009. Specialist reimbursement item numbers were incorporated into that decision process and commence operating in November 2010. AChAM has designed and implemented a training scheme using a model similar to that of the RACP internal medicine training program. This comprises 3 years of basic general medical training post internship followed by 3 years of discipline-specific supervised training. The training is broadly based, with experience in both ambulatory care and inpatient care, and including physical health as well as mental health. Assessment is continuous and competency based. There is no exit examination. The overriding clinical approach rests upon the harm minimization framework consistent with long-established national drug policy in Australia and favors evidence-based treatment.

Han MY; Chen WQ; Chen XG. Do smoking knowledge, attitudes and behaviors change with years of schooling? A comparison of medical with non-medical students in China. Journal of Community Health 36(6): 966-974, 2011. (41 refs.)

This study aimed to compare the tobacco-related knowledge, attitudes and smoking behavior among Chinese medical and non-medical students across three grades from freshmen to juniors. Survey data were collected among 8,138 students using a paper-and-pencil questionnaire. Study findings indicate that compared to non-medical students, medical students in the sophomore and junior years reported significantly higher levels of knowledge regarding tobacco toxicants and tobacco-related diseases, and had stronger attitudes against smoking as personal rights and stronger attitudes in favor of smoking ban. The differences between medical and non-medical students remained after controlling for a number of covariates. However the prevalence rates of cigarette smoking were similar between medical and non-medical students across grades even after adjusted smoking initiation before entering college. Despite increases in tobacco related knowledge, approximately 40% of junior-year medical students did not recognize carbPacific Islanderon monoxide as a toxicant from tobacco, and 30-40% of them were unknown of tobacco smoking as a risk factor for several diseases, including hypertension, stroke, and gastric ulcer. Findings of this study suggest the need for immediate action to enhance tobacco-related education in formal medical training in China to prepare future doctors for smoking prevention and to assist millions of smokers to quit.

Iannucci R; Sanders K; Greenfield SF. A 4-Year curriculum on substance use disorders for psychiatry residents. Academic Psychiatry 33(1): 60-66, 2009. (18 refs.)

Objective: The authors describe an addiction psychiatry curriculum integrated in a general psychiatry training program to demonstrate comprehensive and practical approaches to educating general psychiatric residents on the recognition and treatment of substance use disorders. Methods: The Massachusetts General Hospital/McLean Hospital adult psychiatric residency training program provides training in addiction psychiatry in multiple treatment settings during the 4 years of residency. Addiction specialists, nonspecialty psychiatrists, and residents and fellows provide training. Results: Adult psychiatric residencies can provide comprehensive addiction psychiatry training that spans multiple treatment settings and postgraduate years by training general staff psychiatrists, senior residents, and fellows to assist core addiction faculty in providing addiction psychiatry education. Conclusion: Substance use disorders are common among patients presenting to general psychiatry treatment settings, and thus it is important that all psychiatric residents be well trained in the screening, diagnosis, and treatment of outpatients with these problems.

Jackson AH; Alford DP; Dube CE; Saitz R. Internal medicine residency training for unhealthy alcohol and other drug use: Recommendations for curriculum design. BMC Medical Education 10: e-article: DOI:10.1186/1472-6920-10-22, 2010. (71 refs.)

Background: Unhealthy substance use is the spectrum from use that risks harm, to use associated with problems, to the diagnosable conditions of substance abuse and dependence, often referred to as substance abuse disorders. Despite the prevalence and impact of unhealthy substance use, medical education in this area remains lacking, not providing physicians with the necessary expertise to effectively address one of the most common and costly health conditions. Medical educators have begun to address the need for physician training in unhealthy substance use, and formal curricula have been developed and evaluated, though broad integration into busy residency curricula remains a challenge. Discussion: We review the development of unhealthy substance use related competencies, and describe a curriculum in unhealthy substance use that integrates these competencies into internal medicine resident physician training. We outline strategies to facilitate adoption of such curricula by the residency programs. This paper provides an outline for the actual implementation of the curriculum within the structure of a training program, with examples using common teaching venues. We describe and link the content to the core competencies mandated by the Accreditation Council for Graduate Medical Education, the formal accrediting body for residency training programs in the United States. Specific topics are recommended, with suggestions on how to integrate such teaching into existing internal medicine residency training program curricula. Summary: Given the burden of disease and effective interventions available that can be delivered by internal medicine physicians, teaching about unhealthy substance use must be incorporated into internal medicine residency training, and can be done within existing teaching venues.

