Table 2.

Description of Curricula for Teaching Medical Trainees to Counsel Patients for Behavior Change in Studies With Highest Strength of Findings^* in a Review of the Literature, 1965–2011

Study author and year	Specialty	Behavior addressed with intervention	Framework	Curriculum format	Curriculum hours	Period of time curriculum delivered	How curriculum was assessed	Documentation of improvement	Impact of intervention^†
Curricula for medical students
Haist et al, 2003⁶³	Internal medicine	Domestic violence	None	Seminar, standardized patient (SP) practice	1–4	1–2 weeks	Written exam, SPs, other	Knowledge: written exam Communication/counseling: simulation	2b
Haist et al, 2004⁶⁴	Internal medicine	Sex behavior	None	Seminar, role play, SP practice	1–4	1–2 weeks	SPs	Communication/counseling: simulation	2b
Martino et al, 2007⁶⁵	Psychiatry	Exercise, medication adherence, nutrition, smoking, substance use, general behavior	Transtheoretical²⁸	Didactic lecture, role play, SP practice, other	1–4	1–2 weeks	Satisfaction, confidence, attitudes, written exam, other	Knowledge: written exam Communication/counseling: written exam Trainees’ attitudes: self assessment Trainees’ confidence: self assessment	2b
Leong et al, 2008⁶⁶	Family medicine	Smoking	National Cancer Institute 5 A’s (ask, advise, assess, assist, and arrange)²⁹	Didactic lecture, SP practice, actual patient practice, other	1–4	3–4 weeks	Satisfaction, confidence, attitudes, written exam	Knowledge: written exam Communication/counseling: self assessment Trainees’ attitudes: self assessment Trainees’ confidence: self assessment	2b
Allen et al, 1990⁶⁷	Family medicine	Smoking	Transtheoretical	Didactic lecture, seminar, role play, actual patient practice, SP observe	1–4	1–2 weeks	Confidence, attitudes, SPs	Communication/counseling: simulation Communication/counseling: self assessment	2b
Bell and Cole, 2008⁶⁸	Internal medicine	General behavior	Transtheoretical	Didactic lecture, seminar, role play	5–8	3–4 weeks	Satisfaction, confidence, self report counseling, written exam	Knowledge: written exam Communication/counseling: simulation Communication/counseling: self assessment Trainees’ attitudes: self assessment	2b
Leone et al, 2009⁶⁹	Internal medicine	Smoking	Transtheoretical	Seminar, SP practice	5–8	3–4 weeks	Confidence, attitudes, self report counseling, SPs	Knowledge: self assessment Communication/counseling: self assessment Trainees’ attitudes: self assessment Trainees’ confidence: self assessment	2b
Roche et al, 1996⁷⁰	Not specified	Smoking	None	Didactic lecture, seminar, role play, other	1–4	Not specified	SPs	Communication/counseling: simulation	2b
Yedidia et al, 2003⁷¹	Internal medicine, surgery, neurology, family medicine, pediatrics, psychiatry, OB/gyn, other specialty	Nutrition, sex behavior, smoking, substance use, general behavior	None	Didactic lecture, SP practice, SP observe, other	Not specified	>4 months	SPs	Communication/counseling: simulation	2b
Zweifler et al, 1998⁷²	Internal medicine	Other behavior	None	SP Practice, other	Not specified	1–2 weeks	SPs	Knowledge: written exam Communication/counseling: simulation	2b
Carson et al, 2002⁷³	Other specialty	Nutrition, obesity	None	Seminar, other	1–4	3–4 weeks	Confidence, attitudes, self report counseling, written exam, patient outcomes	Knowledge: written exam Communication/counseling: real patient Communication/counseling: self assessment Trainees’ confidence: self assessment	3
Feddock et al, 2009⁷⁴	Internal medicine	Exercise, nutrition, sex behavior, smoking, substance use, other behavior	None	Seminar, SP observe	1–4	1–2 weeks	Written exam, SPs, other	Knowledge: written exam Communication/counseling: simulation	2b
