New UK doctors cannot handle smoking cessation

By Chibuzo Odigwe London

A new study across 24 medical schools in the United Kingdom has shown that most newly qualified UK doctors are ill equipped to deliver smoking cessation and rehabilitation interventions.

The study, published in Tobacco Control (2004;13:74-7), found that training in smoking cessation was seriously neglected as three fifths of preregistration house officers reported that they were unable to deliver smoking cessation interventions in accordance with national guidelines. Just 17% of preregistration house officers felt well prepared to deliver advice on using nicotine replacement therapy and only 5% could offer help on the use of bupropion, a drug used as an adjunct to smoking cessation in combination with motivational support.

The authors, from the University of Nottingham Medical School on behalf of the Tobacco Advisory Group of the Royal College of Physicians, also found that 42% of the medical schools surveyed did not mention smoking nor smoking cessation in their published curriculum material.

Elin Roddy, leader of the team of researchers, said, "One of the most striking findings of [the] research was that in many medical schools, no one seemed clear as to what needed to be taught or who should teach it."

During the course of the study, the researchers searched published curriculums from all UK medical schools for the 2001-2 academic year and did questionnaire surveys of all UK medical school deans and preregistration house officers using validated techniques.

Roddy said, "Medical students should view smoking cessation as a medical intervention, rather than a social one--smoking has been seen as a social problem for a long time, but if you look at it using a disease model, particularly thinking about nicotine addiction, then it is easier to see how individual doctors can do something about it." He continued, "I'm constantly surprised about how much priority is given on ward rounds and in clinics to interventions that are much less effective--and much less cost effective--than smoking cessation." He added, "Doctors are happy to prescribe inhalers for COPD [chronic obstructive pulmonary disease], and statins after heart attacks, but much less happy to give simple advice about smoking and follow it through with a prescription for nicotine replacement therapy or bupropion."