Kralikova E; Bonevski B; Stepankova L; Pohlova L; Mladkova N. Postgraduate medical education on tobacco and smoking cessation in Europe. Drug and Alcohol Review 28(5): 474-483, 2009. (28 refs.)

Issues. Smoking prevalence in European countries is high. Adequately trained physicians can play a key role in reducing smoking rates in Europe. This paper provides an overview of postgraduate smoking cessation training for physicians in Europe. Approach. Two methods were used: (i) a review of the Europe-based published and grey literature between 1999 and 2009 on postgraduate education programs for physicians in smoking cessation; and (ii) a survey of key informants identified through two European tobacco control list serves. Key Findings. A total of nine relevant articles were identified through the literature search which showed over 170 postgraduate training programs offered in Europe in smoking cessation. The survey resulted in a 100% response rate from 38 key informants from 28 European countries. Respondents from all countries except Latvia reported knowledge of the existence of smoking cessation training programs. Course content included brief intervention training (93%), pharmacotherapy (96%), motivational interviewing skills (85%) and training in the stages of change (89%). Participation by physicians in these courses was reported to be low (ranging in total participation estimates from 15 to 1100 per country). Implications. The study showed numerous training opportunities for physicians in Europe. However, postgraduate training in smoking cessation might not be reaching physicians and might not be rigorously evaluated. Conclusions. It is imperative that the effectiveness of the programs in changing provider practices and patient smoking outcomes is adequately evaluated. Further research is also indicated for methods of disseminating effective educational activities throughout Europe with the intention of increasing participation.

Leone FT; Evers-Casey S; Veloski J; Patkar AA; Kanzleiter L. Short-, intermediate-, and long-term outcomes of Pennsylvania's continuum of tobacco education pilot project. Nicotine & Tobacco Research 11(4): 387-393, 2009. (299 refs.)

The most effective time to introduce formal tobacco use treatment training for physicians is during the medical school experience. However, few medical schools have adopted standardized curricula, missing an important opportunity to influence future physician behavior. The Pennsylvania Continuum of Tobacco Education pilot project was undertaken from spring 2003 through summer 2005 to evaluate a generalizable method of improving students' knowledge, attitudes, and behaviors related to tobacco use treatment. Intervention methods included a 1-day intensive multiformat seminar, followed by a reinforcement session 4 weeks later, within an internal medicine clerkship. Outcome measures included changes in students' attitudes, rates of "ask" and "advise" behaviors during clinical encounters, and performance on end-of-year clinical skills examinations. Short, intermediate, and long-term outcomes related to both smoking assessment and counseling improved as a result of the intervention. The percentage of students who obtained tobacco histories and counseled patients in clerkships increased following the seminar compared with the baseline. Nearly, all students demonstrated relevant skills during a clinical skills assessment at the end of the third year. The introduction of a standardized tobacco curriculum into medical school training is both feasible and effective. Results were sustained following the intervention, and the effects were reflected across several valid outcomes.

Lozano P; McPhillips HA; Hartzler B; Robertson AS; Runkle C; Scholz KA et al. Randomized trial of teaching brief motivational interviewing to pediatrics trainees to promote healthy behaviors in families. Archives of Pediatrics & Adolescent Medicine 164(6): 561-566, 2010. (51 refs.)

Hypothesis: That pediatric resident trainees would demonstrate increased counseling skill following training in brief motivational interviewing (MI). Design: Randomized controlled trial. Setting: University of Washington Pediatric Residency. Participants: Pediatric residents (N=18), including residents in postgraduate years 1, 2, 3, and 4. Interventions: Collaborative Management in Pediatrics, a 9-hour behavior change curriculum based on brief MI plus written feedback on communication skills (based on a 3-month Objective Standardized Clinical Evaluation [OSCE]). Main Outcome Measure: The percentage of MI-consistent behavior (%MICO), a summary score for MI skill, was assessed via OSCEs in which standardized patients portray parents of children with asthma in 3 clinical scenarios (stations). The OSCEs were conducted at baseline and 3 and 7 months. Blinded coders rated videotaped OSCEs using a validated tool to tally communication behaviors. Training effects were assessed using linear regression controlling for baseline %MICO. Global ratings of counseling style served as secondary outcome measures. Results: Trained residents demonstrated a trend toward increased skill (%MICO score) at 3 months compared with control residents. At 7 months, %MICO scores increased 16% to 20% (P<.02) across all OSCE stations after the combined intervention of Collaborative Management in Pediatrics training plus written feedback. The effect of training on global ratings supported the main findings. Conclusions: Pediatric trainees' skills in behavior change counseling improved following the combination of training in brief MI plus personalized feedback.

