Chiropractic Education Research Articles

A focus group study of chiropractic students following international service learning experiences.

One objective of chiropractic education is to cultivate clinical confidence in novice practitioners. The purpose of this qualitative study was to describe how participation in a short-term international service learning experience changed perceptions of clinical confidence in senior chiropractic students. Seventeen senior chiropractic students participated in 4 moderated focus group sessions within 4 months after a clinical educational opportunity held in international settings. Participants answered standard questions on how this educational experience may have changed their clinical confidence. Two investigators performed qualitative thematic analysis of the verbatim transcripts to identify core concepts and supporting themes. The core concept was transformation from an unsure student to a confident doctor. The service learning experience allowed students to deliver chiropractic treatment to patients in a real-world setting, engage in frequent repetitions of technical skills, perform clinical decision-making and care coordination, and communicate with patients and other health professionals. Students described increased clinical confidence in 9 competency areas organized within 3 domains: (1) chiropractic competencies including observation, palpation, and manipulation; (2) clinical competencies including problem solving, clinic flow, and decision-making; and (3) communication competencies, including patient communication, interprofessional communication, and doctor-patient relationship. Students recommended that future service learning programs include debriefing sessions similar to the experience offered by these focus groups to enhance student learning. Senior chiropractic students who participated in an international service learning program gained confidence and valuable practical experience in integrating their chiropractic, clinical, and communication skills for their future practices.

Learning spinal manipulation: A best-evidence synthesis of teaching methods.

The purpose of this study was to evaluate the effectiveness of different reported methods used to teach spinal manipulative therapy to chiropractic students. For this best-evidence literature synthesis, 5 electronic databases were searched from 1900 to 2015. Eligible studies were critically appraised using the criteria of the Scottish Intercollegiate Guidelines Network. Scientifically admissible studies were synthesized following best-evidence synthesis principles. Twenty articles were critically appraised, including 9 randomized clinical trials, 9 cohort studies, and 2 systematic reviews/meta-analyses. Eleven articles were accepted as scientifically admissible. The type of teaching method aids included a Thrust in Motion cervical manikin, instrumented cardiopulmonary reanimation manikin, padded contact with a load cell, instrumented treatment table with force sensor/transducer, and Dynadjust instrument. Several different methods exist in the literature for teaching spinal manipulative therapy techniques; however, future research in this developing area of chiropractic education is proposed. It is suggested that various teaching methods be included in the regular curricula of chiropractic colleges to aid in developing manipulation skills, efficiency, and knowledge of performance.

Similarities and differences of graduate entry-level competencies of chiropractic councils on education: a systematic review.

BackgroundCouncils of Chiropractic Education (CCE) indirectly influence patient care and safety through their role of ensuring the standards of training delivered by chiropractic educational institutions. This is achieved by CCEs defining competence and creating lists of descriptive statements to establish the necessary standards for students to attain before graduating. A preliminary review suggested that these definitions and descriptive lists lacked consensus. This creates the potential for variations in standards between the CCE jurisdictions and may compromise patient care and safety and also inter-jurisdictional mutual recognition. The purposes of this study were 1) to investigate similarities and differences between the CCEs in their definitions of competence, domains of educational competencies, components of the domains of competencies, as represented by assessment and diagnosis, ethics, intellectual development, and 2) to make recommendations, if significant deficiencies were found.MethodWe undertook a systematic review of the similarities and differences between various CCEs definitions of competence and the descriptive lists of educational competencies they have adopted. CCEs were selected on the basis of WHO recommendations. Blinded investigators selected the data from CCE websites and direct contact with CCEs. This information was tabulated for a comparative analysis.ResultsAll CCEs’ definitions of competence included the elements of “knowledge”, “skills” and “attitudes” whereas only one CCE included the expected “abilities” element. The educational application of the definition of competency among CCEs varied. A high level of similarity when comparing the domains of competence adopted by CCEs was found despite variations in the structure.Differences between CCEs became increasingly apparent when the three selected representative domains were compared. CCEs were found to stipulate varying levels of prescriptiveness for graduate entry level standards.ConclusionsA series of recommendations are proposed to create uniform and high quality international standards of care. Future research should compare the levels of CCEs enforcement of standards to see if similarities and differences exist.