Haist et al, 2008⁷⁵	Internal medicine	Sex behavior	None	Seminar, SP practice	1–4	1–2 weeks	Written exam, SPs	Knowledge: written exam Communication/counseling: simulation	2b
Curricula for residents
Davis et al, 2008⁴¹	Internal medicine	Obesity	Social Learning, Health Beliefs⁸³	Seminar, SP observe, other	1–4	Not specified	Focus group of patients, actual patients, other	Communication/counseling: real patient environment	4b
Allen et al, 1998⁷⁶	Internal medicine, surgery, family medicine, other specialty	Smoking	None	Didactic lecture, role play, actual patient practice, SP observe	1–4	1–2 weeks	Focus group of patients, patient outcomes	Communication/counseling: real patient environment	3
Cornuz et al, 1997³⁰	Internal medicine	Smoking	Transtheoretical	Seminar, role play, other	1–4	1–2 weeks	Confidence, self report counseling, focus group of learners, patient outcomes	Communication/counseling: real patient environment Communication/counseling: self assessment	4b
Evans et al, 1996³⁵	Internal medicine	Nutrition	None	Other	1–4	Not specified	Confidence, attitudes, self report counseling, focus group patient, written exam, patient outcomes, other	Communication/counseling: real patient environment Communication/counseling: self assessment Trainees’ attitudes: self assessment Trainees’ confidence: self assessment	4b
Fox et al, 1998³⁶	Family medicine	Exercise, nutrition, other behavior	Continuous quality improvement⁸⁴	Other	Not specified	>4 months	Other	Communication/counseling: real patient environment	3
Gray et al, 1988⁴³	Family medicine	Nutrition	None	Didactic lecture, actual patient practice, actual patient observe	>12	Not specified	Patient outcomes	Communication/counseling: real patient environment	3
Hymowitz et al, 2001³³	Internal medicine, pediatrics, psychiatry	Smoking	Transtheoretical, 5 A’s	Didactic lecture, seminar, role play, other	5–8	>4 months	Self report counseling, patient outcomes, other	Communication/counseling: real patient environment Communication/counseling: self assessment	4b
Katz et al, 2008³⁴	Internal medicine	Exercise	Transtheoretical, Pressure System Model³⁴	Seminar, role play	5–8	>4 months	Patient outcomes	Communication/counseling: real patient environment	3
Kogan et al, 2003⁵⁸	Internal medicine	Exercise, nutrition, obesity, sex behavior, smoking, substance use	None	Other	1–4	Not specified	Other	None	3
McIlvain et al, 1992⁴⁰	Family medicine	Smoking	Transtheoretical	Seminar, role play, SP observe, other	1–4	3–4 weeks	Satisfaction, attitudes, self report counseling, written exam	Communication/counseling: real patient environment	3
Pololi and Potter; 1996⁷⁷	Internal medicine	Exercise, smoking	Transtheoretical	Seminar, SP practice	5–8	Not specified	Confidence, attitudes, SPs	Communication/counseling: simulation Trainees’ attitudes: self assessment Trainees’ confidence: self assessment	2b
Prochaska et al, 2008³¹	Psychiatry	Smoking	Transtheoretical, Rx for change,³¹ 5 A’s	Didactic lecture, seminar, actual patient practice	1–4	Not specified	Satisfaction, confidence, attitudes, self report counseling, self report counseling, written exam, patient outcomes	Knowledge: written exam Communication/counseling: real patient environment Communication/counseling: self assessment Trainees’ attitudes: self assessment Trainees’ confidence: self assessment	3
Saitz et al, 2003⁷⁸	Other specialty	Substance use	Transtheoretical	Other	Not specified	Not specified	Focus group of patients	Communication/counseling: real patient environment	4b
Seale et al, 2005⁷⁹	Family medicine	Substance use	None	Didactic lecture, other	1–4	1–2 weeks	Other assessment	Communication/counseling: real patient environment	4a
