Study objective:
To evaluate the effectiveness of two teaching interventions to increase residents’ performance of smoking cessation counseling.
Design:Randomized controlled factorial trial.
Setting:Eleven residency programs, in internal medicine (six), family medicine (three), and pediatrics (two). Programs were located
in three university medical centers and four university-affiliated community hospitals.
Participants:261 residents who saw ambulatory care patients at least one half-day per week, and 937 returning patients aged 17 to 75 years
who reported having smoked five or more cigarettes in the preceding seven days. Of the 937, 843 were eligible for follow-up,
and 659 (78%) were interviewed by phone at six months.
Interventions:Two interventions (tutorial and prompt) and four groups. The tutorial was a two-hour educational program in minimal-contact
smoking cessation counseling for residents. The prompt was a chart-based reminder to assist physician counseling. One group
of residents received the tutorial; one, the prompt; and one, both. A fourth group received no intervention.
Measurement and results:Six months after the intervention, physician self-reports showed that residents in the tutorial + prompt and tutorial-only
groups had used more counseling techniques (1.5–1.9) than had prompt-only or control residents (0.9). Residents in all three
intervention groups advised more patients to quit smoking (76–79%) than did control group residents (69%). The tutorial had
more effect on counseling practices than did the prompt. Physician confidence, perceived preparedness, and perceived success
followed similar patterns. Exit interviews with 937 patients corroborated physician self-reports of counseling practices.
Six months later, self-reported and biochemically verified patient quitting rates for residents in the three intervention
groups (self-reported: 5.3–8.2%; biochemically verified: 3.4–5.7%) were higher than those for residents in the control group
(self-reported: 5.2%; biochemically verified: 1.7%), though the differences were not statistically significant.
Conclusion:A simple and feasible educational intervention can increase residents’ smoking cessation counseling.
Key words smoking intervention - internship and residency - education - physician counseling - health promotion
Presented at the annual meeting of the American Public Health Association, November 14–18, 1988, Boston, Massachusetts.
Supported by the University of North Carolina Faculty Development Program in General Medicine and General Pediatrics (PE54004,
Bureau of Health Professions, Washington, D.C.) and by grants from the Cancer Prevention and Control Program of the National
Cancer Institute (RO3-CA43994), the North Carolina Chapter of the American Heart Association (1986-86-37-A), and the University
of North Carolina Center for Health Promotion and Disease Prevention.