Australian Drug and Alcohol Review 1989; 8:43-44

New Moves in Undergraduate Education Ian W. Webster

Department of Community Medicine, University of New South Wales Whatever your view of medicine, alcohol

and drug problems must be important - - j u s t to deal with people suffering from these problems and to overcome them. In the day- to-day context of general practice, the work of orthopaedic surgeons, the control of diabetes, managing mental illness, and so many aspects of medicine, the task of dealing with alcohol and drug problems is important. But there is no evidence of this in status, and the intellec- tual activities of researchers and in medical schools. It is a remarkable incongruity. There is a wide gulf between what we know, and what we do.

On the other side, there are the students, thousands of them, intelligent, bright young people, who start medicine with the aim of doing good. They are socially aware and committed. They can see through much of the hypocrisy in the area of alcohol and drug u s e .

We have not harnessed their expectations, not given them role models, and, certainly not provided them with opportunities in clinical work after graduation, for satisfying experience and work in this field.

Whatever the efforts of the members of this society, and people of like minds in medical schools, little has been achieved.

There is a need for a systematic interven- tion in medical education. What should we look for as a measure for success? Hours in the curriculum? Measured attitudinal change? Evidence of practical skills? Evidence of inter- vention in medical practice? Evidence of the impact of public health? Hopefully, these are what could be achieved and should be realistic objectives in the end.

We can't hope for too much. There is much that is wrong with medicine which cannot be overcome by curriculum change - - this requires structural changes in the organisa- tion of health care. Many people want to blame the educators for society's ills. Hardly a commission of inquiry or report in health does not point a finger at medical schools.

During 1985, a Steering Committee of the Alcohol and Drug Foundation of Australia (ADFA) assessed medical education about drugs and alcohol, and the interest of medical schools, in teaching this area. We found that not a great deal was taking place directly, and, there was interest in improving the situation. It was clear too, that new efforts were being mounted, and, that with the wider teaching base in faculties in medicine, there was a lot to build upon.

We turned to other countries for guidance, and found that in the 1970's, increasing concern about drug and alcohol abuse in the United States led to a federally funded programme - - the Career Teaching Programme in Alcohol and Drug Abuse. The career teachers acted as co-ordinators with the aim of using more constructively the teaching time available in medical schools. The career teachers achieved increased hours of teaching, increased exposure to treatment programmes, and developed a substantial amount of curriculum material and resources. An analysis 5 years after the programme started showed there was a significantly higher input in medical schools with a career teacher, but, there had been some improve- ment in schools without a career teacher.

As a result of this inquiry, and the interest in medical schools, it was put to the Federal Government that a co-ordinator of drug and alcohol studies be appointed to each medical school. The guidelines proposed were that the person should be a senior tenured academic person, who would be freed from usual academic duties for half their time, to undertake initiatives in drug and alcohol education.

The co-ordinator would review the content of the course, consult with staff members and curriculum committees, and ensure that drug and alcohol topics are included in undergrad- uate examinations. Further, we felt that such a position would be ineffective unless there were funds for research and evaluation, and secretarial and administrative support.

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ADFA also proposed that there should be an annual five day work shop to support the co-ordinators and to provide them with a network of information and resource. It was recognised that such a project would require monitoring at a federal level.

In August 1986 an ADFA delegation met with Australasian Medical Deans who supported the proposal in principle. In November 1986 the Ministerial Council on Drug Strategy endorsed the recommendation of a federal task force on education and training to establish this programme.

Since then, the Federal Minister for Educa- tion has allocated funds to appoint a half-time senior lecturer in medical schools (to co- ordinate the initiative) with some administra- tive and evaluative support. Rather than

funding for five years as was requested, the project was funded for three years. This level of funding was less than had been hoped for and some medical schools are looking for ways to gather additional resources. At this time, some medical schools have appointed a co-ordinator of drug and alcohol education, and, a national committee has been appointed, chaired by Professor Geffen, Dean of the Faculty of Medicine, Flinders Univer- sity, to oversee the development of the project. ADFA is seeking to organise workshops to follow-up and support the drug and alcohol educators.

Correspondence and requests for reprints to: Professor L W. Webster, Dept of Community Medicine, The University of N.S.W., PO Box 1, Kensington, NSW 2033.