Editorial board and peer reviewer acknowledgement 2015

I wish to thank the peer reviewers, editorial board, authors, and production staff who work tirelessly to produce the Journal of Chiropractic Education (JCE). One person who works consistently to bring an expert educator's perspective to our own professional growth is Assistant Editor Julie Nyquist. With her many years of training health professions educators, Julie has helped me greatly in developing the book review section into a part of the journal that focuses on topics that educators are keenly interested in reading about. I thank her for bringing her talents to the Journal. Every manuscript submitted to the Journal is reviewed by a minimum of 2 blinded reviewers. The JCE peer reviewers provide outstanding formative reviews, and also assure that each published manuscript meets rigorous academic and scientific standards. As the JCE has increased its international presence, there has been a corresponding increase in peer review activity from a number of countries. I am pleased to see international diversity in the peer review team, with critiques coming from 15 countries, including Australia, Brazil, Canada, Denmark, Republic of Korea, Malaysia, Mexico, New Zealand, Oman, South Africa, Spain, Sweden, Switzerland, United Kingdom, and the United States. Thank you to the following peer reviewers for the 2014 to 2015 year who volunteered their time to critique submitted manuscripts: Barclay Bakkum, Jennifer Bolton, David Byfield, Ashley Cleveland, Mary Kate Connolly, Robert Cooperstein, Edward Crowther, Dustin Derby, Thiana Paula dos Santos Schmidt, Andrew Dunn, Stephen Duray, Ana Facchinato, Matthew Funk, Christopher Good, Heidi Haavik, Michael Haneline, John Hart, Ruina He, Xiaohua He, Mark Hecimovich, Sean Herrin, Lisa Hines, Kelly Holt, Claire Johnson, Dale Johnson, Charmaine Korporaal, Laura Lamm, Dana Lawrence, Hao Le, Alexander Lee, Ken Masters, Angela McCall, Marc McRae, Christopher Meseke, Joyce Miller, Thomas Milus, John Mrozek, Harrison Ndetan, Valerie Nichols, Julie Nyquist, Per Palmgren, Robert Percuoco, Cynthia Peterson, Reed Phillips, Kevin Rose, Severiano Ruiz, Greg Snow, Randy Swenson, Rodger Tepe, Subramanyam Vemulpad, Michael Wiles, Christopher Yelverton, Kenneth Young, and Niu Zhang. The members of the editorial board, listed on the Journal masthead, also are all volunteers and, in addition to performing peer review, provide advice to me on a range of matters from suggesting future initiatives for the JCE to resolving ethics issues. The editorial board was very busy this year and I appreciate the extra dedication that the board members give to the Journal. The JCE is accessible through a variety of media, including our attractive print version and online. All JCE content is available online as open access (free) material at our web site (www.journalchiroed.com). On the web site, readers also can register for table of content alerts, catalog favorite papers, garner references, and perform many other useful functions, all for free. We press on with improvements to the JCE as part of our quality improvement process and look forward to your continued participation and interest in the journal in the coming year.

Leaders Eat Last: Why Some Teams Pull Together and Others Don't

As I picked up Leaders Eat Last, with its preface written by a retired Lieutenant General and its focus on business, I wondered if its contents would connect to those of us in health care. However, as I read the book I was struck by the similarities. As academia becomes “more like a business” and medicine becomes increasingly businesslike, the challenges discussed and insights offered seem very relevant. A key statement in the forward was particularly resonant, “Organizations where people share values and where people are valued succeed over the long term in good and bad times.” Mr. Sinek's description of leaders of great organizations, who “do not see people as a commodity to be managed to help grow the money,” but instead, “see money as the commodity to be managed to help grow their people” also was insightful. Hospitals, schools of chiropractic, and outpatient practices all are organizations that require excellence from every person within them, making this admonition very relevant. In chiropractic education this impact is magnified further as young professionals build their professional identities, and the values that will guide their care of others throughout their careers. Thus, the relevance of this book to us.

US chiropractors' attitudes, skills and use of evidence-based practice: A cross-sectional national survey.