Vinicor et al, 1987⁴²	Internal medicine	Nutrition, obesity, other behavior	None	Seminar, other	9–12	3–4 weeks	Patient outcomes	Communication/counseling: real patient environment	4b
Lee et al, 2004⁸⁰	Pediatrics	Smoking	Transtheoretical, 5 A’s	Didactic lecture, seminar, role play, other	1–4	4–8 weeks	Confidence, written exam, SPs	Knowledge: written exam Communication/counseling: simulation Trainees’ confidence: self assessment	2b
Cornuz et al, 2002²⁶	Internal medicine	Smoking	Transtheoretical	Seminar, role play, SP practice, SP observe, other	5–8	1–2 weeks	Confidence, focus group patient outcomes	Communication/counseling: real patient environment Trainees’ confidence: self assessment	4b
Strecher et al, 1991³⁷	Internal medicine, family medicine, pediatrics	Smoking	None	Didactic lecture, seminar, SP observe, other	1–4	1–2 weeks	Confidence, attitudes, self report, focus group of learners, patient outcomes	Communication/counseling: real patient environment Communication/counseling: self assessment Trainees’ attitudes: self assessment Trainees’ confidence: self assessment	3
Wilk and Jensen; 2002⁸¹	Internal medicine	Substance use	National Institute on Alcohol Abuse and Alcoholism 3 A’s (ask, assess, advise)⁸⁵	Seminar, SP practice	1–4	1–2 weeks	Satisfaction, written exam, SPs	Communication/counseling: simulation	3
D’Onofrio et al, 2002³⁸	Emergency medicine	Substance use	Social Learning	Didactic lecture, seminar, role play, other	1–4	3–4 weeks	Satisfaction, confidence, attitudes, self report counseling, written exam, other assessment	Knowledge: written exam Communication/counseling: real patient environment Communication/counseling: self assessment Trainees’ attitudes: self assessment Trainees’ confidence: self assessment	3
Humair et al, 2003²⁷	Internal medicine	Smoking	Transtheoretical, Brief Negotiation Interview⁸⁶	Seminar, role play, SP practice, SP observe	5–8	1–2 weeks	Satisfaction, confidence, self report counseling, patient outcomes	Communication/counseling: real patient environment Communication/counseling: self assessment Trainees’ confidence: self assessment	4b
Hymowitz et al, 2007⁸²	Pediatrics	Smoking	Transtheoretical, 5 A’s	Seminar, role play, SP practice, other	Not specified	>4 months	Confidence, attitudes, self report counseling, other assessment	Communication/counseling: simulation Communication/counseling: self assessment Trainees’ attitudes: self assessment Trainees’ confidence: self assessment	2b

All studies listed in this table were determined to have strength of findings of 3 (“conclusions can probably be based on the results”) or 4 (“results are clear and very likely to be true”) on a five-point scale (1 = no clear conclusions can be drawn, 5 = results are unequivocal).

^†

Outcomes of intervention: 1 = Participation (covers learners’ views on the learning experience, its organization, presentation, content, teaching methods, and aspects of the instructional organization, materials, quality of instruction); 2a = Modification of attitudes/perceptions(changes in the reciprocal attitudes or perceptions between participant groups toward intervention/curriculum); 2b = Modification of knowledge/skills – (for knowledge, the acquisition of concepts, procedures, and principles; for skills, the acquisition of thinking/problem-solving, psychomotor, and social skills); 3 = Behavioral change – (documents the transfer of learning to the workplace or willingness of learners to apply new knowledge and skills); 4a = Change in organizational practice (wider changes in the organizational delivery of care, attributable to an educational program); 4b = Benefits to patient(any improvement in the health and well being of patients as a direct result of an educational program)