Can distance learning improve smoking cessation advice in family practice? A randomized trial

INTRODUCTION: Family physicians (FPs) underuse opportunities to provide smoking cessation advice during routine consultations with patients who smoke. Distance learning is a promising approach to continuing medical education, particularly for FPs practicing in rural and remote areas. We developed a distance learning module, conducting a randomized trial to assess its educational impact on knowledge, attitudes and skills ("competence"), self-rated competence, confidence, and readiness to change. METHODS: Volunteer FPs were randomly allocated to receive either a distance learning module or a preventive care guideline. Self-administered questionnaires were completed at baseline and post-test. RESULTS: Fifty-three FPs enrolled in the study. There were no changes in knowledge or attitudes. Change in skills was limited to a reduction in use of one ineffective technique, namely "nicotine fading." Change in self-rated competence between baseline and post-test was significantly greater for the intervention than for the control group, however (p = .03). Although self-ratings of confidence increased significantly between baseline and post-test in both groups, the magnitude of change was no greater in the intervention than the control group (p = .3). Both groups demonstrated only nonsignificant shifts in readiness to change. DISCUSSION: These modest changes are of uncertain educational value, inviting caution before recommending distance learning approaches to promote smoking cessation advice in family practice.