The primary care pediatrician's influence on medical student's performance of smoking assessments and counseling.
BACKGROUND: American medical schools lack significant educational programs for teaching medical students about counseling parents and children on smoking prevention and cessation. Thus, the objectives of this study were to describe medical student's self-reported behaviors in the assessment of parents and children's use of tobacco and to compare these practices with well-accepted pediatric activities: injury prevention and developmental assessment. METHODS: Third year medical students in a pediatric clerkship at Boston University, all of whom spend part of their clerkship with pediatricians in their offices, completed six weekly surveys (2001-2002) recording their clinical activities in counseling parents and children about smoking, injury prevention, and performing developmental assessments. RESULTS: Of the 150 third year students completing the pediatric orientation, 108 (72%) completed all six feedback surveys and the general cancer prevention survey. Of the 108 students, 77% completed smoking assessments with at least one family per week during their 6-week clerkship compared with performance of injury prevention (85%, P = 0.09) and developmental assessment (91%, P = 0.006). Among all smoking cessation and prevention recommendations, students were most likely to discourage parents from smoking in the house and least likely to offer tips for parents to counsel their children about smoking. All variables related to primary care pediatricians' role modeling and feedback for optimal tobacco counseling practices were significantly associated with student counseling practice. CONCLUSIONS: Third year medical students were less likely to complete smoking assessments than those for developmental assessment and injury prevention counseling. However, primary care pediatricians' strong expectations and modeling of smoking counseling were uniformly associated with improved self-perceived student performance. Future educational activities should engage the primary care pediatrician preceptors of students completing pediatric rotations.