Prerequisites, components and barriers to the implementation of a smoking cessation training course for medical residents in Armenia

Introduction Studies suggest that trained physicians are about twice as likely to offer help to patients who smoke in contrast to non-trained physicians. Yet, inadequate training on tobacco dependence and its treatment is one of the major obstacles for consistent and effective treatment of tobacco dependence. The study aimed to explore the needed resources, prerequisites, components and barriers for implementing a pilot smoking cessation training course for medical residents in Armenia to provide practical skills and knowledge on smoking cessation counseling. Methods The research team utilized a qualitative research method by conducting four focus group discussions (overall 14 residents participated in the discussions) with medical residents from Yerevan State Medical University and four in-depth interviews with medical faculty members and administrators. The participants were recruited using convenience and snowball sampling techniques. Directed content analysis was utilized for data analysis. Results The main preconditions for teaching a smoking cessation training course were the residents’ exposure to tobacco related topics during the years of study, having some experience in advising smokers to quit and in managing patients, and negative attitude toward patient’s smoking. The duration of the training and use of active learning methods were likely to be the important components in planning and implementing the training course. Finally, the major barriers mentioned by participants included lack of time to attend the training due to clinical duties, underestimation of the physician’s role in patient’s decisions related to smoking cessation, low interest in the topic among residents who were smokers themselves, and shortage of time for counseling patients during hospitalization due to their short in-hospital stay. Conclusions Most of the participants were interested in the smoking cessation training course and helping their patients to quit. The study team will need to account for the identified barriers for the successful implementation of the program. Funding The study was a part of a larger collaborative project funded by the Swiss National Science Foundation and Swiss Agency for Development and Cooperation

Learning to assist smokers through encounters with standardized patients: An innovative training for physicians in an Eastern European country

Objectives: A lack of physician training is a major obstacle for effective tobacco dependence treatment. This study assessed the feasibility of an active learning training program and its effects on smoking cessation counselling skills of medical residents in Armenia, an Eastern European country with high smoking prevalence. Study design: The study used a pre-post assessment of smoking cessation counselling activities and a course evaluation survey to assess the feasibility of the intervention in a different environment. Methods: We adapted an active learning training model developed in Switzerland. Residents were trained in Yerevan, Armenia, using video-taped counselling sessions, role plays, standardized patients (actors), group discussions and immediate feedback. The training evaluation was done using a semi-structured anonymous questionnaire. The study assessed the physicians' self-reported smoking cessation counselling activities before and 6 months after the training. A non-parametric Mann-Whitney test was used to assess pre-post differences in physicians' counselling skills measured on ordinal scale. Results: Of the 37 residents trained, 75% were female, 89% aged 20-29 years and 83% were never-smokers. Twenty-eight trainees (76%) returned the course evaluation survey and 32 (86%) answered a questionnaire on skills self-assessment at 6 months follow-up. The majority agreed the course was successful in achieving its learning objectives (64%-96%) and increased their confidence in assisting their patients to quit (74%). After 6 months, the physicians were more likely than at baseline to adhere to evidence-based counselling strategies, including assessing the smoking status and dependence and matching the advice to the patient motivation. The training did not, however, improve the prescription of tobacco dependence medications. Conclusions: Six months after the training, several self-reported smoking cessation counselling activities had significantly improved compared to baseline. This training model is acceptable for medical residents in Yerevan, Armenia and offers a promising approach in addressing the lack of physician counselling skills in similar settings and populations