E-Cigarettes: Harmful or Harm-Reducing? Evaluation of a Novel Online CME Program for Health Care Providers
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Stanford Prevention Research Center, Department of Medicine, , Stanford University, Stanford, CA, USA; 2Evaluation Sciences Unit, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA; 3Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; 4Department of Otolaryngology–Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.
AIM: Patients are asking health care providers about ecigarettes, vaping, and other electronic nicotine delivery systems (ENDS). Provider advice on ENDS has varied greatly, suggesting a need for evidence-based continuing medical education (CME). SETTING: A novel free online CME course was developed on ENDS risks and benefits, product types (e.g., vape pens, pods), and screening and counseling best practices for adults, adolescents, and different smoker profiles (e.g., daily, social). PARTICIPANTS: From January 2017 through June 2018, 1061 individuals accessed the course: 46% physicians, 7% physician assistants, 7% nurse practitioners, 15% nurses, 4% pharmacists, and 28% allied health/ student/other; 41% were international. PROGRAM DESCRIPTION: The course was built from observed online patient-provider interactions. Through video role-plays, expert interviews, and interactive activities, the course engaged learners in the evidence on ENDS. Completers earned 1.5 CME units. PROGRAM EVALUATION: A total of 555 health care providers earned 832.5 CME units. Pre- to post-test scores significantly increased from 57 to 90%; 76% rated the course as above average (41%) or outstanding (35%); 99% indicated the course was free of commercial bias. DISCUSSION: Addressing the growing need for balanced provider education on ENDS, this interactive online CME engaged learners and increased knowledge on devices and evidence-based cessation approaches. KEY WORDS: e-cigarettes; vaping; Juul; continuing medical education; nicotine; ENDS. J Gen Intern Med DOI: 10.1007/s11606-019-05388-7 © Society of General Internal Medicine 2019
INTRODUCTION
Electronic nicotine delivery systems (ENDS) entered the US market in 2007.1 In 2017, 6.9 million (2.8%) adults reported every day or some day use of ENDS, with greater use (7.9%) Received March 27, 2019 Revised August 9, 2019 Accepted September 10, 2019
among current conventional smokers.2 Adults report dual use of ENDS in places where smoking is banned, as a means to reduce the number of cigarettes smoked per day, and in an effort to quit smoking.3,4 While some observational studies suggest a benefit of ENDS use, particularly daily use, for quitting smoking,5 randomized controlled trial evidence of ENDS for quitting smoking is limited.6 Two cessation studies showed no advantage of ENDS relative to placebo (i.e., ENDS without nicotine). The third, and most recent trial (published after release of this CME), tested ENDS with behavioral support against nicotine replacement therapies (NRT).7 The study found significantly higher cigarette quit rates for
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