Tobacco dependence curricula in US undergraduate medical education

Context: Tobacco use is the leading preventable cause of death in the United States. And yet only 21% of practicing physicians claim they received adequate training to help their patients stop smoking. Objective: To assess the content and extent of tobacco education and intervention skills in US medical schools' curricula. Design: A survey with 13 multiple-response items on tobacco education. Survey questions were based on the recommendations of the Agency for Health Care Policy and Research and the National Cancer Institute Expert Panel. The Liaison Committee on Medical Education included 4 of these items in a modified form on the 1997 annual questionnaire. Setting: One hundred twenty-six US medical schools. Participants: Surveys were obtained from 122 associate deans for medical education (98.6%). Main Outcome Measures: Curriculum content in basic science and clinical science, elective or required clinical experience, hours of instruction, and resource materials. Results: Inclusion of all 6 tobacco curricula content areas recommended by the National Cancer Institute and the Agency for Health Care Policy and Research was higher in basic science (63/115 [54.8%])than in clinical science (5/115 [4.4%]). Most medical schools (83/120 [69.2%]) did not require clinical training in smoking cessation techniques, while 23.5% (27/115) offered additional experience as an elective course. Thirty-one percent (32/102) of schools averaged less than I hour of instruction per year in smoking cessation techniques during the 4 years of medical school. A minority of schools reported 3 or more hours of clinical smoking cessation instruction in the third (14.7%) and fourth (4.9%) years. Conclusions: A majority of US medical school graduates are not adequately trained to treat nicotine dependence. The major deficit is the lack of smoking cessation instruction and evaluation in the clinical years. A model core tobacco curricula that meets national recommendations should be developed and implemented in all US medical schools.