Smoking cessation counseling training for pediatric residents in the continuity clinic setting

To determine the effectiveness of a clinic-based smoking cessation counseling curriculum on pediatric resident confidence, knowledge, counseling skills, and provision of counseling.

Twenty-six residents at a pediatric residency program completed a new smoking cessation counseling curriculum as part of continuity clinic training. We assigned residents to 2 groups (study group, n = 12 vs control group, n = 14) on the basis of clinic site. We used a quasi-experimental, crossover design with pre- and posttests for each group. Control-group residents served as an initial control before the intervention crossover. Residents were tested at baseline and at completion of each group's intervention. Standardized patients measured resident provision of counseling and quality of counseling during resident continuity clinic. Knowledge and confidence were measured by a written exam and self-administered survey. Analysis of variance with a mixed design assessed overall group differences and group performances over time.

There were no baseline differences between groups. Across time, there were significant differences between study-group and control-group residents for confidence (F [2, 48] = 11.82; P <.01), knowledge (F [2, 48] = 6.24; P <.01), and provision of counseling (F [2, 48] = 3.60, P <.05) but not counseling skills (F [2, 48] = 2.44; P <.10). After each group's intervention, their confidence, knowledge, counseling skills, and inclusion of counseling increased significantly (P <.01 for all).

Our findings suggest that a clinic-based curriculum in smoking cessation counseling can significantly increase knowledge, confidence, counseling skills, and provision of counseling. Future research should evaluate the long-term impact of such curricula on resident counseling behavior and patient outcomes.