BackgroundEvidence based practice (EBP) is being increasingly utilized by health care professionals as a means of improving the quality of health care. The introduction of EBP principles into the chiropractic profession is a relatively recent phenomenon. There is currently a lack of information about the EBP literacy level of US chiropractors and the barriers/facilitators to the use of EBP in the chiropractic profession.MethodsA nationwide EBP survey of US chiropractors was administered online (Nov 2012-Mar 2013) utilizing a validated self-report instrument (EBASE) in which three sub-scores are reported: attitudes, skills and use. Means, medians, and frequency distributions for each of the sub-scores were generated. Descriptive statistics were used to analyze the demographic characteristics of the sample. Means and proportions were calculated for all of the responses to each of the questions in the survey.ResultsA total of 1,314 US chiropractors completed the EBASE survey; the sample appeared to be representative of the US chiropractic profession. Respondents were predominantly white (94.3%), male (75%), 47 (+/− 11.6) years of age, and in practice for more than 10 years (60%). EBASE sub-score means (possible ranges) were: attitudes, 31.4 (8–40); skills, 44.3 (13–65); and use, 10.3 (0–24). Survey participants generally held favorable attitudes toward EBP, but reported less use of EBP. A minority of participants indicated that EBP coursework (17%) and critical thinking (29%) were a major part of their chiropractic education. The most commonly reported barrier to the use of EBP was “lack of time”. Almost 90% of the sample indicated that they were interested in improving their EBP skills.ConclusionAmerican chiropractors appear similar to chiropractors in other countries, and other health professionals regarding their favorable attitudes towards EBP, while expressing barriers related to EBP skills such as research relevance and lack of time. This suggests that the design of future EBP educational interventions should capitalize on the growing body of EBP implementation research developing in other health disciplines. This will likely include broadening the approach beyond a sole focus on EBP education, and taking a multilevel approach that also targets professional, organizational and health policy domains.Electronic supplementary materialThe online version of this article (doi:10.1186/s12998-015-0060-0) contains supplementary material, which is available to authorized users.

Chiropractic Professionalization and Accreditation: An Exploration of the History of Conflict Between Worldviews Through the Lens of Developmental Structuralism

ObjectiveThe purpose of this commentary is to describe the conflicts in the history of chiropractic’s professionalization and conflict through the path of increasing educational standards and accreditation using the lens of developmental structuralism. DiscussionWithin the story of chiropractic’s professionalization and accreditation lie the battles between competing worldviews. Gibbons proposed 4 periods of chiropractic’s educational history; this article proposes a fifth period along with a new methodological approach to explore the complexity of chiropractic’s history. The methodology draws upon constructive developmental psychology and proposes 5 levels of thinking common to the individuals from chiropractic’s history. By using a psychological framework to analyze historical events, it appears that the battle within chiropractic education continues at present. Several important issues are explored: the Council on Chiropractic Education's origins in the medical paradigm and rational thinking, the pre-rational, rational, and post-rational critics of the Council on Chiropractic Education, the schools of thought that were reified or emerged from the history, as well as the more recent legal, economic, and social pressures, which helped to shape chiropractic's accreditation and professionalization. ConclusionA transrational approach, one that includes the partial truths of all perspectives, is a first step to allow for a richer understanding of how the interior worldviews, individual actions, and the exterior forces (legal, economic, political, and educational) brought forth the chiropractic clashes together. Viewing the conflicts within chiropractic from this approach may foster new educational structures to evolve.

Relationship Between Chiropractic Teaching Institutions and Practice Characteristics Among Canadian Doctors of Chiropractic: A Random Sample Survey

ObjectiveThe objectives of this study were to determine if faction membership among Canadian doctors of chiropractic (DCs) is associated with differences in educational program characteristics among English-speaking Canadian and United States chiropractic colleges and to determine if those differences are expressed in terms of surveyed attitudes and behaviors regarding treatment efficacy, radiographic imaging, vaccinations, and interprofessional referrals. This study also aims to identify if educational programs may be a potential source of multiple professional identities. MethodsA randomly selected sample of Canadian DCs, stratified across the English-speaking provinces, was surveyed by mail. Survey items included school of graduation, self-categorization by chiropractic subgroup, perceptions of condition-specific treatment efficacy, use of plain film radiographic imaging, vaccination attitudes/behaviors, and patient referral patterns. Self-categorization by chiropractic subgroup included: the unorthodox faction (associates the chiropractic subluxation as an encumbrance to the expression of health) and the orthodox perspective (associates with musculoskeletal joint dysfunction, public health, and lifestyle concerns). For data analysis, chiropractic schools were divided into 2 groups according to location: English-speaking Canada and the US. The US was further clustered into liberal (“interested in mixing elements of modern and alternative therapies into the practice of chiropractic") and conservative categories (“chiropractors who believe in continuing the traditions of chiropractic"). ResultsOf 740 deliverable questionnaires, 503 were returned for a response rate of 68%. χ2 Testing revealed significant differences in self-categorized faction membership associated with the clustering of colleges based on ideological viewpoints (χ2 = 27.06; P = .000). Descriptive results revealed a relationship between school of origin and perceived treatment efficacy, use of radiographic imaging, and vaccination attitudes. No significant differences were found relative to interprofessional referral patterns. ConclusionChiropractic program attended is a significant predictor of orthodox vs unorthodox faction membership and professional practice characteristics for Canadian DCs. This suggests that the current chiropractic education system may contribute to multiple professional identities.

