Medical Education: The Present Situation in Europe
The Way Forward

Medical Education: The Present Situation in Europe

Though some useful initiatives have taken place, there remains no standardised system of education about substance misuse in general or alcohol problems in particular. In no EU country has there been a co-ordinated national response to alcohol or substance misuse education such as has been adopted in the United States, Canada and Australia. 20

The picture varies from country to country, but there are some important common features. Everywhere medical education on alcohol problems has suffered from the known limitations of the traditional medical curriculum in dealing with health issues which have a major psychosocial component and that require integrative, multidisciplinary learning. 21

The basic picture to emerge, therefore, is that currently medical education on alcohol appears to be inadequate in both quantity and quality. In some countries, during years of medical training, the time devoted to study of alcohol problems amounts to a few hours.

The amount and type of education provided tends to vary from medical school to medical school, depending on the commitments and interests of individual teachers. Only recently in some countries have steps been taken to integrate education about alcohol problems into the core curriculum. Generally, however, it remains optional and with no real requirement to achieve agreed standards.

Hence, across the European Union, it is still possible for people to qualify and practice as doctors without having obtained, or being required to demonstrate, an acceptable level of competence in regard to substance misuse.

The Way Forward

In view of previous neglect, substance abuse and alcohol problems should now be regarded as a priority in medical education and be given a higher profile in the basic curriculum at all levels, under-graduate, post-graduate and continuing medical education.

There is a need to embrace co-ordinated, multi-disciplinary approaches which address lifelong learning. Opportunities to advance this agenda are currently available in many European countries through two interrelated developments: 22

• Health reforms - many countries are strengthening the primary care orientation and input of their health systems. This is commonly associated with an increased emphasis on health promotion, encouraging activities related to the prevention and early detection of alcohol problems. These activities often involve multi-disciplinary team-working.

• Medical education reforms - undergraduate curricula in many countries are becoming more community-oriented and involve greater primary care and general practice input. Postgraduate and continuing medical education are recognising the importance of lifelong learning, practice-based education and multi-disciplinary learning.

There is a clear case for including alcohol in a broader syllabus concerned with substance misuse, especially as alcohol problems are often associated with tobacco, prescribed drugs or illegal drug abuse, especially in younger patients.

Education on alcohol problems is facilitated by the creation of and support for academic departments of Addiction Behaviour, particularly those with a Chair of Addiction. These have been shown to be associated with the most comprehensive alcohol treatment services, the most postgraduate training opportunities and average or above average medical school training. 23

However, while approaches and courses concerned with the addictions and substance abuse in general have much to recommend them, it is suggested that in countries such as Italy it may be unwise to merge alcohol issues completely into a substance abuse framework. This is because of alcohol being seen as an integral part of diet, alcohol consumption thus having a specific cultural meaning very different from that attaching to other forms of substance abuse. 25

There is ample evidence that while it is comparatively easy to devise educational programmes to increase knowledge and instill or change attitudes, it is more difficult to affect actual behaviour. In our view it is therefore essential for evaluation to be an inherent feature of education and training programmes.

In any process of evaluation, it would, of course, be necessary to allow for the fact that doctors' performance is influenced not just by what they know but also, and sometimes crucially, by the amount and quality of role support available to them in their working situation.

Clearly, any initiative to improve medical education on alcohol will to a large extent have to be carried out through and by the various medical specialisms. We believe that the relevant medical authorities should now give serious consideration to establishing or further developing an appropriate system of qualification and accreditation in order to promote uniform standards of competence in this field. In this connexion, international fora such as the International Society of Addiction Medicine could have an important role to play. 26

References:

20 Prof. N. el-Guebaly: Medical educationa and alcohol-related problems in Canada. Paper presented at the Merck-Lipha Consensus Forum on Medical Education, Lisbon November 1998.
21 Kinney et al. Impediments to alcohol education. Journal of Studies on Alcohol. 45 453-459 1984.
22 Pr B. McAvoy Consensus Forum on Medical Education Lisbon 1998. This volume.
23 I.B. Glass - Crome: Alcohol misuse as a challenge to medical education: a belated remedy. British Medical Bulletin (1994) Vol.50 no.1.
24 Broadening the Base of Treatment for Alcohol Problems 1990. Institute of Medicine. Reprinted with permission of National Academy of Sciences. Courtesy of National Academy Press, Washington, DC, USA.
25 F Poldrugo Under- and Postgraduate medical education in alcohol problems. Paper presented at the Merek-Lipha Consensus Forum on Medical Education, Lisbon Novemberv 1998.
26 Prof. N. el-Guebaly: Medical Education and alcohol-related problems in Canada. Paper presented at the Merek-Lipha Consensus Forum on Medical Education, Lisbon Novemberv 1998.