Maria N Kelly, MD - University of Florida; Lindsay Thompson, MD, MA - University of Florida; Teresa Lynch, MD - University of Florida; Maureen Novak, MD - University of Florida
Tobacco use is a global cause of pediatric morbidity and mortality. Physicians must be competent to address this epidemic, yet medical curricula inconsistently include rigorous tobacco education. This study evaluates the impact of a tobacco curriculum on medical student tobacco knowledge and documentation practices for use, exposure and cessation guidance in pediatric primary care.
We used a cohort design at a large academic health center using volunteer 3rd year medical students (n=240). The student intervention group (n=120) participated in a 4-phase research design. Phases included: 1) pre-test knowledge assessment, 2) tobacco curriculum (EPA’s Smoke-Free Homes), 3) post-test knowledge assessment, and 4) random chart audit of clinical encounters (n=642) for tobacco-related documentation. Data analyses included comparison of pre/post-test scores (within subjects t-test, Cohen’s-d) and tobacco documentation practices.
After completion of the tobacco curriculum, students receiving the intervention had significant improvements in tobacco knowledge. Pretest mean scores improved from 10.1 (possible 12) to 11.2 (p=0.000, Cohen’s effect: ‘large’ d=1.1). For all visit types combined (well and sick), the curriculum improved student documentation of tobacco cessation practices (OR 22.6, 95% CI 6.8-74.6, p=0.000), but did not improve documentation of use (p=ns) or exposure (p=ns). However, for well visits only, the curriculum improved student documentation of tobacco cessation practices (OR 34.1, 95% CI 10.5-110.7, p=0.000), use (OR 6.5, 95% CI 3.2-13.2, p=0.000) and exposure (OR 10.1, 95% CI 4.8-21.2, p=0.000). Unexpectedly, in children with a tobacco-related condition, students’ documentation was lower for tobacco use (OR 0.5, 95% CI 0.3-0.8, p=0.004), but not exposure (p=ns) or cessation practices (p=ns).
The tobacco curriculum significantly improved students’ knowledge and documentation of tobacco cessation strategies in all visit types. It also improved documentation of tobacco use, exposure and cessation strategies during well child visits. However, these modules did not improve documentation of tobacco use when tobacco-related conditions existed. In an era of increased need for documentation, future studies must promote documentation in addition to knowledge and clinical counseling skills.