Learning From a Lifetime of Leading Effective Change

ObjectiveThe purpose of this article is to report on the opening plenary session of the Association of Chiropractic Colleges Educational Conference—Research Agenda Conference (ACC-RAC) 2014, “Aiming for Effective Change: Leadership in Chiropractic Education, Research and Clinical Practice.” DiscussionSpeakers with extensive backgrounds with implementing substantial change on a broad level shared personal examples from their experiences in education, research, political organizations, and clinical practice. They described efforts, challenges, and opportunities that are encountered in order to implement effective change and shared their personal thoughts on leadership. ConclusionEach of the speakers shared their diverse, unique insights and personal experiences to convey the process and meaning of leadership.

Editorial board and peer reviewer acknowledgement 2014

Many people do a great deal of work to publish the Journal of Chiropractic Education (JCE). Thus, I wish to extend a heartfelt thank you to the peer reviewers, editorial board, authors, and production staff who work so diligently to produce the Journal. Every manuscript submitted to the Journal is reviewed by a minimum of two blinded reviewers. The JCE peer reviewers provide outstanding formative reviews, and also assures that each published manuscript meets rigorous academic and scientific standards. Thank you to the following peer reviewers for the 2013 to 2014 year who volunteered their time to critique submitted manuscripts: Alan Adams, Barclay Bakkum, Jennifer Bolton, Rick Branson, David Byfield, Alana Callender, Ashley Cleveland, Mary Kate Connolly, Robert Cooperstein, Edward Crowther, Thiana Paula dos Santos Schmidt, Andrew Dunn, Stephen Duray, Phillip Ebrall, Ana Facchinato, Matthew Funk, Brian Gleberzon, Christopher Good, Julie-Marthe Grenier, Maruti Gudavalli, Heidi Haavik, Michael Haneline, John Hart, Xiaohua He, Mark Hecimovich, Sean Herrin, Kelly Holt, Claire Johnson, HanSuk Jung, Lisa Killinger, Charmaine Korporral, Laura Lamm, Alexander Lee, Kathleen Linaker, Christopher Meseke, John Mrozek, Valerie Nichols, Julie Nyquist, Anthony Onorato, Per Palmgren, Robert Percuoco, Cynthia Peterson, Reed Phillips, Kevin Rose, Severiano Ruiz, Greg Snow, Randy Swenson, Rodger Tepe, Subramanyam Vemulpad, David Ward, Christopher Yelverton, Kenneth Young, and Niu Zhang. The members of the editorial board also are volunteers and provide advice to me on a range of matters from suggesting future initiatives of the JCE to resolving ethics issues. I rely upon the board for critical input regarding a vast array of issues. The editorial board, listed on the Journal's masthead in the front of the Journal and on the JCE web site, has international representation, which helps improve the relevance, quality, and access of the Journal to a broad audience of educators. The diversity of the board continues to grow, with new representatives from Southeast Asia, Western Asia, Latin America, and North America. The JCE is accessible through a variety of media. Of course, the JCE still is printed and delivered to chiropractic institutions globally. However, it is worth reminding readers that all content is available online as open access (free) material at our web site (www.journalchiroed.com). On the web site readers also can register for table of content alerts, catalog favorite papers, garner references, and perform many other useful functions, all for free. The Journal always is evolving and your participation is welcome. If you have an idea for the Journal or would like to participate in some way, please feel free to contact me by e-mail.

