Can distance learning improve smoking cessation advice in family practice? A randomized trial

Family physicians (FPs) underuse opportunities to provide smoking cessation advice during routine consultations with patients who smoke. Distance learning is a promising approach to continuing medical education, particularly for FPs practicing in rural and remote areas. We developed a distance learning module, conducting a randomized trial to assess its educational impact on knowledge, attitudes and skills ("competence"), self-rated competence, confidence, and readiness to change.

Volunteer FPs were randomly allocated to receive either a distance learning module or a preventive care guideline. Self-administered questionnaires were completed at baseline and post-test.

Fifty-three FPs enrolled in the study. There were no changes in knowledge or attitudes. Change in skills was limited to a reduction in use of one ineffective technique, namely "nicotine fading." Change in self-rated competence between baseline and post-test was significantly greater for the intervention than for the control group, however (p = .03). Although self-ratings of confidence increased significantly between baseline and post-test in both groups, the magnitude of change was no greater in the intervention than the control group (p = .3). Both groups demonstrated only nonsignificant shifts in readiness to change.

These modest changes are of uncertain educational value, inviting caution before recommending distance learning approaches to promote smoking cessation advice in family practice.