Letters to the Editor  |   September 2005
Evidence Base Presented—and Expanding—for Investment in Tobacco Dependence Curricula for Osteopathic Medical Education
Author Notes
  • Professor of Family Medicine Robert C Byrd Health Sciences Center – Charleston Division West Virginia University School of Medicine Charleston, West Virginia Resident Physician, Internal Medicine Mayo Clinic Rochester, Minnesota 
Article Information
Addiction Medicine / Evidence-Based Medicine / Medical Education / Curriculum
Letters to the Editor   |   September 2005
Evidence Base Presented—and Expanding—for Investment in Tobacco Dependence Curricula for Osteopathic Medical Education
The Journal of the American Osteopathic Association, September 2005, Vol. 105, 402-403. doi:
The Journal of the American Osteopathic Association, September 2005, Vol. 105, 402-403. doi:
We appreciate Dr Shatsky's support for smoking cessation protocols and primary prevention in his February 2005 letter to the editor (“DO questions evidence for including tobacco dependence curricula.” J Am Osteopath Assoc. 2005;105[2]:52–53). 
Prior to our original research, published in the August 2004 issue of The Journal (“Tobacco dependence curricula in undergraduate osteopathic medical education.” 2004;104[8]:317–323 [published correction appears in J Am Osteopath Assoc. 2004 104(9):368]), the focus of the medical literature on smoking cessation protocols and primary prevention that Dr Shatsky cites was based on allopathic medical education. Despite the seeming inclusiveness of the title of the 1999 JAMA article by our coauthor, Linda H. Ferry, MD, MPH, 1 osteopathic medical schools were not included in that original research. 
Our study, unlike many others, was based on research conducted exclusively in osteopathic medical schools. We concluded that osteopathic medical education curricula were deficient in clinical training for students on topics of nicotine dependence during the third and fourth years of medical school and were not in compliance with the National Cancer InstituteExpert Panel recommendations nor the Clinical Practice Guidelines issued for tobacco-use cessation. 24  
In our original contribution, we made no conclusions that were not supported by our research. Dr Shatsky is therefore mistaken to suggest that we drew “conclusions outside the boundary of that which has been measured.” We believe that the first step to improving training lies in identifying specific deficiencies, which we outlined in detail and stand by. Our “conclusions” were no more than detailed suggestions as to how to rectify identified deficiencies. 
We agree with Dr Shatsky that when curricular elements, teaching methods, faculty objectives and performance-based assessments are used, medical students can learn cessation counseling skills. Can we improve the educational process and evaluate its success more fully at the medical school and postgraduate levels? Clearly, the answer is “Yes.” 
In his letter to the editor, Dr Shatsky calls for a pilot study to prove tobacco dependence curricula in medical training result in physicians who are better able to assist patients with smoking cessation. Such a study is currently underway at the Bowman Gray School of Medicine Comprehensive Cancer Center at Wake Forest University, in Winston-Salem, NC, where a $1.6-million grant was funded within the Cancer Education Grant Program by the US National Institutes of Health's National Cancer Institute to develop a comprehensive model curriculum for tobacco intervention. 5 This grant will teach medical students how to help their patients stop using tobacco and will be integrated throughout all four years of medical training (oral communication, J.G. Spangler, MD, MPH, May 2005). This five-year federal grant allows for extensive evaluation of the comprehensive tobacco intervention curriculum developed by Dr Spangler and has already produced direct outcomes, including a five-lesson course that has been posted on the Internet for healthcare professionals who wish to provide guidance to their patients who require help in quitting smoking (see 
Once fully developed and evaluated, this model curriculum should provide a template that medical schools nationwide can implement. 
Our hope is that all medical schools will accept the challenges of teaching tobacco cessation to their students for many of the public health reasons Dr Shatsky cited. 
We recommended methods in which improved smoking cessation training could be instituted in osteopathic medical schools. We welcome objective, evidence-based research that will guide clinical performance and support the success of smoking cessation training at the medical school and postgraduate levels. Best evidence—not expert opinion alone—clearly supports the training of healthcare professionals for a statistically favorable impact on their performance and for improving counseling and cessation rates in their tobacco-dependent patients. 4,6  
We are confident that, based on a large body of evidence from other areas of medical education, improved curricular elements and teaching methods will improve medical students' (ie, our future clinicians) interactions with tobacco-dependent patients, increase cessation rates, and reduce the morbidity and mortality associated with all forms of tobacco use. 7  
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Ferry LH, Grissino LM, Runfola PS. Tobacco dependence curricula in US undergraduate medical education. JAMA. 1999;282:825-829.
Fiore MC, Epps RP, Manley MW. A missed opportunity: teaching medical students to help their patients successfully quit smoking. JAMA. 1994;271:624-626.
US Department of Health and Human Services. Smoking Cessation. Clinical Practice Guideline Number 18. AHCPR publication 96-0692. Rockville, Md: Agency for Health Care Policy and Research; April 1996.
Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Gritz ER, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, Md: US Department of Health and Human Services Public Health Service; June 2000.
Conn R. Wake Forest receives federal grant to develop model tobacco intervention curriculum [press release]. Washington, DC: American Association for the Advancement of Science; July 14, 2003. EurekAlert! [serial online]. Available at: Accessed August 31, 2005.
Lancaster T, Stead LF. Physician advice for smoking cessation. The Cochrane Database Systematic Reviews. 2004;(4):CD000165.pub2. DOI: 10.1002/14651858.CD000165.pub2 . Accessed May 13, 2005.
Spangler JG, George G, Foley KL, Crandall SJ. Tobacco intervention training: current efforts and gaps in US medical schools. JAMA. 2002;288:1102-1109.