One in 10 medical students exceeds weekly alcohol consumption guidance, a Student BMJ survey finds
Heavier drinking is more prevalent in students’ early years at university, but a quarter of respondents claim to be teetotal during an average week
An online survey sent to UK based Student BMJ subscribers, which asked questions about health and lifestyle habits, shows that only one in 10 respondents (85 people) drink more alcohol than the recommended maximum intake of 14 units a week (table 1).
|No of alcohol units consumed on average per week||No of responses (total 832)||Percentage|
Of the 823 respondents, 23.8% (196 respondents) reported drinking, on average, no units of alcohol each week.
The responses received represent around 2% of the UK medical student population. Although self reported surveys are subject to bias because they rely on people accurately remembering and reporting consumption, the results mirror trends among the wider millennial population.
This year, the Office for National Statistics reported that just under 21% of 16-24 year olds drink no alcohol, a percentage that has been rising steadily over the past 10 years.
The proportion of young adults who are teetotal rose by over 40% between 2005 (when the lifestyle surveys began) and 2013.
Commenting on the Student BMJ findings, Dominique Thompson, director of the Students’ Health Service at the University of Bristol, says, “The news that medical students are caring better for themselves is very welcome. Their rates of alcohol use reflect those of the general student population, with more students choosing to become teetotal.”
Most respondents who drank any alcohol consumed less than 10 units per week (57.8%). However, in addition to the 10% who drank more than 14 units, 3.8% (31 respondents) reported drinking 13-14 units on average each week.
The British Medical Association medical students committee welfare lead Twishaa Sheth adds, “Medical students tend to have a ‘work hard, party hard’ stereotype and it is important when studying for any degree to take time out to switch off and socialise.”
“However, it is refreshing and reassuring to see that the majority of respondents are looking after themselves. Hopefully, this shows that wellbeing and welfare are coming to the forefront of students’ minds more and more, which is a step in the right direction.”
The UK’s chief medical officers recommend that adults should not drink more than 14 units of alcohol a week on a regular basis—equivalent to six 175 ml glasses of wine (13% alcohol) or six pints of lager (4% alcohol).
Previous research has shown a link between alcohol abuse and mental health issues among medical students. A study of 12 500 American medical students in the journal Academic Medicine found that those who were depressed or burnt out were more likely to resort to alcohol dependence or abuse. However, it is unclear whether students who already had underlying mental health issues were more likely to drink excessively or whether alcohol misuse caused mental ill health.
In the UK, a small study of 356 medical students at the universities of St Andrew’s and Manchester showed that alcohol intake and binge drinking among students was higher in the first year than in the second year of study.
A third year Manchester student who responded to the Student BMJ survey and leads a healthy lifestyle including consuming little alcohol, agrees that he and his fellow students have tended to “party” less as they have progressed through medical school.
“This may well tie into the fact that the workload increases through the years and free time decreases,” he says.
He adds that every academic year seems to be busier than the last, and that he and his peers wish they had enjoyed themselves more in the earlier years.
The survey results reflect this, with the first and second years of study accounting for 55% (45) of respondents who claimed to drink over 14 units of alcohol per week. Final year students—in years five and six of medical school—only accounted for 15% (12) of all respondents who drank more than the recommended limit.
For some students, their current healthy lifestyles follow earlier substance misuse, including alcohol abuse. One London student describes how he developed an alcohol problem in his second year following a period of depression that began in his first year.
The student, who wants to remain anonymous, says that two of his non-medic flatmates were also struggling personally and academically at the time, and the trio “took to partying as a way to cope.”
“In my second year, I was drinking seven nights a week and by the summer I was drinking in the morning with my cereal,” he says.
He notes that the stresses of the pre-clinical years of his course were far greater than those in the clinical component, which he is now completing.
“I was using alcohol as a way to have fun and to forget about work, mainly because work was incredibly stressful and hard,” he adds.
