Ortho Students Initiate Stop Smoking Program

Medical students, working as volunteers with a hospital’s orthopedic department, have established a program to help people stop smoking. Their timing is impeccable. It has been 50 years since the surgeon general of the United States issued his proclamation on the hazards to human health of smoking. Yet smoking remains the leading cause of preventable death in the United States, claiming 480, 000 deaths a year.

The students are aware that orthopedic surgeons, meeting with patients about their upcoming surgery, face a disturbing situation. If their patient is a smoker, as are 19.5% of all adults between the ages of 45 and 64 according to the Center for Disease Control, the doctor knows that the surgery could be compromised by the patient’s smoking habit. They know that smoking reduces the blood supply to bones, interferes with the production of bone-forming cells, slows the absorption of calcium from the diet and leads to a higher rate of complications after surgery. Rotator cuff tears in smokers are nearly twice as large as are those in nonsmokers. The most common preoperative compilations associated with smoking are wound-healing, infection and cardiopulmonary.

What to do? At best, the typical surgeon has 30 minutes or less to spend counseling his patients. Peter Cole, M.D., chair of the Department of Orthopedics at Region’s Hospital, Saint Paul, Minnesota, and a professor at the University of Minnesota School of Medicine, regretted that time prevented him from dealing with the health problems experienced by his smoking patients. But he had an idea. While he did not have the time to counsel his patients on a non-smoking program, why not enlist medical students to do it?

A five A.M. meeting over coffee between Cole and Mike Torchia, a medical student at the University of Minnesota, led to an unusual stop-smoking program run out of a university in partnership with a hospital orthopedic department. Called STOPSS, which stands for Students Treating Orthopaedic Patients to Stop Smoking, the program quickly gained volunteers from among the medical student population.

At Cole’s request, students Joshua Olson and Brandon Kelly joined with Torchia and psychologist Christine Danner, Ph.D., in a year-long effort to design the program. To participate, the medical student volunteers must complete a four hour program on how to conduct a 30 minute patient interview and five additional hours of online learning. They must gain a basic knowledge of orthopedics, tobacco-related complications of surgery and pharmacological interventions for smoking cessation. The goal is to help participants gain the inner strength necessary to overcome their addiction. The students maintain contact with the patients via phone follow up at 2, 4, 8, 12, 24 and 52 week intervals.

The group has completed its pilot program. Out of 20 referrals from surgeons during the six-week pilot project, nine patients agreed to participate in the medical-student run program. Five of the nine received both nicotine replacement and behavioral therapy while four received only the behavioral intervention. At the end of the second week, seven out of nine patients reported a reduction in their use of cigarettes of at least 50%. At the end of five weeks seven out of eight smokers had maintained the 50% reduction in their smoking. Of the eight patients who reported a reduction in nicotine use, all were “highly” or “moderately” motivated to quit smoking compared to” minimal” motivation for the patient who did not report smoking reduction.

The founders are encouraged by the initial results and by the response of their fellow students. Medical students at the University of Minnesota are required, as part of their program, to participate in approved volunteer activities. As Torchia explained, this program gives them a meaningful opportunity, early in their careers, to interact with patients. More than a dozen medical students, some studying in disciplines other than orthopedics, have signed on to participate. Regions Hospital has created a medical record interface for the program, trained the volunteers how to use it and assigned them an office where they can meet with patients. Every surgeon in the department has agreed to refer patients to STOPSS.

The students have analyzed the results of their pilot program and plan to go full bore in the fall. They are aware that, for a patient, committing to surgery can be a sentinel event in their lives. The students hope to take advantage of this moment when vulnerable patients may be persuaded to make a beneficial change in their behavior.