Catherine A. Powers

A randomized trial to improve early detection and prevention practices among siblings of melanoma patients

Identifying high‐risk individuals for melanoma education and risk reduction may be a viable strategy to curb the incidence of melanoma, which has risen precipitously in the past 50 years. The first‐degree relatives of melanoma patients represent a risk group who may experience a ‘teachable moment’ for enhanced education and risk reduction.

Tobacco control competencies for US medical students

The 2004 National Action Plan for Tobacco Cessation recommended that the US Department of Health and Human Services convene a diverse group of experts to ensure that competency in tobacco dependence interventions be a core graduation requirement for all new physicians and other key health care professionals. Core competencies would guide the design of new modules and explicitly outline the learning objectives for all graduating medical students. In 2002, the National Cancer Institute funded a consortium to develop, test, and integrate tobacco curricula at 12 US medical schools. Because there was neither an explicit set of tobacco competencies for medical schools nor a process to develop them, one of the consortiums tasks was to articulate competencies and learning objectives.

Skin cancer prevention and detection practices among siblings of patients with melanoma.

BACKGROUND Family members of patients with melanoma have an increased risk of the disease, and families with multiple affected members account for about 10% of melanoma cases. These statistics suggest that first-degree relatives of patients with melanoma, who are at particularly high risk, warrant targeted public health action. OBJECTIVE We sought to document rates for dermatologist examinations for cutaneous lesions, the practice of skin self-examination, and sunscreen use in this at-risk group. METHODS Before participation in a randomized trial, 404 siblings of recently diagnosed patients with melanoma completed a survey on beliefs and practices regarding skin cancer prevention and detection. RESULTS Sixty-two percent of participants had carefully examined their skin, 54% routinely used sunscreen, and 27% had received a skin cancer examination by a dermatologist during the past year; 47% had never received a dermatologist examination. Multivariate analysis found modifiable positive predictors for skin self-examination and dermatologist examinations, including having a clinician with whom to talk about melanoma and believing in the importance of regular skin examinations by a physician. Significant modifiable negative predictors included enjoyment of being tanned, not being sure what to look for when examining moles, and feeling uncomfortable having others look at their skin. CONCLUSIONS Skin self-examination rates among these high-risk siblings are markedly higher than in population-based studies. However, many siblings were not screened for skin cancer by a dermatologist despite having strong risk profiles, being nearly fully insured, and being under care of primary care physicians. Improvements in communication between physicians and high-risk families and changes in office systems to assess family history of melanoma could increase screening rates for the estimated 1 million siblings of patients with melanoma.

Tobacco Cessation and Prevention Practices Reported by Second and Fourth Year Students at US Medical Schools

BackgroundTobacco dependence counseling is recommended to be included as core curriculum for US medical students. To date, there has been little information on students’ self-reported skills and practice opportunities to provide 5A’s (Ask, Advise, Assess, Assist, and Arrange) counseling for tobacco cessation.MethodsWe conducted anonymous surveys of second year and fourth year students at multiple US medical schools between February 2004 and March 2005 (overall response rate 70%). We report on the tobacco control practices of the 860 second year and 827 fourth year students completing the survey.Measurements and Main ResultsFourth year students reported multiple opportunities to learn tobacco counseling in case-based discussions, simulated patient encounters, and clinical skills courses. They reported more instruction in family medicine (79%) and Internal Medicine (70%) than Pediatrics (54%), Obstetrics/Gynecology (41%), and Surgery clerkships (16%). Compared with asking patients about smoking, advising smokers to quit, and assessing patient willingness to quit, fourth year students were less likely to have multiple practice opportunities to assist the patient with a quit plan and arrange follow-up contact. More than half of second year students reported multiple opportunities for asking patients about smoking but far fewer opportunities for practicing the other 4 As.ConclusionsBy the beginning of their fourth year, most students in this group of medical schools reported multiple opportunities for training and practicing basic 5A counseling, although clear deficits for assisting patients with a quit plan and arranging follow-up care exist. Addressing these deficits and integrating tobacco teaching through tailored specific instruction across all clerkships, particularly in Surgery, Pediatrics, and Obstetrics/Gynecology is a challenge for medical school education.

Teaching smoking cessation in u.s. Medical schools: a long way to go.

Teaching about tobacco cessation interventions should be integrated into the medical school curriculum. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Basic Skills for Working With Smokers: A Pilot Test of an Online Course for Medical Students*

Background. Online learning can be an excellent method for presenting clinical skills to address health behaviors.Methods. Medical students pilot tested a skills-building course consisting of an online component and a practical application.Results. A total of 38 students were registered, 25 (66%) completed the online component, and 22 (58%) completed both course components. Students reported they were adequately trained to administer the brief 5A intervention to patients who smoke and they intended to deliver the intervention routinely.Conclusions. Online skill-building courses can have a positive effect on students’ knowledge and skills and can be used across health behaviors promote healthy lifestyles.

Cultural competency and tobacco control training in US medical schools: many but missed opportunities.

Tobacco-related morbidity and mortality disproportionately burdens America’s most vulnerable populations, and many physicians in the USA are untrained in smoking cessation skills with patients of various literacy levels and races and ethnicities. An anonymous survey was administered to 860 second year and 827 fourth year students at 12 medical schools. A faculty representative at each of the schools completed an assessment of the curriculum and rated medical students’ knowledge and skills for cultural competency. Report of experience in tobacco counseling for persons of various literacy levels and ethnicities rose from 42% (second year students) to 82% (fourth year students) and 48% (second year students) to 91% (fourth year students), respectively. However, only 37% of second year students and 40% of fourth year students reported that they had ever been taught to employ culturally competent strategies for tobacco cessation. This study found that almost two thirds of students in 12 medical schools reported no exposure to teaching about cultural competency and tobacco cessation, and approximately one third reported no practical experience with tobacco cessation counseling persons of various races and ethnicities. Effective cultural competency training for tobacco control should include teaching the social constructs of race, ethnicity, and socio-cultural concepts within a medical context. Additionally, students should receive supervised clinical opportunities to practice counseling, including opportunities to discuss and reflect on their experiences.

Smoking Sleuths: a pilot tobacco prevention elective for medical school students.

Background. Smoking Sleuths is an experiential learning curriculum that was developed and taught to elementary through high school aged children by medical students. Methods. A total of 14 first- and 4th-year medical students from 2 medical schools participated in the tobacco service learning elective. Results. Medical students trained Adolescent Tobacco Education Leaders who provided tobacco education to peers and members of the public. Conclusions. Smoking Sleuths provides opportunities for medical students to learn counseling and health education skills across many disciplines. The elective may have a broader audience in schools of allied health, nursing, dentistry, education, and public health.