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 adeq uate training to help their patients stop smoking. Objective To assess the content and extent of tobacco education and interve ntion skills in US medical schools' curricula. Design A survey with 13 multiple-response items on tobacco education, Surve y questions were based on the recommendations of the Agency for Health Care Policy and Research and the National Cancer Institute Expert Panel, The Li aison Committee on Medical Education included 4 of these items in a modifie d form on the 1997 annual questionnaire. Setting One hundred twenty-six US medical schools. Participants Surveys were obtained from 122 associate deans for medical edu cation (98.6%), Main Outcome Measures Curriculum content in basic science and clinical scie nce, elective or required clinical experience, hours of instruction, and re source materials, Results Inclusion of all 6 tobacco curricula content areas recommended by t he National Cancer Institute and the Agency for Health Care Policy and Rese arch 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 clini cal 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 1 hour of instruction per year in smoking cessa tion 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 tr ained to treat nicotine dependence. The major deficit is the lack of smokin g cessation instruction and evaluation in the clinical years. A model core tobacco curricula that meets national recommendations should be developed a nd implemented in all US medical schools.