RCT for Smoking Cessation in 10 Medical Schools

10 所医学院的戒烟随机对照试验

基本信息

批准号：
8071175
负责人：
JUDITH K OCKENE
金额：
$ 76.34万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-06 至 2014-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8071175
关键词：
Academic Detailing Accounting Address Adult Attention Behavior Cessation of life Clinical Clinical Practice Guideline Collaborations Control Groups Cost of Illness Counseling Crowding Data E-learning Education Educational Curriculum Educational process of instructing Effectiveness Elements Enrollment Epidemic Evaluation Evidence based intervention Feedback Geographic Locations Goals Health Hour Impact evaluation Individual Instruction Intervention Knowledge Learning Measures Mediating Medical Medical Education Medical Students Methods Modality Modeling Online Systems Outcome Patient Self-Report Patients Performance Physicians Play Policies Process Randomized Reporting Research Research Design Research Methodology Research Personnel Role Schedule Schools Self Efficacy Site Smoke Smoker Smoking Societies Structure Students Surveys System Teaching Method Testing Tobacco Tobacco Dependence Tobacco Use Cessation Tobacco use Training United States Public Health Service Update Withholding Treatment Work base cohort combat compare effectiveness control trial design evidence base experience follow-up improved innovation interest killings medical schools next generation premature primary outcome programs randomized trial secondary outcome skill acquisition skills skills training smoking cessation smoking prevalence theories tobacco control

项目摘要

DESCRIPTION (provided by applicant): Each year smoking kills 430,000 U.S citizens, exacerbates a myriad of diseases, and costs society approximately $100 billion. Despite the proliferation of information and restrictive smoking policies, adult smoking prevalence has remained relatively stable during the past five years, currently at 21%. Brief physician- delivered tobacco treatment, commonly known as "the 5As", is an evidence-based intervention demonstrated to double a smoker's likelihood of quitting. Given that 70% of smokers see a physician each year, it is imperative that all clinicians have the appropriate knowledge and skill level to counsel smokers. However, few physicians and physicians-in-training receive adequate training to develop these skills. Using a pair-matched, randomized group-controlled (RGC) design (implemented in 10 medical schools), we will compare two methods of teaching the 5As to medical students: 1) traditional medical education (TE), and 2) multi-modal education (MME) that adds two components to TE: a web-based instructional program for students and preceptor training. The primary outcome is observed tobacco treatment counseling skill as measured by the Objective Structured Clinical Examination (OSCE), the standard method for evaluating medical student skill level at all U.S. medical schools. A secondary outcome is self-reported tobacco treatment counseling skill level. In a nested cohort design, during the second year of the study a cohort of medical students will be followed from early in their first year of medical school (MS1) through the end of their third year (MS3) which occurs in the 4th year of the study. The Primary Aim of this RGC trial is to compare the effectiveness of MME for teaching the 5As counseling skills in medical school against TE. Hypothesis 1: MME will outperform TE on observed 5As counseling skills (OSCE). Hypothesis 2: MME will outperform TE on self-reported 5As counseling skills. Strengths of this study include: 1) the innovative study design that tests common and integrative teaching methods and 2) the potential to disseminate throughout US medical schools effective educational methods that can build physicians' skills to assist the millions of patients who continue to smoke. This is a unique window of opportunity to build on our team's prior research in medical education and tobacco dependence treatment. This study involves close collaboration among researchers, practitioners, educators, and stakeholders at 10 U.S. medical schools. This unique team is comprised of investigators with extensive experience developing and teaching an evidence-based, physician-delivered 5A tobacco treatment model; developing and evaluating a web-based tobacco dependence treatment course; implementation of academic detailing with physician preceptors; and experience in building a large medical school consortium for tobacco curriculum reform. PUBLIC HEALTH RELEVANCE: Each year, smoking kills 430,000 U.S citizens, exacerbates myriad diseases, and costs society approximately $100 billion. Brief physician-delivered tobacco cessation counseling, commonly known as "the 5As", is an evidence-based intervention strategy that has been shown to double a smoker's likelihood of quitting. Although 70% of smokers see a physician each year, few physicians are skilled in tobacco cessation treatment, making it imperative that all clinicians and all physicians-in-training have the appropriate knowledge and skill level to counsel their patients who smoke. The goal of this group randomized trial conducted at 10 medical schools is to test the effectiveness of two conditions using different methods for teaching the 5As (Ask, Advise, Assess, Assist, and Arrange) to medical students on their observed and reported counseling behaviors.

描述（由申请人提供）：每年吸烟会杀死430,000名美国公民，加剧无数疾病，使社会损失约1000亿美元。尽管信息扩散和限制性吸烟政策，但在过去五年中，成人吸烟率仍然相对稳定，目前为21％。简短的医师进行了烟草治疗，通常称为“ 5AS”，是一种基于证据的干预措施，证明是吸烟者退出的可能性。鉴于70％的吸烟者每年都会看医生，因此所有临床医生必须拥有适当的知识和技能水平来为吸烟者提供咨询。但是，很少有医生和培训的医生接受足够的培训来发展这些技能。使用成对匹配的，随机的小组对照（RGC）设计（在10所医学院实施），我们将比较两种教授5A的教学方法：1）传统医学教育（TE）和2个）多模式教育（MME），将两个组成部分添加到TE：TE：基于Web的学生和先生培训的网络教学计划。通过客观结构化临床检查（OSCE）衡量的烟草治疗咨询技能的主要结果是评估所有美国医学院医学学生技能水平的标准方法。次要结果是自我报告的烟草治疗咨询技能水平。在嵌套的队列设计中，在研究的第二年中，将从医学院的第一年（MS1）开始，直到他们的第三年（MS3）（MS3）进行了一系列学生。这项RGC试验的主要目的是比较MME在向TE教授医学院5AS咨询技能的有效性。假设1：MME在观察到的5A咨询技能（OSCE）上的表现将胜过。假设2：MME在自我报告的5AS咨询技能上的表现将胜过。这项研究的优势包括：1）测试常见和综合教学方法的创新研究设计，以及2）在整个美国医学学校中传播有效的教育方法的潜力，这些方法可以建立医生的技能，以帮助数百万继续吸烟的患者。这是建立我们团队先前在医学教育和烟草依赖治疗方面的研究的独特机会。这项研究涉及美国医学院10所研究人员，从业人员，教育者和利益相关者之间的密切合作。这个独特的团队由研究人员组成，这些研究人员的经验丰富，开发和教授循证医师使用的5A烟草治疗模型；开发和评估基于网络的烟草依赖治疗课程；通过医师受体实施学术细节；以及建立一个大型医学院联盟进行烟草课程改革的经验。公共卫生相关性：每年，吸烟会杀死43万美国公民，加剧众多疾病，使社会造成约1000亿美元的损失。简短的医师延长了戒烟咨询，通常称为“ 5AS”，是一种基于证据的干预策略，已被证明是吸烟者戒烟的可能性加倍。尽管有70％的吸烟者每年都会看医生，但很少有医生熟练地进行戒烟治疗，这使得所有临床医生和所有培训的医生都必须具有适当的知识和技能水平，以咨询吸烟的患者。该小组在10所医学院进行的随机试验的目标是使用不同的方法来测试两种条件的有效性，以教授5A（询问，建议，评估，协助和安排）对医学生的观察和报告的咨询行为。