Abstract
Background
Medical complications of substance use are a considerable cause of morbidity and the role of the physician in the care of such problems has consistently been demonstrated. Appropriate knowledge and skills are necessary to carry out this role.
Aims
To review the literature on training undergraduate medical students in identifying and managing substance misuse and to discuss the implications of this literature for Irish medical education.
Methods
A search of the literature was performed using keywords; “substance-related disorders”, “undergraduate” and “curriculum”. All abstracts were reviewed and the full text of relevant abstracts was studied and references reviewed for further articles.
Results
Despite an increase in prevalence of the problem of drug and alcohol use in Ireland and the UK, this has not been reflected in undergraduate medical curricula. In the UK, minimal time is devoted to formal teaching of medical undergraduates in the area of substance misuse and many doctors do not have the appropriate knowledge, skills, attitudes and confidence to treat patients with such problems. In Ireland, no data has reported formal undergraduate teaching hours in the area of drug and alcohol misuse. Internationally, substance abuse curricula have been developed and implemented in medical schools in the United States and Australia.
Conclusion
While substance misuse is increasing in prevalence, this is not reflected in the composition of medical curricula, especially in Ireland. International best practice whereby undergraduate curricula that adequately address substance misuse and related issues are systematically developed and implemented, is recommended for adoption by Irish medical schools.
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References
Hope, A. Alcohol consumption in Ireland 1986–2006. Dublin: Health Services Executive–Alcohol Implementation Group; 2007
Martin J, Barry J, Goggin D, Morgan K, Ward M, O’Suilleabhain T (2010) Alcohol–Attributable Mortality in Ireland. Alcohol Alcohol. 45(4):379–386
Reynolds S, Fanagan S, Bellerose D, Long J (2008) Trends in treated problem drug use in Ireland, 2001 to 2006. Dublin: Health Research Board
National Advisory Committee on Drugs and Public Health Information and Research Branch. Drug use in Ireland and Northern Ireland: 2006/2007. Drug prevalence survey: regional drugs task force (Ireland) and health and social services board (Northern Ireland) Results–bulletin 2. June 2008
Office of Tobacco Control Ireland: Current trends in cigarette smoking. [www.otc.ie/research.asp#section1]
National Institute on Drug Abuse (1999) Principles of drug addiction treatment: a research-based guide. Rockville, Md: NIDA/National Institutes of Health (NIH Publication No.99-4180)
Babor T F, Higgins-Biddle J C (2001) Brief intervention for hazardous and harmful drinking. A manual for use in primary care. Geneva, Switzerland: Department of Mental Health and Substance Dependence, World Health Organisation
Kahan M, Wilson L, Becker L (1995) Effectiveness of physician–based interventions with problem drinkers: a review. CMAJ. 152(6):851–859
Wallace P, Cutler S, Haines A (1988) A randomised control trial of GP intervention in patients with excessive alcohol consumption. BMJ 297(6649):663–668
Richmond RL, Anderson P (1994) Research in general practice for smokers and excessive drinkers in Australia and the UK. II. Representativeness of the results. Addiction 89(1):41–47
Miller NS, Sheppard LM, Colenda CC, Magen J (2001) Why physicians are unprepared to treat patients who have alcohol- and drug-related disorders. Acad Med 76(5):410–418
Deehan A, Taylor C, Strang J (1997) The general practitioner, the drug misuser, and the alcohol misuser: major differences in general practitioner activity, therapeutic commitment and ‘shared care’ proposals. Br J Gen Pract 47(424):705–709
Mcavoy BR, Kaner EF, Lock CA, Heather N, Gilvarry E (1999) Our healthier nation: are general practitioners willing and able to deliver? A survey of attitudes to and involvement in health promotion and lifestyle counselling. Br J Gen Pract 49(440):187–190
Crome IB (1999) The trouble with training: substance misuse education in British medical schools revisited. What are the issues? Drugs Edu Prev Policy 6(1):111–123
Health Policy and Economic Research Unit. Medical students’ welfare survey (2006). Junior BMA
Coggan PG, Davis AC, Hadac R (1984) Alcoholism curriculum development: an examination of the process. J Fam Pract 19(4):527–532
Hannon, F Medical education in alcohol and alcohol problems: A European perspective. country profile-Ireland. Eurocare.n.d St Ives
Anderson P (1993) Effectiveness of general practice interventions for patients with harmful alcohol consumption. Br J Gen Pract 43(374):386–389