Muramoto ML; Lando H. Faculty development in tobacco cessation: Training health professionals and promoting tobacco control in developing countries. Drug and Alcohol Review 28(5): 498-506, 2009. (76 refs.)

Issues. Cessation programs are essential components of comprehensive tobacco control. Health-care providers, especially physicians, have major responsibility for role modeling and promoting cessation. For successful, sustainable cessation training programs, countries need health-care professionals with knowledge and skills to deliver and teach tobacco cessation. Approach. Review literature relevant to faculty development in tobacco cessation and discuss its strategic potential in tobacco control. Key Findings. Faculty development is essential for sustainable tobacco cessation training programs, and a potentially powerful strategy to shift professional and societal norms towards cessation and support of comprehensive tobacco control in countries with normative tobacco use and underdeveloped tobacco control programs. Implications. Medical faculty are in a key position to influence tobacco cessation and control programs because of their roles as educators and researchers, receptivity to innovation and, influence on competencies and standards for medical education and practice. Faculty development programs must consider the number and type of faculty, and tobacco cessation curricula needed. Faculty development fosters the ability to institutionalise cessation education for students and community practitioners. Academic faculty are often leaders in their professional disciplines, influential in establishing clinical practice standards, and technical experts for government and other key health organisations. Conclusion. Training health-care professional faculty to become knowledgeable and committed to tobacco cessation opens opportunities to promote cessation and shift professional and societal norms away from tobacco use.

O'Connor PG; Nyquist JG; McLellan AT. Integrating addiction medicine into graduate medical education in primary care: The time has come. Annals of Internal Medicine 154(1): 56-U192, 2011. (25 refs.)

Substance use disorders create an enormous burden of medical, behavioral, and social problems and pose a major and costly public health challenge. Despite the high prevalence of substance use and its consequences, physicians often do not recognize these conditions and, as a result, provide inadequate patient care. At the center of this failure is insufficient training for physicians about substance use disorders. To address this deficit, the Betty Ford Institute convened a meeting of experts who developed the following 5 recommendations focused on improving training in substance abuse in primary care residency programs in internal medicine and family medicine: 1) integrating substance abuse competencies into training, 2) assigning substance abuse teaching the same priority as teaching about other chronic diseases, 3) enhancing faculty development, 4) creating addiction medicine divisions or programs in academic medical centers, and 5) making substance abuse screening and management routine care in new models of primary care practice. This enhanced primary care residency training should represent a major step forward in improving patient care.

O'Connor D; Schweizer Y; Spratt C. Expanding psychiatry training: Australian specialists' and trainees' perceived gaps in experiences and settings. Australasian Psychiatry 17(6): 506-508, 2009. (12 refs.)

Objective: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is working together with the Australian Federal Government to expand the range of training experiences and settings with the object of producing better equipped and better distributed psychiatrists to address the rising prevalence of mental disorder. To assist in this process, the College sought the views of its Fellows (psychiatrists) and trainees concerning important gaps in clinical experience and the settings best suited to filling them. Method: An electronic survey was sent to all Australian RANZCP psychiatrists and trainees in June 2008. Results: Only 15% of psychiatrists and 28% of trainees responded to the survey. There was striking concordance, however, that psychological therapies required much greater emphasis and that this experience would best be acquired in the private healthcare system. Conclusions: These findings support the recommendations of the Medical Specialist Training Steering Committee's report on expanded settings, suggesting that RANZCP members are likely to engage enthusiastically in the expanded specialist training program. It will be important to ensure that trainees are well supervised in their treatment of anxiety, affective and substance abuse disorders.

Pinxten WJL; De Jong C; Hidayat T; Istiqomah AN; Achmad YM; Raya RP et al. Developing a competence-based addiction medicine curriculum in Indonesia: The training needs assessment. Substance Abuse 32(2, special issue): 101- 107, 2011. (23 refs.)

Indonesia has one of the fastest growing, injecting drugs user-driven, human immunodeficiency virus (HIV) epidemics in Asia. Coverage of needle and syringe programs (NSPs), opioid substitution therapy (OST), and antiretroviral treatment (ART) is increasing, but is still low, whereas professional training in addiction medicine is not yet established. Urgent development and scaling-up of professional capacity in comprehensive, evidence-based addiction medicine is needed. In this article the results of the first step is presented, being the training needs assessment (TNA) and the process of further developing a national evidence- and competence-based addiction medicine curriculum in Indonesia.

Powers CA; Zapka J; Biello KB; O'Donnell J; Prout M; Geller A. Cultural competency and tobacco control training in US medical schools: Many but missed opportunities. Journal of Cancer Education 25(3): 290-296, 2010. (45 refs.)