Attitudes of Australian Chiropractic Students towards Anatomy and Chemistry

KEYWORDS Chiropractic Education. Basic Sciences. Health Sciences. Curriculum. Integration ABSTRACT Education of chiropractic students has traditionally been based on a good grounding in basic sciences. However, the place and significance of these disciplines in chiropractic education, as well as student, staff and clinician attitudes towards them have been rarely investigated. In this study, the attitudes of Macquarie University chiropractic students towards anatomy and chemistry were examined, using a modified version of the questionnaire previously used in a survey of medical students in the UK and France. Pearson's chi-square test and logistic regression were used in data analysis. The results suggest that chiropractic students recognize anatomy as a very important subject in their education while chemistry is perceived as a subject of lesser importance. Several factors are suggested as reasons for this difference. Chiropractic is a health profession focused on musculoskeletal disorders, for which manual therapy is the major treatment approach, and this makes the importance of anatomy almost self-evident. It is also argued that the other major factor influencing students' attitudes is the way anatomy is currently taught at Macquarie University and other chiropractic schools in Australia. Following the recent evolution in anatomy education for health professionals, anatomy has become better integrated within the chiropractic curricula with strong applied and clinical focus. This indicates that an efficient integration of basic sciences into a chiropractic or other health profession curricula could contribute towards the better and easier recognition of their importance among the student body.

Peer review acknowledgments

This is the 21st meeting of the scientific, peer-reviewed presentation section of the Association of Chiropractic Colleges (ACC) Educational Conference, now a part of the ACC–Research Agenda Conference (ACC-RAC). This conference has grown substantially since its humble beginnings in 1994. The theme of this year's conference is “Aiming for effective change: Leadership in chiropractic education, research, and clinical practice,” which is very fitting. If the true essence of leadership is to implement effective change, then in my observation over the past 2 decades, I can say that we have done much as it relates to education and research in the chiropractic profession. For leaders to be successful, they must (1) establish direction and vision, (2) communicate goals, and (3) develop coalitions and alliances. The ACC Peer-Review Committee continues to establish direction and vision for scientific presentations, communicate these goals, and develop alliances in order to improve the current state of science and scholarship through the scholarly art of peer review. We are pleased that each year we observe the quality of presentations improve and exceed the quality of the previous year. We are honored to be a part of the quality improvement of scholarship in the chiropractic profession. The purpose of this summary report is to provide a brief review of the peer-review processes for the ACC-RAC 2014.

Collaborative strategies for teaching common acid-base disorders to medical students

the ability to recognize and diagnose acid-base disorders is of the utmost importance in the clinical setting. However, in our experience, medical students often have difficulties learning the basic principles of acid-base physiology in the respiratory physiology curriculum, particularly when

Publication rates of abstracts presented at the Association of Chiropractic Colleges Educational Conference/Research Agenda Conference from 2002 to 2008

Objective : The purposes of this study were to investigate the overall publication rates of presentations at the Association of Chiropractic Colleges Educational Conference/Research Agenda Conference (ACC/RAC) meetings (2002-2008), differences in the publication rates of platform vs poster presentations, and the consistency of the meeting abstract compared to the full-length journal article. Methods : Abstracts were obtained from proceedings published in the Journal of Chiropractic Education. Literature searches using PubMed and the Index to the Chiropractic Literature (ICL) were performed to locate peer-reviewed journal articles based upon those abstracts. Whether the article was based upon a poster or platform presentation, and the congruence of the information in the abstract and article were recorded. Results : We identified 776 proceeding abstracts, 249 of which eventually were published between 2002 and 2012. The overall publication rate was 32.2%. A total of 42.7% of platform presentations eventually were published vs 20.3% of posters. Congruency showed that 43.2% had the same title as the meeting abstract, 59.7% had the same authorship, and 88.8% had the same methods. Conclusion : Publication rates of abstracts from spine and orthopedic surgery national meetings range from 34% to 59%. The ACC/RAC meetings have similar publication rates. More platform than poster presentations reach full publication. The congruency of ACC/RAC abstracts to published articles is higher than national meetings in other fields.

