The adverse outcomes associated with tobacco use are well documented and include an increased risk of cardiovascular diseases, cancers, respiratory diseases, adverse effects in pregnancy and oral diseases. One-half of all smokers will die prematurely as a consequence of their tobacco use. Tobacco cessation substantially reduces the risk of death associated with smoking and interventions to quit smoking are both efficacious and cost-effective. Every hospitalisation provides an opportunity to perform these interventions. Counselling for smoking cessation needs to be started during the hospitalisation and should be continued for at least a month after discharge to be effective. To address the twin problems of inadequate medical student training and lack of systematic counselling of hospitalized smokers, we designed a study to implement a smoking cessation training module for medical students, which will include a component of practical training amongst hospitalized smokers. We hypothesise that this training module will simultaneously result in improved quit rates amongst hospitalized smokers and improve medical student knowledge and comfort with counselling.

MEDICAL STUDENT TRAINING:

Students at each site will sit through a workshop conducted by a psychiatrist educator. There will be a didactic lecture, followed by group role-playing scenarios for 1–2 hours (students split into pairs and enact different scenarios), with peer and proctor feedback. Students who complete the workshop and test out using a questionnaire will be inducted into the trial.

PATIENT COUNSELLING:

A site coordinator will be recruited separately and trained. He/she will approach all patients in medicine, cardiology and/or pulmonology wards, who are eligible for the study. Consented patients will be stratified based on the centre and randomly assigned to intervention and control arms. Participating medical students will offer inpatient counselling to patients in the intervention arm once during their hospitalisation (recommended duration of 15-20 minutes). 

Pharmacotherapy:

Medical students are allowed to decide if their patients are eligible for Nicotine Replacement Therapy (nicotine gum and/or patch). These products can be purchased from the local pharmacy upon discharge after approval by the attending physician/resident involved in the patient’s care. Patients will be advised not to use the gum or patch until after the quit date.

Follow up:

Students will then follow up with their patients and provide telephone counselling (a minimum of 3 sessions of 15 mins each over 2 months). At each session, the student will assess the patient’s motivation and discuss relevant themes. He/she will also maintain patient information in a workbook.

The control patients will not receive specialised counselling. For these patients, smoking cessation advice and referring to counselling are left at the discretion of the treating physician. The number of patients counselled by their treating physician will be tracked throughout the study.