Tobacco-related morbidity and mortality disproportionately burdens America's most vulnerable populations, and many physicians in the USA are untrained in smoking cessation skills with patients of various literacy levels and races and ethnicities. An anonymous survey was administered to 860 second year and 827 fourth year students at 12 medical schools. A faculty representative at each of the schools completed an assessment of the curriculum and rated medical students' knowledge and skills for cultural competency. Report of experience in tobacco counseling for persons of various literacy levels and ethnicities rose from 42% (second year students) to 82% (fourth year students) and 48% (second year students) to 91% (fourth year students), respectively. However, only 37% of second year students and 40% of fourth year students reported that they had ever been taught to employ culturally competent strategies for tobacco cessation. This study found that almost two thirds of students in 12 medical schools reported no exposure to teaching about cultural competency and tobacco cessation, and approximately one third reported no practical experience with tobacco cessation counseling persons of various races and ethnicities. Effective cultural competency training for tobacco control should include teaching the social constructs of race, ethnicity, and socio-cultural concepts within a medical context. Additionally, students should receive supervised clinical opportunities to practice counseling, including opportunities to discuss and reflect on their experiences.

Powers CA; Zapka J; Phelan S; Ozcan T; Biello KB; O'Donnell J et al. Tobacco education and counseling in obstetrics and gynecology clerkships: A survey of medical school program directors. Maternal and Child Health Journal 15(8): 1153-1159, 2011

The 16,000 medical students completing OB/GYN clerkship programs each year provide a unique opportunity to motivate and mentor students in facilitating tobacco cessation. To determine the scope of current tobacco teaching in obstetrics/gynecology (OB/GYN) education at US medical schools and to assess opportunities for including new tobacco teaching, a 28-question survey was administered to directors and assistant directors at US medical school OB/GYN clerkship programs. Surveys were completed at 71% of schools. Only 9% reported having at least 15min of dedicated teaching time for improving tobacco cessation skills. Nearly three-fourths of respondents reported teaching students how to intervene to reduce smoking during a work-up in the OB/GYN clinic, but only 43% reported that students would know where to refer someone wishing to quit. Only a third of respondents reported teaching students both to intervene with and refer OB/GYN patients who smoke. These findings suggest that although medical students see many OB and GYN patients who smoke, they have few opportunities to learn comprehensive cessation skills during their clerkships.

Rastegar DA; Bertram A; Sisson SD. Use of an internet-based curriculum to teach internal medicine residents about addiction. Journal of Addiction Medicine 4(4): 233-235, 2010. (21 refs.)

Objectives: Addiction is an important and common health problem. Many internal medicine training programs do not offer structured training in addiction; as a result, residents often report feeling unprepared in caring for patients with this problem. We developed an Internet-based curriculum to teach internal medicine residents about evaluating and treating patients with substance use disorders. Methods: Three educational modules on addiction were developed and posted on an established Web site that provides an internal medicine curriculum for training programs throughout the United States. Baseline and posttest questions were tested and validated by having house officers and addiction medicine faculty members complete the tests. We compared baseline pretest scores between first (PGY-1) and third year (PGY-3) residents to assess baseline knowledge and pretest and posttest scores for the entire cohort to assess the impact of the modules. Results: Each module was completed by over 1200 residents at 86 different training programs. Although overall baseline pretest scores were better among PGY-3 than PGY-1 residents (mean 58% vs 55%; P < 0.05), the difference between the 2 groups for individual modules was not significant. The mean baseline pretest score was 56.4% and posttest score was 74.8%, a difference that was statistically significant (P < 0.001). When asked to rate the educational value of the program, the residents gave it a mean score of 4.2 on a 5-point Likert scale (1 = not instructive; 5 = highly instructive). Conclusions: Internet-based curricula can be an effective tool to disseminate knowledge on addiction to trainees. Learners show an improvement in testing scores and rate these programs highly.

Richmond R; Zwar N; Taylor R; Hunnisett J; Hyslop F. Teaching about tobacco in medical schools: A worldwide study. Drug and Alcohol Review 28(5): 484-497, 2009. (50 refs.)