He says that now the intensity of his course is more manageable and his work as a doctor feels more relevant he is coping better and not drinking excessively.
“Part of it is also maturity and figuring out how I work well, and how best to study and manage my time,” he says.
The Student BMJ survey also found that just 7% of respondents (58 students) had taken a psychoactive substance, such as mephedrone, during their time at medical school. A fifth (170 respondents) had taken other illegal drugs. A total of 642 respondents (79.1%) had not taken illegal drugs while at medical school.
This is similar to statistics for the general population, which show 18% of 16-24 year olds taking illegal drugs between 2015 and 2016.
Box 1: Definition and risk of unprofessional behaviour
The General Medical Council’s guidance for students, Achieving good medical practice, says that “a medical student’s behaviour must justify the trust that patients and the public have in them.”
Repeated drug taking and excessive drinking can lead to concerns being raised by your medical school about your fitness to practise medicine, which could delay or prevent you from graduating. Examples of unprofessional behaviour that would be a cause for concern include:
- Driving under the influence of alcohol or drugs
- Misusing prescription drugs
- Alcohol consumption that affects clinical work or the work environment
- Dealing, possessing, supplying, or misusing drugs (which may include legal highs), even if there are no legal proceedings
- A pattern of excessive misuse of alcohol
One student says that she was using cannabis and alcohol—drinking midweek and bingeing at weekends—to cope with the stress of supporting a fellow student with mental health problems. She was not sleeping well and fell behind with her studies.
“I did not seek help at the time. I ended up failing my January exams and became increasingly worried that I would fail the year and be kicked out of medical school. I did not realise I was struggling with anxiety, until someone suggested that I seek pastoral support,” she says.
The student was prescribed drugs for anxiety by her GP, but says that the most valuable advice she received was about mindfulness when her pastoral support tutor loaned her a book on the subject. She now does not use cannabis and only drinks if she goes out at weekends.
For some students, however, making good lifestyle choices are a direct response to learning about and seeing unhealthy lives.
One student says, “Being a medical student on placement, you can see the ‘bad’ lifestyle choices that patients have made and the consequences later down the line. So, subconsciously, this may have affected my choices.”
Box 2: Support for students
The Student BMJ survey highlights mixed opinions about the pastoral support available for medical students in difficulty. Although some respondents said that their medical school only “pays lip service” to supporting student wellbeing, others say that counselling support services or their personal tutor are “brilliant.”
Clare Owen, the policy adviser responsible for fitness to practise guidance at the Medical Schools Council (MSC) says, “Personal tutors and others who have the responsibility of pastoral support should be trained for this role and must not be in a position to make decisions on students’ academic progression.” The General Medical Council recommends that different tutors should be responsible for pastoral support and academic progression.
Owen adds that medical schools should encourage students to come forward if they have a mental health condition and encourage a culture of wellbeing within their schools.
“Medicine is by its nature a degree with a high workload and comes with significant responsibility, so medical students deserve the support that will help them fulfil their talents as doctors,” says Owen.
The GMC’s annual returns for 2014 asked medical schools what they were doing to introduce its mental health guidance, which includes signposting students to support and separating out personal tutor and academic tutor roles. In its summary of the returns, the regulator reported that most schools had introduced wellbeing systems and were either signposting students to support, or providing tailored learning sessions about coping with the intensity of studies.
In some cases, medical students are also providing support networks for their peers through medical societies or other groups.
The University of Birmingham medical school delivers “Over and Above” awards—good citizen awards to encourage students to be “all rounders”—not just academic achievers.
There are also “tea and empathy” pages on Facebook for students and the Our Mental Health Matters website (www.our-mental-health-matters.weebly.com), where students can share their experiences and support each other.
Another useful resource is the MSC and GMC guidance Supporting medical students with mental health conditions (2015): www.gmc-uk.org/Supporting_students_with_mental_health_conditions_0816.pdf_53047904.pdf.
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
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