Cultural competency and tobacco control training in US medical schools: many but missed opportunities.

Tobacco-related morbidity and mortality disproportionately burdens America's most vulnerable populations, and many physicians in the USA are untrained in smoking cessation skills with patients of various literacy levels and races and ethnicities. An anonymous survey was administered to 860 second year and 827 fourth year students at 12 medical schools. A faculty representative at each of the schools completed an assessment of the curriculum and rated medical students' knowledge and skills for cultural competency. Report of experience in tobacco counseling for persons of various literacy levels and ethnicities rose from 42% (second year students) to 82% (fourth year students) and 48% (second year students) to 91% (fourth year students), respectively. However, only 37% of second year students and 40% of fourth year students reported that they had ever been taught to employ culturally competent strategies for tobacco cessation. This study found that almost two thirds of students in 12 medical schools reported no exposure to teaching about cultural competency and tobacco cessation, and approximately one third reported no practical experience with tobacco cessation counseling persons of various races and ethnicities. Effective cultural competency training for tobacco control should include teaching the social constructs of race, ethnicity, and socio-cultural concepts within a medical context. Additionally, students should receive supervised clinical opportunities to practice counseling, including opportunities to discuss and reflect on their experiences.