Introduction and Aims. As medical practitioners of the future, medical students should be taught about tobacco control strategies and smoking cessation interventions. By including education about tobacco in the medical curricula, they can be informed about the health effects of tobacco use and learn to assist smokers to quit. Our study aimed to estimate the extent of teaching about tobacco and smoking cessation techniques in medical schools worldwide and compare with results we reported 10 years ago, to determine the content of curricula and range of teaching formats and to identify barriers to teaching about tobacco in medical schools and solutions. Design and Methods. A cross-sectional survey of all existing medical schools (n = 2090) in 171 countries was conducted. A questionnaire was designed, translated and sent to all medical schools. Main outcome measures included whether and how tobacco is taught; comparisons with the survey conducted 10 years ago; tobacco content in the curriculum; format of teaching; and barriers to teaching and solutions. Results. 665 medical schools from 109 countries completed the full questionnaire, with a response rate of 31.8% from medical schools and 64% of countries and consisting of 39% of medical schools in developed and 28% in less developed countries. A further 67 medical schools responded to a single question on whether they taught about tobacco. The total response rate was 35%. Of 561 medical schools responding to questions on teaching options, 27% of medical schools taught a specific module on tobacco compared with only 11% in our survey of medical schools conducted a decade ago; 77% integrated teaching on tobacco with other topics compared with 40% 10 years ago; 31% taught about tobacco informally as the topic arose (vs. 58%) and 4% did not teach about tobacco (vs. 12%). Most common topics taught were: health effects of smoking (94%), health effects of passive smoking (84.5%), epidemiology of tobacco use (81%), nicotine dependence (78%) and taking a smoking history (75%). Most popular method of teaching was by lectures (78%), case study discussions and problem-based learning exercises (51%), class readings 46%, in the clinical setting with real patients (45%), special projects and assignments (45%) and patient-centred teaching approaches, such as role plays (31%). Significantly, more barriers to teaching were identified by less developed countries (> 60%) including: lack of available teaching time in the medical program, limited organisational ability to include new subjects, lack of staff resources to teach, lack of current plans to introduce a tobacco curriculum, lack of a key person to champion and organise teaching, lack of financial resources and lack of incentives or advantages to teach. A majority described solutions to these problems. A case study of education on tobacco throughout the medical curriculum is presented. Discussion and Conclusions. We found an encouraging increase in the extent of teaching on tobacco in medical schools over 10 years. We report that although progress has been made to address the teaching of tobacco in medical schools worldwide, there is a great deal more effort required so that education on tobacco is an ongoing part of medical curricula. The teaching content is generally based on evidence-based smoking cessation guidelines.

Seale JP; Shellenberger S; Clark DC. Providing competency-based family medicine residency training in substance abuse in the new millennium: A model curriculum. BMC Medical Education 10, 2010. (87 refs.)

Background: This article, developed for the Betty Ford Institute Consensus Conference on Graduate Medical Education (December, 2008), presents a model curriculum for Family Medicine residency training in substance abuse. Methods: The authors reviewed reports of past Family Medicine curriculum development efforts, previously-identified barriers to education in high risk substance use, approaches to overcoming these barriers, and current training guidelines of the Accreditation Council for Graduate Medical Education (ACGME) and their Family Medicine Residency Review Committee. A proposed eight-module curriculum was developed, based on substance abuse competencies defined by Project MAINSTREAM and linked to core competencies defined by the ACGME. The curriculum provides basic training in high risk substance use to all residents, while also addressing current training challenges presented by U. S. work hour regulations, increasing international diversity of Family Medicine resident trainees, and emerging new primary care practice models. Results: This paper offers a core curriculum, focused on screening, brief intervention and referral to treatment, which can be adapted by residency programs to meet their individual needs. The curriculum encourages direct observation of residents to ensure that core skills are learned and trains residents with several "new skills" that will expand the basket of substance abuse services they will be equipped to provide as they enter practice. Conclusions: Broad-based implementation of a comprehensive Family Medicine residency curriculum should increase the ability of family physicians to provide basic substance abuse services in a primary care context. Such efforts should be coupled with faculty development initiatives which ensure that sufficient trained faculty are available to teach these concepts and with efforts by major Family Medicine organizations to implement and enforce residency requirements for substance abuse training.

Sims C; Sabra D; Bergey MR; Grill E; Sarani B; Pascual J et al. Detecting intimate partner violence: More than trauma team education is needed. Journal of the American College of Surgeons 212(5): 867-872, 2011. (31 refs.)

