摘要：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 consortium’s tasks was to articulate competencies and learning objectives. CIGARETTE SMOKING REMAINS the leading cause of preventable morbidity and mortality in the United States. Despite this, 23% of Americans, or 48 million, continue to smoke. 1 , 2 A large body of evidence supports the effectiveness of physician interventions, and the Public Health Service guidelines recommend that all clinicians counsel their patients to quit smoking. 3 Research has shown, however, that physicians do not routinely and effectively counsel their patients to quit smoking. 4 , 5 Most recently, the Subcommittee on Cessation of the Interagency Committee on Smoking and Health published a national action plan for tobacco cessation that included a recommendation for investing in “training and education by FY 2005 to ensure that all clinicians in the United States have the knowledge, skills and support systems necessary to help their patients quit tobacco use.” 6 (p208) They specifically recommended that the US Department of Health and Human Services “convene a diverse group of experts to ensure that competency in tobacco dependence interventions is a core graduation requirement for all new physicians and other key health care professionals.” 6 (p208) Earlier, in 1992, a National Cancer Institute expert panel on cigarette smoking and undergraduate medical education wrote that “a specific curriculum devoted to smoking cessation and prevention must become a mandatory component of undergraduate medical education in every US school.” 4 (p626) However, studies and reviews conducted in the late 1990s documented suboptimal tobacco intervention training in medical schools. 7 – 8 In 2002, the National Cancer Institute funded a consortium of 12 US medical schools to develop, test, and integrate tobacco intervention curricula throughout the 4 years of medical school. Previous work has identified the need for a systematic process of testing before the development of new curricula. 9 After the tobacco curriculum modules within the 12 participating medical schools are tested, dissemination of the tested curriculum to all medical schools in the United States is anticipated. Because there was neither an explicit set of tobacco control competencies for medical schools nor a process to develop them, one of the first tasks was to articulate competencies and learning objectives. Core competencies would guide the design of new modules and explicitly outline the learning objectives (knowledge, attitudes, skills, and behaviors) that all medical students should have met on graduation. Competency-driven education is becoming the standard for medical education in the United States. In undergraduate medical education, a number of groups have stated the importance of using competencies to develop curricula and have thus created competencies in their fields. The Association of Teachers of Preventive Medicine developed core competencies that cover clinical prevention, quantitative skills, health services organization and delivery, and community dimensions of medical practice. 10 The Accreditation Council for Graduate Medical Education also noted the importance of identifying competencies in order to develop medical school curricula and has developed general competencies for graduate medical students (or residents). 11 We report on the delineation of core competencies and learning objectives for tobacco education in medical schools. Formative research and outcome analysis is planned to test attainment of these competencies as specific tobacco curriculum modules are implemented at participating medical schools. Future studies must go beyond the development of competencies to develop a national strategic plan for the integration of these competencies into medical school curricula.
