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Using Standardized Patients to Teach Smoking Cessation

Using Standardized Patients to Teach Smoking Cessation. Susan Stangl, MD, MSEd David Geffen School of Medicine at UCLA. Today’s Agenda. Standardized patient case development Working with standardized patients in the small group Go through a smoking cessation module.

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Using Standardized Patients to Teach Smoking Cessation

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  1. Using Standardized Patients to Teach Smoking Cessation Susan Stangl, MD, MSEd David Geffen School of Medicine at UCLA

  2. Today’s Agenda • Standardized patient case development • Working with standardized patients in the small group • Go through a smoking cessation module

  3. Standardized Patient Case Development • Choose a broad theme or topic • Determine learning objectives • Select a case • Decide the format of the case • Develop the case outline and patient profile • Documents needed for a complete case

  4. Working with Standardized Patients • Before the patient arrives • Presenting situation • Choose interviewers • During the interview • Time outs • Switching interviewers • Let the students do it

  5. Help Reluctant Patients to Quit • Relevance: ask for their OWN reasons why they should quit • Risks: emphasize risks for THAT patient • Rewards: highlight benefits of quitting for THEM • Roadblocks: acknowledge barriers and help overcome them • Repetition: repeat at each visit

  6. Pharmacotherapy • For all smokers unless pregnant, <10 cigs/day, adolescents • 1st line Rx • Bupropion SR • Nicotine inhaler or nasal spray • Nicotine patch or gum (no Rx needed) • 2nd line Rx • Clonidine • Nortryptiline

  7. Stages of Behavior Change • Pre-contemplation - Denial (Try to move from “No” to “Maybe”) • Contemplation - Ambivalence (Leave decision to them; be available) • Determination - Motivated to change (Provide direction & support) • Action - Engaged in change • Maintenance - Maintaining change • Relapse - Ambivalent or motivated

  8. 5 “A’s” of Smoking Cessation • ASK: All patients at each visit • ADVISE: All patients to quit • ASSESS: Ready to quit now or in the next 30 days • ASSIST: Set a date; anticipate problems; provide counseling and info • ARRANGE follow-up within 2 weeks

  9. Pros & Cons of Changing Behavior • Ask patient to think about the following: • Benefits of smoking (or not losing weight, not exercising, etc.) • Drawbacks of smoking • Benefits of quitting smoking • Drawbacks of quitting smoking • After this exercise, does patients still want to try to make a change?

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