Recent developments in drug and alcohol medical education in Australia

Have efforts to improve medical students' drug and alcohol knowledge, skills and attitudes worked?

A series of surveys were undertaken at one Australian medical school to examine alcohol and drug-related knowledge, skills and attitudes before and after the introduction of the National Campaign Against Drug Abuse and also before and after major alcohol and drug medical education initiatives. The surveys were conducted with 5th year medical students at the University of Sydney in 1986, 1990 and 1993 (total n = 379). Response rates of approximately 70% were achieved in each of the survey years. The three cohorts of students were similar demographically with the exception that significantly more males in 1990 and 1993 reported that English was not their first language. Very low prevalence levels for smoking were reported. By 1993, only 3% of 5th year medical students reported that they smoked. There was a significant decrease in the frequency of drinking occasions for males and females between 1986 and 1990. There was also a four-fold increase in both male and female abstainers. There was no significant difference in the amount of alcohol consumed on any drinking occasion, although there was a trend in that direction. There was a significant increase in alcohol and drug-related knowledge in the 1990 and 1993 groups, compared to the 1986 group. Skill levels were not found to change significantly across the three year groups. Students' ability to recognize NHMRC hazardous consumption levels increased substantially between 1986 and 1990. Only 4% of 1986 students considered <30 of alcohol a day to be hazardous for females compared to 47% in 1990. For men, only 8% of students considered 31-60 hazardous drinking in 1986 compared to 55% in 1990 and 61% in 1993. More recently trained students tended to express slightly more tolerant and accepting views about patients with alcohol and benzodiazepine dependence and had greater confidence in success of interventions. The present studies indicate important progress and achievements have been made. The paper discusses the further work needed to ensure that newly graduating medical practitioners are adequately equipped to deal effectively with alcohol and drug-related problems.

Medical education in substance use disorders

This paper outlines recent developments in drug and alcohol medical education, and highlights improved prospects for prevention and appropriate management of substance use disorders. The paper also presents a model of effective drug and alcohol medical education designed to induce both clinical competence and effective practice behaviour. Of particular note is the trend towards greater emphasis on skills development, especially clinical interaction skills. This emphasis is underpinned by an increasingly behavioural orientation, whereby concern is focused on fostering clinical competence in specific skills, e.g. identification, history taking and interventions. Practical examples of the application of such approaches are noted. In addition, relevance of concepts, such as self-efficacy and role legitimacy, to the area of drug and alcohol medical education is highlighted. Together with recent data on early intervention, and the widespread recognition and support for medical practitioners' involvement in drug and alcohol problems, future prospects are viewed as very encouraging.

Establishment and evaluation of a statewide drug and alcohol specialist advisory service

The New South Wales Drug and Alcohol Specialist Advisory Service aims to provide prompt, relevant and reliable advice on the clinical management of drug- and alcohol-related problems to health professionals throughout New South Wales. We gauged the performance of the Service against present indicators by interviewing 120 callers who had contacted the Service during its first two years. Accessibility and the quality of information provided were rated highly. Of the 120 respondents, 105 (90 per cent) rated the speed of response to their calls as very good or excellent, and 109 (91 per cent) considered the advice given to be very relevant to their needs. Nearly all (97 per cent) indicated their intention to reuse the Service, and 78 (65 per cent) nominated it as their preferred source of clinical advice on drug and alcohol problems. The Service has established itself as an accessible and reliable source of advice on the management of drug and alcohol problems, especially for rural health professionals. This model of a telephone-based consultancy could have application in other medical specialities.