Reid ALA, Webb GR, Hennrikus D, Fahey PP, Sanson-Fisher RW (1986) Detection of patients with high alcohol intake by general practitioners. BMJ 293(6549):735–737
Paille F Medical education in alcohol and alcohol problems: a European perspective. country profile: France. Eurocare.n.d St Ives
Buisman W Medical education in alcohol and alcohol problems: a European perspective. country profile: The Netherlands. Eurocare.n.d St Ives
Larsson S Medical education in alcohol and alcohol problems: a European perspective. country profile: Scandinavia. Eurocare.n.d St Ives
Glass IB (1989) Undergraduate training in substance abuse in the United Kingdom. Br J Addict 84(2):197–202
Lewis DC (1990) Medical education for alcohol and other drug abuse in the United States. CMAJ 143(10):1091–1096
Mcavoy B (2000) Alcohol education for general practitioners in the United Kingdom–a window of opportunity? Alcohol Alcohol 35(3):225–229
Office of National Drug Control Policy: Leadership conference on medical education in substance abuse. 2003 [www.ncjrs.gov/ondcppubs/publications/pdf/medical_educ_2004.pdf]
Association for Medical Education and Research in Substance Abuse: Project MAINSTREAM. Strategic plan for interdisciplinary faculty development: arming the health professional workforce for a new approach to substance use disorders. 2002 [www.projectmainstream.net/projectmainstream.asp?cid=1134]
Gopalan R, Santora P, Stokes EJ, Moore RD, Levine DM (1992) Evaluation of a model curriculum on substance abuse at the Johns Hopkins University School of Medicine. Acad Med 67(4):260–266
Roche AM (1992) Drug and alcohol medical education: evaluation of a national programme. Br J Addict 87(7):1041–1048
Sanson-Fisher RW, Redman S, Walsh R, Mitchell K, Reid ALA, Perkins JJ (1991) Training medical practitioners in information transfer skills: the new challenge. J Med Educ 25(4):322–333
Glass IB (1988) Substance abuse and professional education: a tops-down or bottoms-up approach? Br J Addict 83(9):999–1001
Hanlon MJ (1985) A review of the recent literature relating to the training of medical students in alcoholism. J Med Educ 60(8):618–626
Geller G, Levine DM, Mamon JA, Moore RD, Bone LR, Stokes EJ (1989) Knowledge, attitudes, and reported practices of medical students and house staff regarding the diagnosis and treatment of alcoholism. JAMA 261(21):3115–3120
El-Guebaly N, Toews J, Lockyer J, Armstrong S, Hodgins D (2000) Medical education in substance-related disorders: components and outcome. Addiction 95(6):949–957
Christison GW, Haviland MG (2003) Requiring a one-week addiction treatment experience in a six-week psychiatry clerkship: effects on attitudes toward substance abusing patients. Teach Learn Med 15(2):93–97
Larsson S: Medical education in alcohol and alcohol problems: a European perspective. pp31–32 Eurocare.n.d St Ives
Kothari D, Gourevitch M, Lee J, et al (2011) Undergraduate medical education in substance abuse: A review of the quality of the literature. Acam Med 86(1):98–112
Roche AM, Stubbs JM, Sanson–Fisher RW, Saunders JBA (1997) controlled trial of educational strategies to teach medical students brief intervention skills for alcohol problems. Prev Med 26(1):78–85
Crome IB, Shaikh N (2004) Undergraduate medical school education in substance misuse in Britain iii: can medical students drive change? Drugs Edu Prev Policy. 11(6):483–503
Ritson EB (1990) Teaching medical students about alcohol. BMJ 301(6744):134–135
International Centre for Drug Policy. Substance Misuse in the Undergraduate Medical Curriculum. St George’s University, London. 2007
Anderson P, Kaner E, Wutzke S et al (2004) Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study. Alcohol Alcohol 39(4):351–356
Kaner EFS, Heather N, Mcavoy BR, Lock CA (1999) Intervention for excessive alcohol consumption in primary health care: attitudes and practices of English general practitioners. Alcohol Alcohol. 34(4):559–566(8)
Pokorny AD, Solomon JA (1983) Follow-up survey of drug abuse and alcoholism teaching in medical schools. J Med Educ 58(4):316–321
Shaw S, Cartwright A, Spratley T, Harwin J (1978) Responding to drinking problems. Croom Helm, London
Acknowledgments
The work described in this paper was conducted as part of the Summer Students Research Awards Programme at the UCD School of Medicine and Medical Science.
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O’Brien, S., Cullen, W. Undergraduate medical education in substance use in Ireland: a review of the literature and discussion paper. Ir J Med Sci 180, 787–792 (2011). https://doi.org/10.1007/s11845-011-0736-y
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DOI: https://doi.org/10.1007/s11845-011-0736-y