BACKGROUND: Intimate partner violence (IPV) is an underappreciated cause of morbidity and mortality in female trauma patients. We investigated the impact of a domestic violence education program for trauma residents on the detection of IPV. STUDY DESIGN: In January 2008, an educational IPV program was implemented for all trauma residents. A retrospective review of all female patients evaluated by the trauma service before and after institution of the IPV program was performed. Medical records were reviewed for demographic data, injury mechanism, social habits, and IPV documentation. Chi-square and Fisher's exact tests were used to compare patients before and after institution of the educational IPV program. RESULTS: The records of 645 female trauma patients evaluated in 2007 and 2008 were reviewed. Patients were not routinely asked about IPV, despite implementation of the educational program; 39.9% were asked about IPV in 2007 versus 46.1% in 2008 (p = 0.11). The positive disclosure of IPV did not increase from 2007 to 2008 (20.1% versus 21.2%; p = 0.83). Documentation about social habits increased considerably. In 2008, patients were asked more regularly about alcohol (71.8% versus 80.8%; p = 0.01), drugs (64.1% versus 73.7%; p = 0.01), and tobacco use (67.0% versus 78.1%; p = 0.002). Importantly, patients with documented IPV (n = 57) frequently presented to the trauma team with nonviolent mechanisms of injury (n = 30, 52.6%). CONCLUSIONS: IPV is a frequent finding in female trauma patients. Despite increased education, questions about IPV are not documented routinely. In addition, screening at-risk patients by mechanism will underestimate the prevalence of IPV. Universal screening should be mandated to increase IPV detection and enhance opportunities for intervention.

Stein MR; Arnsten JH; Parish SJ; Kunins HV. Evaluation of a substance use disorder curriculum for internal medicine residents. Substance Abuse 32(4): 220-224, 2011

Teaching about diagnosis, treatment, and sequelae of substance use disorders (SUDs) is insufficient in most Internal Medicine residency programs. To address this, the authors developed, implemented, and evaluated a novel and comprehensive SUD curriculum for first year residents (interns) in Internal Medicine, which anchors the ensuing 3-year longitudinal SUD curriculum. This intern curriculum includes didactic and experiential elements and allows skills practice. Topics include local epidemiology of substance abuse, neurobiology of SUDs, and screening, treatment, and referral. The entire curriculum is delivered over 7 hours during a month-long ambulatory rotation. Among 58 interns who have completed a pre-post evaluation of the curriculum, the majority reported an increased sense of responsibility for and confidence in treating patients with SUDs.

Sullivan MD; Gaster B; Russo J et al. Randomized trial of web-based training about opioid therapy for chronic pain. Clinical Journal of Pain 26: 512-517, 2010. (18 refs.)

Tontchev GV; Housel TR; Callahan JF; Kunz KB; Miller MM; Blondell RD. Specialized training on addictions for physicians in the United States. Substance Abuse 32(2, special issue): 84- 92, 2011. (7 refs.)

In the United States accredited residency programs in addiction exist only for psychiatrists specializing in addiction psychiatry (ADP); nonpsychiatrists seeking training in addiction medicine (ADM) can train in nonaccredited fellowships, or can receive training in some ADP programs, only to not be granted a certificate of completion of accredited training. Information about ADP residency programs has been tabulated, but it is not available for ADM fellowships. The authors conducted a national survey to compile information about the location, structure, curriculum, and other characteristics of active ADM fellowships. Of the 40 accredited ADP residency programs, 7 offered training in addiction to nonpsychiatrists. The authors identified 14 nonaccredited ADM fellowships. In 2009 and 2010, there were approximately 15 nonpsychiatrists in ADP programs and 25 in ADM fellowships. Clinical experiences included inpatient services, outpatient treatment services such as methadone maintenance or buprenorphine maintenance, and providing addiction consult services. The most common academic activities included weekly lectures and the teaching of medical students.

Torabi MR; Tao R; Jay SJ; Olcott C. A cross-sectional survey on the inclusion of tobacco prevention/cessation, nutrition/diet, and exercise physiology/fitness education in medical school curricula. Journal of the National Medical Association 103(5): 400-406, 2011. (49 refs.)

Chronic diseases are currently the major cause of death and disability worldwide. Addressing the main causes of chronic diseases from a preventive perspective is imperative for halting a continual increase in premature deaths. Physicians occupy a unique position to assist individuals with chronic disease prevention. Hence, medical school is an opportunity to prepare physicians for preventive interventions with patients at risk for developing chronic diseases. This study asserts that education on chronic disease prevention that targets tobacco cessation/prevention, nutrition/diet, and exercise physiology/fitness is a key aspect of medical school curricula. However, many US medical schools do not include all 3 components in their curricula. This study investigates the extent to which medical school curricula include the above 3 areas. Two methods were utilized for the study: (1) a cross-sectional survey was given to the associate dean of academic affairs of 129 US medical schools and (2) relevant data were retrieved from the Association of American Medical Colleges. Findings support the notion that medical schools are in need of increased curricula covering tobacco prevention/cessation, nutrition/diet, and exercise physiology/fitness. Results indicate that exercise physiology/fitness was the area receiving the least attention in medical schools. Ultimately, this study's purpose was to provide a basis for determining whether inclusion of these 3 subjects in medical school curricula has any significant effect on training future doctors to meet the needs of growing numbers of individuals with chronic disease.

