Geller Alan C, Brooks Daniel R, Powers Catherine A, Brooks Katie R, Rigotti Nancy A, Bognar Bryan, McIntosh Scott, Zapka Jane
Department of Dermatology, Boston University School of Medicine, Boston, MA, USA.
J Gen Intern Med. 2008 Jul;23(7):1071-6. doi: 10.1007/s11606-008-0526-z.
Tobacco dependence counseling is recommended to be included as core curriculum for US medical students. To date, there has been little information on students' self-reported skills and practice opportunities to provide 5A's (Ask, Advise, Assess, Assist, and Arrange) counseling for tobacco cessation.
We conducted anonymous surveys of second year and fourth year students at multiple US medical schools between February 2004 and March 2005 (overall response rate 70%). We report on the tobacco control practices of the 860 second year and 827 fourth year students completing the survey.
Fourth year students reported multiple opportunities to learn tobacco counseling in case-based discussions, simulated patient encounters, and clinical skills courses. They reported more instruction in family medicine (79%) and Internal Medicine (70%) than Pediatrics (54%), Obstetrics/Gynecology (41%), and Surgery clerkships (16%). Compared with asking patients about smoking, advising smokers to quit, and assessing patient willingness to quit, fourth year students were less likely to have multiple practice opportunities to assist the patient with a quit plan and arrange follow-up contact. More than half of second year students reported multiple opportunities for asking patients about smoking but far fewer opportunities for practicing the other 4 As.
By the beginning of their fourth year, most students in this group of medical schools reported multiple opportunities for training and practicing basic 5A counseling, although clear deficits for assisting patients with a quit plan and arranging follow-up care exist. Addressing these deficits and integrating tobacco teaching through tailored specific instruction across all clerkships, particularly in Surgery, Pediatrics, and Obstetrics/Gynecology is a challenge for medical school education.
建议将烟草依赖咨询纳入美国医学生的核心课程。迄今为止，关于学生自我报告的提供戒烟5A（询问、建议、评估、协助和安排）咨询的技能和实践机会的信息很少。
2004年2月至2005年3月期间，我们对美国多所医学院的二年级和四年级学生进行了匿名调查（总体回复率70%）。我们报告了完成调查的860名二年级和827名四年级学生的烟草控制实践情况。
四年级学生报告在基于案例的讨论、模拟患者问诊和临床技能课程中有多次学习烟草咨询的机会。他们报告说，在家庭医学（79%）和内科（70%）中接受的指导比儿科（54%）、妇产科（41%）和外科实习（16%）更多。与询问患者吸烟情况、建议吸烟者戒烟以及评估患者戒烟意愿相比，四年级学生有多个实践机会协助患者制定戒烟计划并安排后续联系的可能性较小。超过一半的二年级学生报告有多次询问患者吸烟情况的机会，但练习其他4个A的机会要少得多。
到四年级开始时，这组医学院的大多数学生报告有多次培训和实践基本5A咨询的机会，尽管在协助患者制定戒烟计划和安排后续护理方面存在明显不足。解决这些不足并通过在所有实习中进行量身定制的具体教学来整合烟草教学，尤其是在外科、儿科和妇产科，对医学院教育来说是一项挑战。
