COMSEP 2009 Baltimore Meeting with APPD
EFFECT OF MEDICAL STUDENT TOBACCO EDUCATION ON DOCUMENTATION PRACTICES OF TOBACCO IN PEDIATRIC PRIMARY CARE
Maria N. Kelly, MD, Teresa A. Lynch, MD, Lindsay A. Thompson, MD, Maureen A. Novak, MD, University of Florida College of Medicine, Gainesville, Florida
OBJECTIVE: Tobacco is a global cause of morbidity and mortality. Physicians must be competent to address this epidemic but medical curricula inconsistently include tobacco. This study aims to evaluate the impact of tobacco educational modules on medical student knowledge, guidance, and documentation practices. METHODS: Cohort design at a large academic medical center using 3rd-year medical students (n=43, intervention group) and pediatric residents (n=48, control group). They participated in a 4-phase design (students: phases 1-4, residents: 1,4 only). Phases included: 1) pre-test knowledge assessment, 2) tobacco education modules (EPA’s Smoke-Free Homes), 3) post-test knowledge assessment, and 4) chart audit of randomly selected clinical encounters (n=488) for tobacco-related documentation. Data analyses included comparison between students and residents of pre/post-test scores (within subjects t-test, Cohen’s-d) and tobacco documentation practices. RESULTS: There was no difference (p=ns) in pretest knowledge scores between students (10.1, possible 12) and residents (10.1), yet students’ post-test scores were higher following tobacco education modules (mean 11.2, p=0.000, Cohen’s effect: large d=1.1). Compared to residents, modules improved student documentation of tobacco cessation/prevention practices (OR 2.0, 95% CI 1.2-3.1, p=0.004), but did not improve documentation of tobacco use (p=ns) or exposure (p=ns). Unexpectedly, if child had a tobacco-related condition, students’ documentation was lower compared to residents’ for tobacco use (OR 0.5, 95% CI 0.3-0.8, p=0.004), exposure (OR 0.6, 95% CI 0.4-0.9, p=0.018), and prevention/cessation practices (OR 0.4, 95% CI 0.2-0.6, p=0.000). CONCLUSIONS: Tobacco education improved students’ knowledge and documentation of tobacco prevention/cessation compared to residents. However, the modules did not improve documentation of tobacco use and exposure, especially when tobacco-related conditions existed. In an era of increased need for documentation, future studies must promote recording in addition to knowledge and skills.