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?