RCT for Smoking Cessation in 10 Medical Schools

~The primary aim of the RCT for Smoking Cessation in 10 Medical Schools is to use a theory-based model to rest the effectiveness of a combined web-based and preceptor training educational intervention for helping medical students to develop skills for conducting the 5As (Ask, Advise, Assess, Assist, and Arrange) for tobacco treatment. The exploratory aim is to explore theory-driven hypotheses regarding the effects of the combined teaching methods on individual, interpersonal, and organizational variables believed to be important for behavior change. Using this integrative approach that builds on traditional medical education, we will examine the effectiveness of combining a web-based curriculum and preceptor training on medical students' tobacco treatment (TT) skills. The web-based program is based on a University of Massachusetts Medical School model successfully pilot tested at two US medical schools. Preceptor training will use an academic detailing design to enhance preceptors' modeling of tobacco treatment skills and providing feedback to students on their performance of the 5As. This RCT will compare two curriculum conditions: 1) traditional medical education (TE) and 2) web plus preceptor-facilitated education (TE+WEB+PRE). Each of the ten participating medical schools will be pair- matched based on baseline "school skill level" scores and then each pair will be randomized to one of two conditions. Starting in grant year 2, we will follow a cohort of first-year students (MS1) through the completion of their third year (M53). In these three years the additional teaching components will be integrated into the curriculum. The primary outcome is TI skill demonstration using the Objective Structured Clinical Examination (OSCE). Secondary outcomes include student self-reported skill levels, awareness of the 5As, and intention to use TT skills. We hypothesize that students in the TE+WEB+PRE condition will exhibit greater skill proficiency than those in the traditional medical education condition.