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A longitudinal evaluation of medical student knowledge, skills and attitudes to alcohol and drugs


Gavin Cape, Department of Psychological Medicine, University of Otago, PO Box 913, Dunedin, New Zealand. E-mail:


Aim  To examine the knowledge, skills and attitudes of medical students to alcohol and drugs as training progresses.

Design  A longitudinal, prospective, cohort-based design.

Setting  The four schools of medicine in New Zealand.

Participants  All second-year medical students (first year of pre-clinical medical health sciences) in New Zealand were administered a questionnaire which was repeated in the fourth (first year of significant clinical exposure) and then sixth years (final year). A response rate of 98% in the second year, 75% in the fourth year and 34% in the sixth year, with a total of 637 respondents (47.8% male) and an overall response rate of 68%.

Questionnaire  The questionnaire consisted of 43 questions assessing knowledge and skills—a mixture of true/false and scenario stem-based multiple-choice questions and 25 attitudinal questions scored on a Likert scale. Demographic questions included first language, ethnicity and personal consumption of alcohol and tobacco.

Findings  The competence (knowledge plus skills) correct scores increased from 23.4% at the second year to 53.6% at the fourth year to 71.8% at the sixth year, being better in those students who drank alcohol and whose first language was English (< 0.002). As training progressed the student’s perceptions of their role adequacy regarding the effectiveness of the management of illicit drug users diminished. For example, at second year 21% and at sixth year 51% of students felt least effective in helping patients to reduce illicit drug use. At the sixth year, 15% of sixthyear students regarded the self-prescription of psychoactive drugs as responsible practice.

Conclusion  Education on alcohol and drugs for students remains a crucial but underprovided part of the undergraduate medical curriculum. This research demonstrated that while positive teaching outcomes were apparent, further changes to medical student curricula need to be considered to address specific knowledge deficits and to increase the therapeutic commitment and professional safety of medical students to alcohol and drugs.