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
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 1 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
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.