Table 3 Themes from qualitative analysis

Training and intervention as a positive experience

“I had a very positive experience as well because it was pre-decided that the people we were going up to in order to ask if they wanted help, had already agreed that they did want help. So I think if we were just going up to known smokers who weren’t at least open to the idea, I would say you could get a few negative experiences as well.” (Focus group [FG] 1)

“It felt more like legitimate patient care, I would say, than me going in and practicing an exam for me. As opposed to trying to find out what’s wrong with the patient. So it felt more needed for the patient and myself, as opposed to just selfishly practicing an exam on a patient” (FG1)

“Interviewer: Could I ask – would anybody like to do it again?

Student(s): Yeah.

Student 1: As I was saying earlier about it - I think, as a medical student, I think it’s good for us to get experience talking to patients because while they’re there for our benefit, we can actually benefit them at the stage we’re at. I think that’s very good.” (FG1)

Critical of current smoking care

“My patient was on Nicorette patches. And on the week follow up he was basically discharged without a refill prescription for Nicorette patches. So that struck me. I’m not sure if the smoking cessation officer or nurse saw or not, or if another doctor would think to prescribe that. But it just shows me how it really is not a priority at all. That’s what it showed me.” (FG1)

“No, they rarely talk about smoking. I had maybe one experience. It wasn’t with smoking; it was part of the visit that they just counselled them as smoking. They just said “you need to stop smoking.” Those exact words.” (FG2)

Interviewer: “…do you think that those doctors have time to do this the way you guys were trained?

(some disagreement among students followed)

Student 3: Oh in the actual clinic? Yeah, that’s a different story. I was thinking more of the patients in their care in the wards. I think they would definitely have the time. A lot of times, let’s say the SHO or the registrar is waiting for the consultant to show up. Before that they could definitely spend ten or fifteen minutes to add this on, because they pre-wrap anyway, so.

Interviewer: Do you think you guys could help out in a clinic, in a setting like that?

Student 3: Yeah absolutely. I mean in a clinic, I don’t know about you guys, a lot of the time we are just furniture.” (FG1)

Frustration from constraints/ difficulties

“Mine didn’t even know that there was such a thing as nicotine replacement therapy and that threw me off. And then I knew I wasn’t technically supposed to talk to him about it. But I sort of did and then I found out later that the smoking cessation counsellor hadn’t gotten to him because he’d been distracted.” (FG3)

“…. Like, if you’re fully trained you can say there are other things to help you other than smoking, right? But we’re not really at a stage to start prescribing Nicotine replacement.” (FG3)

Solutions/ improvements for the future

“… we are encouraged by all of the consultants to take a thorough history on the wards. So I don’t think we should just go and talk to them only about smoking. It’s much smoother if you just take a history of the patient, and then talk a little bit about smoking. And in that way, you could be like “hey I heard someone talked to you about smoking. How do you feel about that now?” Then you’re giving them a day to think about it, instead of on the spot kind of motivation. So they have a chance to go do some other stuff.” (FG3)

“I think that maybe including a demonstration in the tutorial of how you incorporate smoking cessation into taking a history. So not just on its own but a complete demonstration putting it together with a complete history and seeing how it fits in with all of that.” (FG 3)

“I think that the forms do a perfectly fine job of assessing how motivated and confident they are. But if it’s more to focus on what would actually benefit the patient, I think they are too limited in evaluating and motivating them because it’s only three quick questions.” (FG1)