Country Profile - Switzerland

Medical education in alcohol problems: a "patient based teaching" experience in Lausanne, Switzerland

Switzerland is a confederation of 26 cantons. It has 5 medical schools within universities. The medical education is under the authority of the Federatio Medicorum Helveticorum (FMH) which gives certifications for specialists. At the moment there is no provision in medical schools for undergraduate education in alcohol related problems. Postgraduate education is determined by the different specialties, but no mention of alcohol training is included in the disciplines. Usually, addiction training is accredited for one year of postgraduate residency but it is optional. A new law makes continuous education mandatory, creating an opportunity for training in the addiction field, for instance in alcohol related problems for general practitioners.

In 1992 a multi-disciplinary alcohol unit was set up at the General Hospital, Lausanne. The work of this unit includes the referral of alcoholic patients as well as the supervision of medical care and social work co-ordination within the network. Through the opportunities given by hospitalisation and medical investigation, evaluation of in- and outpatients in the presence of the general practitioner and relevant professionals of the network is able to be conducted. Two residents are trained every year in the field of alcohol problems. There is continuous education for all the professionals involved, including the staff of hospital wards and in-town social workers. This experience allows clinical research, for example the prospective study of clinical outcomes of an examined cohort and a pilot study investigating predictive variables of referral or treatment success.

This experience led to the following developments: we created a training module for general practitioners in alcohol related problems as well as a structural concept for implementing and assessing such experiences.

The training module for alcohol problems was based on the analysis of the training needs of general practitioners by focus groups and questionnaires. Analysis of the resources in the alcohol network was conducted as well as definitions of pedagogical objectives. The structure of the modules was evaluated.

New perspectives were afforded by the Lausanne experience, leading to a new Division for substance abuse and a project of inter professional certification in addictions. Guidelines for clinical practice after being edited by the Lausanne alcohol Unit and the Swiss Society of Alcohology.

Dr J. Besson