UW-CTRI Course Empowers Med Student to Help Relative, Patients Try to Quit Smoking

Med Student Learns to Help Loved One Quit Smoking
Dr. Chinou Vang poses for a picture with his parents at his graduation this spring.

Before Dr. Chinou Vang began his residency in June at Gundersen Health System in La Crosse, he used the skills he learned from the Tobacco Dependence Treatment Course at the University of Wisconsin, taught by UW-CTRI staff, to help his relative try to quit smoking.

That loved one “is progressing slowly but surely,” Vang said. “One thing I took away from this course is really understanding that patients know their body best. We as providers should trust our patients and be here to support and guide them as needed. The nicotine-replacement therapy is working well because it’s what he was comfortable with as he was familiar with it from previous attempts. Another key point I took away from this course is that it’s better to have patients on nicotine-replacement therapy indefinitely than to have them use tobacco products.”

That’s a key point from the course, a public-health elective class led by UW-CTRI Researchers Drs. Jessica Cook and Megan Piper. The course includes an overview of tobacco treatment and electronic medical records by UW-CTRI Director Dr. Michael Fiore; evidence-based treatment and an intro to the 5 A’s of an intervention and counseling by Piper and Cook. It is offered once a year and has instructed approximately 25 medical students during the last six years.

Students also get to shadow Dr. Douglas Jorenby at the UW-CTRI Clinic and discuss such topics as special populations and smoking with Dr. Adrienne Johnson, tobacco-related health disparities with Dr. Stevens Smith, understanding withdrawal with Dr. Danielle McCarthy, dealing with smoking relapse with Dr. Tanya Schlam, cessation role play with Health Counselor Chris Ripley, alternative tobacco products with Jorenby, motivating smokers to quit with Cook, the Wisconsin Tobacco Quit Line with Coordinator Kate Kobinsky, medical systems and electronic medical records with Outreach Director Rob Adsit, reduction skills practice with Elana Brubaker, clinical evaluations with Piper and Cook, and behavioral health with Dr. Bruce Christiansen.

“I’ve learned and had the chance to practice a variety of techniques that will be extremely helpful in real patient examples,” said Vang. “For example, I learned that patients are more likely to quit smoking if their doctors were to simply and clearly recommend that they quit. Additionally, I’ve learned to use specific verbiage for patients who are not ready to quit like, ‘what are some benefits of quitting?” which don’t have any underlying assumptions or possible misinterpretations. One memorable moment that I recall was when I was (role) playing as a difficult patient and Jessica responded with, ‘sometimes all you can do is try.’

“This was a really defining moment for me because some of our patients will have factors that are outside of their control. Therefore, sometimes the best thing we can do is just to try and continue trying. Lastly, I’m really glad that Jessica and Megan taught us some of their clinical psychology techniques, like the ruler technique, which I can utilize in my patient interactions.”

The ruler exercise involves asking someone, on a 1-10 scale, how confident they are they could quit smoking. If they say a four, the counselor says, “Why didn’t you say two?” The theory is, the patient will tell the counselor reasons why they are confident, which gets them to start arguing for reasons they might be successful, versus talking about why they won’t be successful. It can change momentum and dynamics of the conversation.

Vang said he thought the class was extremely well taught. “I really wish more of my classmates had the opportunity to take this course. We receive really in-depth training on different therapy regimens to help patients quit smoking and also get to practice interview techniques. I plan to use a lot of these interviewing skills on a daily basis because ultimately it will lead to better patient outcomes.”

He hopes that will include his relative, and thanks the UW-CTRI staff for their help. They “really empowered me to believe that I can make a difference and to start making a difference by taking care of someone I love.”

Cook and Piper hope to empower more students in the future.