Truncali A; Lee JD; Ark TK; Gillespie C; Triola M; Hanley K et al. Teaching physicians to address unhealthy alcohol use: A randomized controlled trial assessing the effect of a Web-based module on medical student performance. Journal of Substance Abuse Treatment 40(2): 203-213, 2011. (40 refs.)

Background: The authors developed and evaluated an interactive, Web-based module to train medical students in screening and brief intervention (SBI) for unhealthy alcohol use. Methods: First-year students were randomized to module versus lecture. Change in knowledge, attitudes, and confidence were compared. Performance was assessed by objective structured clinical examination (OSCE) and analyzed by intention to treat and treatment received. Results: Of 141 consenting students, 64% (n = 90) completed an intervention (54% lecture vs. 70% Web assigned). Knowledge, confidence, and attitudes improved in both groups, with more improvement in Advise Assist knowledge for Web students (14% vs. -3%, p = .003). Web students outperformed their lecture peers in both general communication (65% vs. 51% items well done, p = .004);and alcohol-specific tasks (54% vs. 41%, p = .021) on OSCE. Analysis by treatment received enhanced between-group differences. Conclusion: Use of a Web-based module to teach SBI is associated with greater knowledge gain and skills performance compared with a lecture covering similar content. The module provides an efficient means for training in this area.

Victor JC; Brewster JM; Ferrence R; Ashley MJ; Cohen JE; Selby P. Tobacco-related medical education and physician interventions with parents who smoke: Survey of Canadian family physicians and pediatricians. Canadian Family Physician 56(2): 157-+, 2010. (29 refs.)

OBJECTIVE: To examine the relationship between physicians' tobacco-related medical training and physicians' confidence in their tobacco-related skills and smoking-related interventions with parents of child patients. DESIGN: Mailed survey. SETTING: Canada. PARTICIPANTS: The survey was mailed to 800 family physicians and 800 pediatricians across Canada, with a corrected response rate of 65% (N = 900). MAIN OUTCOME MEASURES: Physicians' self-reported tobacco-related education, knowledge, and skills, as well as smoking-related interventions with parents of child patients. Cochran-Mantel-Haenszel chi(2) tests were used to examine relationships between variables, controlling for tobacco-control involvement and physician specialty. Data analysis was conducted in 2008. RESULTS Physicians reporting tobacco-related medical education were more likely to report being "very confident" in advising parents about the effects of smoking and the use of a variety of cessation strategies (P < .05). Furthermore, physicians with tobacco-related training were more likely to help parents of child patients quit smoking whether or not the children had respiratory problems (P < .05). Physicians with continuing medical education in this area were more likely to report confidence in their tobacco-related skills and to practise more smoking-related interventions than physicians with other forms of training. CONCLUSION: There is a strong relationship between medical education and physicians' confidence and practices in protecting children from second-hand smoke. Physicians with continuing medical education training are more confident in their tobacco-related skills and are more likely to practise smoking-related interventions than physicians with other tobacco-related training.

Viets VL; Baca C; Verney SP; Venner K; Parker T; Wallerstein N. Reducing health disparities through a culturally centered mentorship program for minority faculty: The Southwest Addictions Research Group (SARG) experience. Academic Medicine 84(8): 1118-1126, 2009. (38 refs.)

Purpose: Ethnic minority faculty members are vastly underrepresented in academia. Yet, the presence of these individuals in academic institutions is crucial, particularly because their professional endeavors often target issues of health disparities. One promising way to attract and retain ethnic minority faculty is to provide them with formal mentorship. This report describes a culturally centered mentorship program, the Southwest Addictions ResearchGroup (SARG, 2003-2007), at the University of New Mexico (UNM) that trained a cadre of minority researchers dedicated to reducing health disparities associated with substance abuse. Method: The SARG was based at UNM's School of Medicine's Institute for Public Health, in partnership with the UNM's Center on Alcoholism, Substance Abuse, and Addictions. The program consisted of regular research meetings, collaboration with the Community Advisory Board, monthly symposia with renowned professionals, pilot projects, and conference support. The authors collected data on mentee research productivity as outcomes and conducted separate mentee and mentor focus-group interviews to assess the strengths and weaknesses of the SARG program. Results: The SARG yielded positive outcomes as evidenced by mentee increase in grant submissions, publications, and professional presentations. Focus-group qualitative data highlighted program and institutional barriers as well as successes that surfaced during the program. Based on this evaluation, a Culturally Centered Mentorship Model (CCMM) emerged. Conclusions: The CCMM can help counter institutional challenges by valuing culture, community service, and community-based participatory research to support the recruitment and advancement of ethnic minority faculty members in academia.

