The influence of structured education and clinical experience on the attitudes of medical students towards substance misusers

Abstract

Negative attitudes to patients with substance misuse disorders form a well-recognised barrier to the implementation of best practice. The influence of structured education and clinical experience on the attitudes of medical students towards substance misusers was investigated at an Australian university. First-year students were surveyed before and after 3 weeks of drug and alcohol education and in the same year, fourth-year students were surveyed before and after a 9-week block. Males, older students and those with prior clinical experience tended to have more negative attitudes. Attitudes improved significantly after exposure to interactive learning modules which included contact with patients with substance dependence, including individuals in remission. The level of dislike of problem drinkers significantly decreased after teaching. After fourth-year education, students reported a greater sense of responsibility towards providing intervention and less anticipation of discomfort working with these patients. In particular, confidence and attitudes towards heroin users improved near the end of training after contact with illicit drug users in the small group or individual interview setting. By the end of drug and alcohol education, less than half (42%) of students reported they could not imagine working with substance misusers as a career. Findings support the provision of structured drug and alcohol education and supported clinical experience for every medical student if appropriate evidence-based treatment is to be provided. [Silins E, Conigrave KM, Rakvin C, Dobbins T, Curry K. The influence of structured education and clinical experience on the attitudes of medical students towards substance misusers. Drug Alcohol Rev 2007;26:191 -200]

Narrative review of the impact of clinical psychiatry attachments on attitudes to psychiatry

“…55 Indeed, a large American survey found no association between duration of attachment and psychiatry recruitment. 56 The weak evidence of positive attitude change after a child and adolescent psychiatry placement 24,44 and strong evidence for change after addictions psychiatry 46,47,57 highlight the importance of exposing students to subspecialties. This increases awareness of the diversity within psychiatry.…”

“…In studies where attachments consisted of a block of a subspecialty of psychiatry, there was evidence of positive attitude change after attachments in child and adolescent psychiatry (weak evidence) 24,44 and addictions psychiatry (strong evidence). [45][46][47] Oakley & Oyebode 48 examined attitudes to the psychiatry curriculum. Students favoured more integration, with the overall curriculum and teaching focused on scenarios they expected to encounter in their early employment, such as suicide risk assessment.…”

Comparaison des représentations et comportements des médecins généralistes du Canton de Genève et du Poitou-Charentes

“…Les efforts entrepris de manière simultanée par la Faculté de Genève en pré-gradué et le projet MedRotox en post-gradué mené en Suisse romande de 1998 à 2001 semblaient avoir ici une conséquence positive. Certaines études le suggéraient déjà auprès d'étudiants [32]. Il a été souligné que le contact direct entre les étudiants et les usagers amélioraient encore davantage cette situation [33] en modifiant le regard qu'ils avaient des consommateurs.…”

Impact of a medical student alcohol intervention workshop using recovering alcoholics as simulated patients

“…Because a strong correlation has been identified between physicians’ attitudes, confidence, and role legitimacy on reported screening and treatment practices with patients who misuse alcohol and other drugs,32,33 alcohol training programs typically target clinicians’ attitudes, as well as their knowledge and skills. The goal of such training is to dispel any existing biases against these patients and increase clinicians’ commitment to addressing patterns of misuse, as well as their medical or surgical consequences 30,34,35. Numerous programs designed for practicing clinicians indicate that a combination of didactic education and skills training increases clinicians’ confidence in performing alcohol SBI and increases rates of alcohol intervention 34,36–42…”