Alcohol consumption and alcohol counselling behaviour among US medical students: cohort study

Frank and colleagues found a third (1668/4847) of American medical
students surveyed drank excessively, and this proportion changed little
over time(1). We conducted a cross sectional confidential questionnaire to
assess British medical students’ knowledge of the UK Government
recommended weekly drinking allowance (21 units for males and 14 units
for females) and to investigate how much these students were drinking each
week. We also explored the potential impact this might have on their
behaviour.

In December 2007 one hundred questionnaires were distributed to
consecutive second year medical students attending a lecture at St
George’s, University of London. The response rate was 87% (87/100). The
mean age of participants was 21 (range of 19-39 years) and 39% (34/87)
were male. Of the students who responded, 43% (37/87) did not drink
alcohol at all and 90% were aware of the Department of Health recommended
alcohol limits. However half (14/28) of the women and 45% (10/22) of the
men who had drunk alcohol in the previous week had exceeded these with 21%
of females and 23% of males drinking over twice the amount recommended by
the government. Similarly around half (42/87) had experienced memory loss
associated with the high levels of alcohol they had consumed and this was
significantly commoner in those who had engaged in regrettable sexual
activity (18/20) than those who hadn’t (24/ 65 p < 0.0001). A quarter
of male students had taken part in organised drinking competitions.

In line with the study by Frank et al(1), nearly a third (24/87) of
these medical students said they drank in excess of the recommended
guidelines.
As outlined in the 2007 publication ‘Medical Students: Professional
behaviour and Fitness to practice’, the General Medical Council now bases
students’ fitness to practice on their behaviour and not their health. It
is clear that as medical students and future doctors we have an example to
set and can expect our social behaviour to be far more scrutinised,
something we should consider the next time we head for the bar. (2)
As Aaron White said in his study of 2005,(3)

“If recreational drugs were tools then alcohol would be a
sledgehammer.”

1. Frank E, Elon L, Naimi T, Brewer R. Alcohol consumption and
alcohol counselling behaviour among US medical students: cohort study.
BMJ. 2008;337(a2155).

2. General Medical Council, Medical Schools Council. Medical
Students; professional behaviour and fitness to practice. In: Education,
editor. London, Manchester: Plain English Approved by the word centre;
2007.

3. White AM. What happened? Alcohol, Memory Blackouts and the Brain.
Alcohol Research and Health. 2003;27(2):186-96.

Michael John
3rd Year Medical Student,

Pippa Oakeshott
Reader in General Practice

St George’s, University of London

Correspondence to: Michael John <m0500393@sgul.ac.uk>

Competing interests:
None declared

Frank et al. provide a lucid and stimulation discussion of many
factors that influence alcohol interventions by US medical students.
However, we feel they do not go far enough. At St George's, University of
London, each medical (and other health care) student receives four
sessions about their own behaviour and health during the first semester.
The mixture of didactic and small group teaching includes peer learning
with the student union, an introduction to the counselling services and
orientation to the principles of disciplinary and fitness to study
procedures, all of which are examinable. There is discussion about
contentious issues such as "You need alcohol to make a social occasion
pleasurable" and all students learn the basics about illicit drugs and
their effects. Teachers come from a variety of medical disciplines and
other professions as it is very important for the topic to be seen by
colleagues and students alike as being of universal interest.

Once the courses diverge, only the medical students receive a further
six hours mixed teaching on their behaviour and health at the beginning of
their final year, covering additional learning objectives such as the role
of the General Medical Council in relation to their health and practice.
These issues are covered in their final written examination. All this
occurs in addition to substance misuse teaching in various modules of the
course (eg gastroenterology, psychiatry and general practice).

Our experience of this approach for more ten years is that
examination and normalisation of students' own attitudes and behaviours
towards substance misuse, both individually and in groups, are
prerequisite to their optimal subsequent treatment of patients' misuse of
alcohol and drugs.

Competing interests:
None declared