Warren CW; Sinha DN; Lee J; Lea V; Jones NR. Tobacco use, exposure to secondhand smoke, and cessation counseling among medical students: Cross-country data from the Global Health Professions Student Survey (GHPSS), 2005-2008. BMC Public Health 11: e-article 72, 2011. (24 refs.)

Background: GHPSS is a school-based survey that collects self-administered data from students in regular classroom settings. GHPSS produces representative data at the national or city level in each country. This study aims to investigate the prevalence of tobacco use, exposure to secondhand smoke, and cessation counseling among medical students using the GHPSS data. Methods: The Global Health Professions Student Survey (GHPSS) was conducted among 3(rd) year medical students in 47 countries and the Gaza Strip/West Bank from 2005-2008 to determine the prevalence of tobacco use and amount of formal training in cessation counseling. Results: In 26 of the 48 sites, over 20% of the students currently smoked cigarettes, with males having higher rates than females in 37 sites. Over 70% of students reported having been exposed to secondhand smoke in public places in 29 of 48 sites. The majority of students recognized that they are role models in society (over 80% in 42 of 48 sites), believed they should receive training on counseling patients to quit using tobacco (over 80% in 41 of 48 sites), but few reported receiving formal training (less than 40% in 46 of 48 sites). Conclusion: Tobacco control efforts must discourage tobacco use among health professionals, promote smoke free workplaces, and implement programs that train medical students in effective cessation-counseling techniques.

Zoorob R; Aliyu MH; Hayes C. Fetal alcohol syndrome: Knowledge and attitudes of family medicine clerkship and residency directors. Alcohol 44(4): 379-385, 2010. (15 refs.)

Fetal alcohol spectrum disorders (FASD) are the leading preventable causes of developmental disabilities with serious permanent consequences. Regardless of the increased awareness of fetal alcohol syndrome (FAS), 13% of women in the United States drink alcohol during pregnancy. Health care professionals do not routinely assess the frequency and quantity of alcohol use by their patients. This study examined the knowledge, skills, and practices of family medicine residency and clerkship directors and assessed the time devoted and format of FAS curricula in the programs. A self-administered anonymous survey was sent to the residency and clerkship directors (N = 571). Response rate of clerkship directors was 52% and residency directors 46%. Both groups showed high level of knowledge of FASD and of alcohol counseling practices for pregnant women. Although almost two thirds of the residency programs had FASD integrated in the curriculum, an equivalent fraction of predoctoral programs did not. More than half of the clerkship directors without FASD in their curriculum agreed that a need exists for its inclusion. These findings raise important medical education and policy issues and provide insight into the disparity in FASD content of curricula between predoctoral and family medicine residency programs in the United States. The role of physician counseling in primary prevention of FAS should continue to be stressed in predoctoral and residency education.

Zwar NA; Richmond RL; Davidson D; Hasan I. Postgraduate education for doctors in smoking cessation. Drug and Alcohol Review 28(5): 466-473, 2009. (32 refs.)

Introduction and Aims. Smoking cessation advice from doctors helps improve quit rates but the opportunity to provide this advice is often missed. Postgraduate education is one strategy to improve the amount and quality of cessation support provided. This paper describes a sample of postgraduate education programs for doctors in smoking cessation and suggests future directions to improve reach and quality. Design and Methods. Survey of key informants identified through tobacco control listserves supplemented by a review of the published literature on education programs since 2000. Programs and publications from Europe were not included as these are covered in another paper in this Special Issue. Results. Responses were received from only 21 key informants from eight countries. Two further training programs were identified from the literature review. The following components were present in the majority of programs: 5 As (Ask, Advise, Assess, Assist and Arrange) approach (72%), stage of change (64%), motivational interviewing (72%), pharmacotherapies (84%). Reference to clinical practice guidelines was very common (84%). The most common model of delivery of training was face to face. Lack of interest from doctors and lack of funding were identified as the main barriers to uptake and sustainability of training programs. Discussion and Conclusions. Identifying programs proved difficult and only a limited number were identified by the methods used. There was a high level of consistency in program content and a strong link to clinical practice guidelines. Key informants identified limited reach into the medical profession as an important issue. New approaches are needed to expand the availability and uptake of postgraduate education in smoking cessation.