The Trouble with Training: substance misuse education in British medical schools revisited. What are the issues?

Abstract

My 1987 survey of substance misuse education in British medical schools highlighted inadequacies in the quality of undergraduatesubstance misuse training. The continuing difficulty in engaging generalists in the care of substance misusers suggested it was time to revisit the issue. Deans, Heads of Departmentsof Psychiatry and 13 other specialities in 23 medical schools were surveyed. The response rate from Deans and Heads of Psychiatry was 70%. Psychiatry provided a mean of 6.7 (range 2-14) hours formal training (lectures/seminars),excluding one model department which provided 30 hours and co-ordinated an additional 30 hours of undergraduate substance misuse education. In 10 (45.5%) schools training is very limited, while 10 (45.5%) schools provide average (three) or above average (seven) training hours. Average or above average undergraduate training was found in schools with an academic department of addiction behaviour. These centres were associated with the most comprehensiveservices and the most postgraduate substance misuse training opportunities. These findings may partially explain why most doctors are ill-equipped to deal with substance problems. Since 1987, psychiatry has doubled input, but this is offset by diminished input from other departments. The establishment of academic departments of addiction studies in medical schools would influence decision making within university and services, promote scientific credibility and benefit communities.