Education for tobacco use disorder treatment: Current state, evidence, and unmet needs

BACKGROUND: Tobacco use is undertreated in the medical setting. One driver may be inadequate tobacco use disorder treatment (TUDT) training for clinicians in specialties treating tobacco-dependent patients.

OBJECTIVE: We sought to evaluate the current state of TUDT training for diverse professionals and how these skills are assessed in credentialing exams.

METHODS: We performed a focused review of current educational practices, evidence-based strategies, and accreditation exam contents focused on TUDT.

RESULTS: Among medical students, participants in reviewed studies reported anywhere from 45 minutes to 3 hours of TUDT training throughout their 4-year programs, most often in the form of didactic sessions. Similarly, little TUDT training was reported at the post-graduate (residency, fellowship, continuing medical education) levels, and reported training was typically delivered as time-based (expected hours of instruction) rather than competency-based (demonstration of mastery) learning. Multiple studies evaluated effective TUDT curricula at varied stages of training. More effective curricula incorporated longitudinal sessions and active learning, such as standardized patient encounters or proctored patient visits. Knowledge of TUDT is minimally evaluated on certification exams. For example, the American Board of Internal Medicine blueprint lists TUDT as <2% of one subtopic on both the internal medicine and pulmonary exams.

CONCLUSION: TUDT training for most clinicians is minimal, does not assess competency, and is minimally evaluated on certification exams. Effective, evidence-based TUDT training incorporating active learning should be integrated into medical education at all levels, with attention paid to inclusion on subsequent certifying exams.

Veterans Affairs Health Services Research & Development Career Development Award
Minneapolis VA Health Care System
University of Pennsylvania

Anne C Melzer, Zachary A Reese, Lorraine Mascarhenas, Caitlin B Clancy, Janaki Deepak, Hyma Gogineni, Yaron Gesthalter, Joanna L Hart