Geller Alan C, Lash Timothy L, Siegel Benjamin, Annas George David, Prout Marianne N
Department of Dermatology, Boston University School of Medicine, 720 Harrison Avenue, DOB 801A, Boston, MA 02118, USA.
Prev Med. 2005 Jul;41(1):47-52. doi: 10.1016/j.ypmed.2004.08.002. Epub 2004 Nov 10.
American medical schools lack significant educational programs for teaching medical students about counseling parents and children on smoking prevention and cessation. Thus, the objectives of this study were to describe medical student's self-reported behaviors in the assessment of parents and children's use of tobacco and to compare these practices with well-accepted pediatric activities: injury prevention and developmental assessment.
Third year medical students in a pediatric clerkship at Boston University, all of whom spend part of their clerkship with pediatricians in their offices, completed six weekly surveys (2001-2002) recording their clinical activities in counseling parents and children about smoking, injury prevention, and performing developmental assessments.
Of the 150 third year students completing the pediatric orientation, 108 (72%) completed all six feedback surveys and the general cancer prevention survey. Of the 108 students, 77% completed smoking assessments with at least one family per week during their 6-week clerkship compared with performance of injury prevention (85%, P = 0.09) and developmental assessment (91%, P = 0.006). Among all smoking cessation and prevention recommendations, students were most likely to discourage parents from smoking in the house and least likely to offer tips for parents to counsel their children about smoking. All variables related to primary care pediatricians' role modeling and feedback for optimal tobacco counseling practices were significantly associated with student counseling practice.
Third year medical students were less likely to complete smoking assessments than those for developmental assessment and injury prevention counseling. However, primary care pediatricians' strong expectations and modeling of smoking counseling were uniformly associated with improved self-perceived student performance. Future educational activities should engage the primary care pediatrician preceptors of students completing pediatric rotations.
美国医学院校缺乏针对医学生开展关于向家长和儿童提供预防及戒烟咨询教育的重要项目。因此，本研究的目的是描述医学生在评估家长和儿童烟草使用情况时自我报告的行为，并将这些做法与公认的儿科活动（伤害预防和发育评估）进行比较。
波士顿大学儿科实习的三年级医学生，他们都在儿科医生办公室度过部分实习时间，在2001 - 2002年期间完成了六周的每周调查，记录他们在为家长和儿童提供吸烟、伤害预防咨询以及进行发育评估方面的临床活动。
在完成儿科实习导向的150名三年级学生中，108名（72%）完成了所有六项反馈调查和一般癌症预防调查。在这108名学生中，77%在为期6周的实习期间每周至少对一个家庭进行吸烟评估，相比之下，伤害预防评估的完成率为85%（P = 0.09），发育评估的完成率为91%（P = 0.006）。在所有戒烟和预防建议中，学生最常劝阻家长不要在家中吸烟，而最不可能为家长提供指导孩子吸烟问题的建议。与初级保健儿科医生在最佳烟草咨询实践中的榜样作用和反馈相关的所有变量都与学生咨询实践显著相关。
三年级医学生完成吸烟评估的可能性低于发育评估和伤害预防咨询。然而，初级保健儿科医生对吸烟咨询的强烈期望和榜样作用与学生自我感知的表现改善始终相关。未来的教育活动应让参与儿科轮转学生实习的初级保健儿科医生带教老师参与进来。
