St Bartholomew's and the Royal London School of Medicine and Dentistry, St Bartholomew's Hospital, London, UK
Received 5 January 2001; in revised form 26 March 2001; accepted 7 May 2001
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ABSTRACT |
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INTRODUCTION |
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A previous survey of 260 students from this medical school found higher rates of unsafe drinking in both men (34%) and women (~32%) (Collier and Beales, 1989). Only 6% of students did not drink any alcohol. The CAGE scores in the same survey confirmed the finding; 36% of men and 29% of women had abnormal scores, indicating significant drinking problems (Collier and Beales, 1989
).
There is evidence that a significant minority of students continue to drink more than is good for their health or safety, after they qualify. For instance, male doctors' death rates from cirrhosis of the liver is 3.4 times the death rate in an average man's occupation, and is only just below the relative death rate for publicans and bar staff (3.8). The General Medical Council (1995) expressed concern that persistent excessive drinking by students may signal a persistent pattern of behaviour, which has consequences not only for the students' health, but also for their professional ability in the future. A recent survey of house officers suggests that this concern is justified, since 56% of men and 57% of women exceeded safe drinking levels (Birch et al., 1998).
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SUBJECTS AND METHODS |
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Measures
We used a structured questionnaire of 20 questions concerning demographic details, consumption of alcohol, and perceived safe levels of drinking, having piloted a previous version. The questionnaire included both the CAGE and AUDIT questionnaires. The CAGE questionnaire consists of four questions with two or more positive answers suggesting a high risk of alcohol dependency or significant drinking problem currently or in the past (Mayfield et al., 1974). The AUDIT questionnaire is composed of 10 questions regarding drinking problems in the last year, with a score of 04 on each question (Isaacson et al., 1994
). A score of at least 8 out of 40 indicates an alcohol-related problem in the last year. It is a more sensitive measure of hazardous drinking than the CAGE (Royal College of Physicians, 2001
).
The project was considered ethically satisfactory by the East London and the City Health Authority research ethics committee.
Analysis
Regarding the current survey, the data were not normally distributed. Therefore comparisons between years and genders were made with a MannWhitney U-test for interval data and a 2-test (with Yates' correction) for categorical data. When comparing the two separate surveys, we were able to measure the difference [with 95% confidence intervals (CI)] in the proportions of students consuming no alcohol, unsafe amounts, and hazardous amounts of alcohol. We also measured the difference (95% CI) in the proportions with elevated CAGE scores.
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RESULTS |
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DISCUSSION |
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When this interpretation is added to the lack of significant differences between the surveys, in both unsafe drinking and CAGE scores, the only logical interpretation is that there has been no significant change in the prevalence of unsafe drinking by the students of this school. The only previous comparable survey also found no substantial difference in either the amount of alcohol drunk or the proportion of medical students drinking unsafely, 10 years later (1984 to 1994) (Ashton and Kamali, 1995), thus suggesting that this may be a national trend.
The prevalence of problem drinking in men seems to be similar to other medical schools (Ghodse and Howse, 1994). However, a larger proportion of female students drank unsafely than general population norms. Alcohol consumption by female students was the same as men's consumption in the second year. The proportion of women drinking unsafely and hazardously in this year was similar to men. This seems a unique finding and Collier and Beales (1989) drew attention to this in the previous survey.
Rather worryingly for patients, about a third of our students overestimated safe levels of drinking. About a quarter thought that the safe limits for drinking were the UK government levels for safe drinking (21/28), rather than the medical profession's advice (14/21). Our students were less accurate than those from the previous survey, where overestimates were given by 21% of students for men and 18% (imputed data) for women (Collier and Beales, 1989). A survey published at the same time showed that 32% of medical students and 30% of doctors did not know the correct safe limits (Myszor et al., 1990
). Sixth-form pupils were significantly better informed about safe limits than doctors; a result which is both reassuring and alarming (Myszor et al., 1990
). Three Royal Colleges have re-affirmed the safe limits of alcohol consumption as being 14/21 units per week (Royal Colleges, 1995
).
In view of the significant morbidity and mortality caused by excessive alcohol consumption, it is a concern that there has been no significant reduction in the prevalence of drinking alcohol by medical students over the last 12 years at this school. It seems likely that this is a general problem for medical students, rather than one specific to this school, although this is the second report of drinking above the norm by female students from this school.
The response rate was not high (55%) in this study which might make it difficult to generalize from these data. Against this, these data were supported by the estimations by participating students of the proportion of their colleagues which they considered as having alcohol problems being similar to the proportions with both abnormal CAGE scores and the proportions reporting negative academic consequences of their drinking. These data suggest that there was little bias by non-response.
What should be done? The General Medical Council (1997) suggested that students involved in substance abuse should be offered help, but that consideration should also be given to their fitness to qualify and thus practise. There is evidence that the general level of drinking in a community influences the prevalence of harmful drinking (Colhoun et al., 1997). It therefore makes sense to set standards of acceptable alcohol consumption in our medical schools. Some medical schools have written and implemented policies to inform and guide students and staff regarding alcohol, along with other health issues (Gray et al., 1998
). Yet, in a recent survey in the UK, only four out of 17 (24%) medical schools had actually written and implemented such policies (Williams, 1999
). All medical schools should develop their own policies and implement them effectively. Policies should include the setting of standards (e.g. not drinking alcohol during the working day), education about alcohol and its effects, confidential help for those in difficulty, and procedures for managing individuals with drinking problems (Gray et al., 1998
; Royal College of Physicians, 2001
).
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FOOTNOTES |
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REFERENCES |
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