Table 1.

Teachable Moment Communication Process (TMCP) learning module components and objective

Component	Learning objective
WEB Module – 50 minute interactive learning module
1. Call to Action	Alert audience to systems changes at their health system; convey importance of tobacco cessation counseling; introduce the TMCP as skill-building training.
2. Teachable Moment
A. Rationale	Connect with audience about how difficult it can be to talk about smoking cessation; mention common frustrations and introduce video clip.
B. What not to do	Demonstrate common frustrations and pitfalls of clinicians and patients talking about smoking cessation.
C. Background and overview	Provide specific rationale for TMCP, background research, goals of TMCP; introduce schematic of TMCP; describe what is unique about this approach.
D. Training overview and format	Describe what training consists of and how long it will take.
3. Teachable Moment Communication Process
A. Overview of 5 elements	Introduce the TMCP 5 elements
B. Salient Concern	FOR EACH OF 5 ELEMENTS: Introduce and define it; explain importance of the element; explain how it connects to the element before and after; provide examples to illustrate; present case studies to illustrate variations and flow from one element to the next. Provide several complete case studies to demonstrate the TMCP approach.
C. Making a Link
D. Brief Intervention using OPEN statements.
i. Optimism
ii. Partnership
iii. Engage to assess readiness
iv. No more (allow the patient space to respond before moving forward)
E. Assessing Readiness
F. Responding in Alignment
4 TMCP summary and support
A. Putting it all together	Provide a brief summary of the TMCP and expected outcomes. Describe what to expect when implementing the TMCP with own patients.
B. Coaching session	Introduce and explain Coaching Session
C. Using the EHR Smartphrase	Introduce the Teachable Moment EHR Smartphrase Present the content of the Smartphrase and instruct on how it can be used to document the TMCP
5. Conclusion	Summarize and wrap up
Skills Practice – 60 minute active interaction with Standardized Patients and coaches conducted in exam rooms. Training team consisted of pairs of a coach and a standardized patient. Encounter began with clinician knocking and entering the room and enquiring how can I help you today. SP briefly described reason for visit and revealed a salient concern. Clinicians practiced clarifying salient concern, making a link to tobacco use, expressing concern, assessing readiness and responding in alignment with readiness. Coaches provided feedback, suggestions for improvement and answered questions.
6-8 case scenarios	Practice the skills, building self-efficacy with new communication pattern
Coaching Feedback	Fine tune approach, correct misunderstandings, encourage trying variations, reinforce allowing the patient to express themselves and limiting physician actions to match patient readiness.