Date: Aug 31, 1999
By Andrew Buchanan Associated Press Writer
CHICAGO (AP) -- U.S. medical school graduates are woefully
unprepared to help patients quit smoking, the nation's most
deadly preventable health care problem, a study concludes.
The researchers surveyed nearly every accredited medical
school in the country and found very little coursework devoted
to nicotine dependence.
They called the statistics distressing, given National Cancer
Institute recommendations from seven years ago that training
in how to kick the habit be made mandatory at every U.S.
medical school.
The findings appear in Wednesday's Journal of the American
Medical Association.
"The public health community is active and aggressive in
anti-smoking efforts, but there's nothing innovative going on" at
medical schools, said Dr. Linda Ferry, director of preventive
medicine at Loma Linda University School of Medicine in
California. "It starts right at the ground level in medical school."
Cigarette smoking kills more than 400,000 Americans each year,
according to the Centers for Disease Control and Prevention.
One in every five deaths in the United States is smoking-related,
CDC figures show.
Ferry cited a 1991 survey showing that few doctors felt their
formal medical training prepared them to help patients stop
smoking, and another that found few physicians advise their
patients about kicking the habit.
Ferry and colleagues looked at responses from 122 of 126
medical schools about course offerings in the 1996-97 school
year. Not all schools answered every question.
Thirty-two out of 102 medical schools dedicated an average of
less than one hour of classroom time per year in smoking
cessation techniques.
There was more tobacco-related instruction in the first two
years of medical school. But only three schools reported having
a required course devoted to tobacco education in the third and
fourth years.
And almost 70 percent of schools -- 83 of 120 -- did not require
any smoking cessation training at all in those two years, when
students theoretically are learning how to apply their knowledge
to patients.
The authors acknowledged that more smoking cessation
instruction could be taking place in informal settings in the final
years of medical school.
Dr. David Steward, chairman of internal medicine at the
Southern Illinois University School of Medicine in Springfield,
said that is the case at his school, where third- and fourth-year
students are often working directly with patients and practicing
physicians.
"That's probably the most powerful teaching tool and it's hard
to quantify," Steward said.
The authors recommended that a model tobacco curriculum be
developed and put in place in all U.S. medical schools, and said
the licensing exam for doctors should pay greater attention to the
subject.
Nancy Rigotti, director of a preventive medicine course at
Harvard Medical School, suggested a philosophical change may
be in order as well. She said too many doctors particularly older
ones, may be afraid of alienating patients or feel it's not their
place to counsel them.
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