Drugs ignorance helps nobody
25 January 2013
The BMA has just launched a major initiative to open a debate about the future of UK drug policy. One priority highlighted is the need to improve medical schools’ patchy and uncoordinated education about drugs
Drugs are often considered commonplace in student life.
From cheap drinks deals in bars to illegal, recreational highs and the use of so-called ‘study aids’, university life can result in exposure to many and varied forms of drug use.
But unlike students from many other disciplines, those training to become doctors will also see the fallout from drug misuse in their professional lives.
With more than a third of adults having tried drugs at some point in their lives, it is inevitable that medical students will come across patients who use drugs.
Core GMC guidance set out in Tomorrow’s Doctors maintains that medical school graduates need to be able to ‘identify appropriate strategies for managing patients with dependence issues and other demonstrations of self-harm’.
But with each medical school developing their own curriculum, surveys have indicated that education for medical students on drug misuse is patchy and uncoordinated.
A new BMA report, Drugs of Dependence: The Role of Medical Professionals, calls for medical schools to be lobbied to improve education in this area.
It criticises the ‘very limited’ training in issues of drug use and dependence at undergraduate level, and maintains it is vital for medical students to have the core skills and knowledge to identify and understand the complexities of drug use.
The BMA board of science report says: ‘Although medical schools currently include some teaching and learning about drug use, this topic is often taught within psychiatry or public health, with the result that drug use is often seen by students as a specialised or peripheral subject, rather than the common pervasive problem that it is in reality.
‘It is essential that medical schools and medical students are encouraged to place a greater emphasis on the care of those who use drugs.’
The report points out that many patients who use illegal drugs are marginalised in society, offering an added level of complexity. They present with complex medical and social issues, they might have been in prison, and they may require a high level of care and attention even if their complaints do not relate to their drug use.’
The authors warn: ‘These patients are likely to be difficult to treat, as a result of feeling they have little to lose.
‘It is essential that they are offered treatment in a non-judgemental way that includes aspects to support their social reintegration.’
The BMA medical students committee believes that the stigma of alcohol and drug dependence should begin to be addressed at medical school.
MSC joint deputy chair Melody Redman says: ‘The MSC has long supported including the study of substance misuse in medical school curricula.
‘We would welcome a renewed drive to ensure that all students acquire a better understanding, not only of the diagnosis and treatment of drug users and their dependency problems, but also of the complex effects of drug misuse on a patient's medical condition.’
The MSC has specific policy calling for improvements in the teaching of drug misuse, and became involved in a national project that was set up in England several years ago by the Department of Health. The project is due to publish its final report shortly.
The project led to the 2007 guidance Substance Misuse in the Undergraduate Medical Curriculum, which offers a consensus on the integration of alcohol, drugs and tobacco training in medical undergraduate curricula.
This says students should:
- Be able to recognise, assess and understand the management of substance misuse and linked health and social problems and contribute to preventing addiction
- Be aware of the effects of substance misuse on their behaviour, health, professional practice and conduct
- Receive education and training that challenge the stigma and discrimination often experienced by people with addiction problems.
Testing and development
A toolkit developed at the same time covered core aims and learning outcomes in curricula for undergraduates and good practice on delivery.
Testing this became a key part of the next phase, carried out between 2008 and 2011, and on which the DH is set to report. Curriculum coordinators at medical schools worked with local academic champions to identify the suitability of the current substance misuse teaching and recommend changes in line with the 2007 guidance.
Improvements so far have included the development of problem-based learning, a medical school setting up an alcohol awareness week, and other schools developing role play in substance misuse or inviting drug-dependent individuals to speak to students.
BMA medical academic staff committee co-chair Peter Dangerfield welcomes the positive outcomes and the work of the group.
‘They highlight the increasing importance of all trainees and students to the problems of drug dependency and how to approach management of the addict,’ he says.
Global health challenge
The guidance was produced by the ICDP (International Centre for Drug Policy). ICDP national coordinator Christine Goodair says the project has been important in addressing a major global health challenge.
‘This initiative has enhanced the training and education of our student doctors,’ she says, adding it is also necessary to link this to postgraduate training.
‘It is important that people are kept aware of new developments with drugs such as legal highs that are becoming available and people are purchasing through the internet, so that they can be treated effectively,’ she explains.
The chair of the project’s national steering committee is St George’s University of London principal Peter Kopelman. He suggests the achievements are also a tribute to project leader Hamid Ghodse, the director of the ICDP until his death in December.
He says: ‘The substance misuse curriculum was very much Hamid’s idea, and reflects his concerns that a very important aspect of clinical practice is not given sufficient detail and attention at an undergraduate level to prepare medical graduates for the foundation programme.
‘It was Hamid who persuaded the Department of Health to fund the project for English medical schools, and it was Hamid’s commitment and drive that brought the curriculum into fruition. The curriculum is a part of the legacy of Hamid’s lifelong work in addiction that extends through all elements of health professional training.’
The BMA report will add further weight to the push for the doctors of tomorrow to understand this vital clinical area.
East Anglia pioneers fresh approach
The University of East Anglia made several changes to its teaching after implementing the Substance Misuse in the Undergraduate Medical Curriculum project. Modifications to the Norwich medical school course included altering problem-based learning, and mapping learning objectives to national guidance.
First-year learning objectives focus on substance abuse and prescribing potentially addictive medications, and consider the ethical implications of doctors who misuse substances. Final years have direct contact with patients who misuse substances, in placements at specialist drug services.
Caitlin Notley held a fixed-term lecturer post in substance abuse at the medical school during the project. She says: ‘Substance misuse is an extremely important issue for students to cover, as it is likely to impact on all areas of their future practice as doctors.
‘The misuse of tobacco and alcohol are common problems encountered by GPs within daily practice, impacting on all areas of patients’ health.
‘Students need to be prepared to deal with the issues of misuse of these substances, as well as to be aware of more specialist services for referral for those with addiction to class A drugs and other drugs.’