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J Gen Intern Med. 2007 Feb;22(2):223-7.

Medical students' use of the stages of change model in tobacco cessation counseling.

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  • 1Department of Psychiatry, University of California, San Francisco, CA 94143-0984, USA.



Many medical schools have incorporated the Stages of Change Model into their curricula with specific application to tobacco cessation.


This study examined the extent to which medical students were prepared to provide stage-based interventions to treat nicotine dependence.


Using a quasi-experimental design, medical students' counseling interactions were evaluated with a standardized patient portraying a smoker in either the precontemplation or preparation stage of change.


Participants were 147 third-year medical students at the University of California, San Francisco.


Checklists completed by standardized patients evaluated students' clinical performance. Surveys administered before and after the encounters assessed students' knowledge, attitudes, confidence and previous experience with treating smoking.


Most students asked about tobacco use (89%), advised patients of the health benefits of quitting (74%), and assessed the patient's readiness to quit (76%). The students were more likely to prescribe medications and offer referrals to patients in the preparation than in the precontemplation stage of change (P < 0.001); however, many students had difficulty identifying patients ready to quit, and few encouraged patients to set a quit date or arranged follow-up to assess progress. Students' tobacco-related knowledge, but not their attitudes, confidence, or previous experience predicted their clinical performance.


The findings indicated evidence of students tailoring their counseling strategies to the patients' stage of change; however, they still could do more to assist their patients in quitting. Additional training and integration of cessation counseling into clinical rotations are needed.

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