Book Review

Book Review

Chiropractic treatment of idiopathic scoliosis with the CLEAR Institute method: a description of the protocol

Background Chiropractic care is a healthcare discipline that focuses upon the diagnosis and treatment of problems that affect the alignment of the muscles and bones of the body. According to the National Board of Chiropractic Examiners, 2.7 million visits are made each year in the U.S. to chiropractors for scoliosis and scoliosis-related complaints[1]. Despite the frequency with which chiropractic services are employed for scoliosis, there is insufficient evidence to draw conclusions on the chiropractic treatment of scoliosis; the majority of published papers are case reports, with the only exception being a cohort study by Lantz et al.[2] that finds little benefit to the practices commonly employed by most chiropractors in the treatment of scoliosis[3]. Recognizing this, a novel chiropractic protocol for the evaluation, assessment, and treatment of scoliosis was developed by the CLEAR (Chiropractic Leadership, Educational Advancement, and Research) Scoliosis Institute, a non-profit organization. Chiropractic doctors become certified in these methods to provide care to scoliosis patients.

Editorial board and peer reviewer acknowledgement 2013

Producing the Journal of Chiropractic Education is a team effort. Thus, I wish to extend a heartfelt thank you to the peer reviewers, editorial board, authors, and production staff who work so diligently to produce the journal.Our dedicated cadre of peer reviewers ensures that each published manuscript meets rigorous academic and scientific standards. I thank the peer reviewers for the 2012–2013 year who volunteered their time to critique submitted manuscripts. Reviewers were as follows:The editorial board continues to provide sage advice in matters related to the journal. I turn to the board for critical input regarding a vast array of issues, such as change with the journal, potential ethical misconduct cases, and quality control. The members of the editorial board are also volunteers. The editorial board, listed on the journal's masthead in the front of the journal and on our web site, has international representation, which helps improve the relevance, quality, and access of the journal to a broad audience of educators. The diversity of the board continued to grow this year, with new representatives from South Africa, Latin America, and North America, to whom we extend a warm welcome.The readers are the greatest source of input to the Journal of Chiropractic Education. Many of our improvements are a result of requests by the readership, and we value your feedback. The journal continues to evolve, and your participation is welcome. If you have an idea for the journal or would like to participate in some way, please feel free to contact me by e-mail (JChiroEd@aol.com).

Association of Chiropractic Colleges Educational Conference and Research Agenda Conference 2013

Association of Chiropractic Colleges Educational Conference and Research Agenda Conference 2013

Stress in chiropractic education: a student survey of a five-year course

Objective : Stress encompasses academic issues, such as time management, increased work load, and new subject matter, but cannot be separated from stressors, such as social adjustment and financial pressure. Our study investigated whether perceived level of academic or practical attainment and the method of study were associated with the amount of perceived stress during students" studies. Methods : A semi-structured self-administered questionnaire was piloted and distributed to 134 students at a chiropractic college at the end of a lecture. Results : The survey had a response rate of 81%. Students in their fourth year consistently reported the highest perceived levels of stress, with 81% feeling that their ability to study was affected by their financial situation and 56% felt overwhelmed at their ability to cope with their college workload. All year groups were stressed during their course of studies, but the stressor varies depending on the year of study. Conclusions : Year 4 consistently demonstrated the highest levels of stress. All students, regardless of year group, experienced varying degrees of stress while studying and the central stressor changed depending on the time position within the course.

Feasibility of using a standardized patient encounter for training chiropractic students in tobacco cessation counseling

Objective : Although tobacco cessation training is included in many health profession programs, it is not yet routinely incorporated into chiropractic education. The purpose of this study was to assess the feasibility of incorporating a problem-based learning tobacco cessation activity into a lecture course for chiropractic students. Methods : Seventy-two students were assigned to participate in two 1-hour lectures on health promotion counseling and tobacco cessation followed by an experiential student-driven lab session using standardized patients at various stages of dependency and willingness to quit. The intervention was based on the transtheoretic model and the "5 A's" of counseling (ask, advise, assess, assist, arrange). Outcomes were assessed via (1) questionnaires completed by the standardized patients regarding the students' use of the 5A's, and (2) questionnaires completed by the students using a 5-point Likert scale of "strongly disagree" to "strongly agree" on the acceptability of this method of learning. Descriptive statistics were computed. Results : Sixty-eight students (94%) completed the activity, spending a median of 2.5 minutes with patients. Over 90% addressed 4 of the 5A's: 99% asked patients if they were smokers; 97% advised them to quit; 90% assessed if they were willing to quit; and 99% offered assistance in quitting. Only 79% arranged a follow-up visit. Overall, students expressed a positive response to the experience; 81% said it increased their confidence in being able to advise patients, and 77% felt it would be valuable for use in their future practice. Conclusion : This active learning exercise appeared to be a feasible way to introduce tobacco counseling into the curriculum.