Drinking, illicit drug use, stress and other lifestyle variables in medical students and doctors

PhD ThesisLifestyles, including alcohol consumption and illicit drug use in medical students were assessed using a self-completion questionnaire. Eight cohorts of secondy ear medical students were assessed consecutively between 1993-2000. The proportion of medical students in each cohort drinking excessively increased during this period. Illicit drug use stayed fairly stable with approximately half of each year group reporting having experimented with illicit drugs. Lifestyles in medical students were assessed in the second and final year of studies and one year after graduation. Alcohol consumption and illicit drug use had significantly increased over the 4 year period of the study. Two cohorts of medical and dental students were also compared in a similar study design. Although alcohol consumption in dental students was more than their medical student counterparts during the second year of the studies, it decreased one year after graduation. Illicit drug use was higher in medics than in dentists at all three time points. Nearly half of the fresher medical students reported to have been drinking excessively and using illicit drugs before beginning university life. Personality characteristics of the students were found to be related to their alcohol and illicit drug use. A significant proportion of pre-registration house officers suffered from stress and anxiety with more women than men having anxiety scores within the clinically significant range. Job satisfaction was low, with more pre-registration house officers being dissatisfied with the organisational processes of their jobs. Personality was significantly related to stress, anxiety, depression and job satisfaction. Education on alcohol and illicit drugs for young people may be needed at a much earlier age. Dealing with the problems of drink, drugs and stress among medical students and doctors may require a holistic approach which considers both the culture of medical education and work conditions.Catherine Cookson Trust: British Medical Association (Joan Dawkins Fellowship)

Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literature

BACKGROUND: Increasing demand on the UK emergency services is creating interest in reviewing the structure and content of ambulance services. Only 10% of emergency calls have been seen to be life-threatening and, thus, paramedics, as many patients’ first contact with the health service, have the potential to use their skills to reduce the demand on Emergency Departments. This systematic literature review aimed to identify evidence of paramedics trained with extra skills and the impact of this on patient care and interrelating services such as General Practices or Emergency Departments. METHODS: International literature from Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and grey literature from 1990 were included. Articles about any prehospital emergency care provider trained with extra skill(s) beyond their baseline competencies and evaluated in practice were included. Specific procedures for certain conditions and the extensively evaluated UK Emergency Care Practitioner role were excluded. RESULTS: 8724 articles were identified, of which 19 met the inclusion criteria. 14 articles considered paramedic patient assessment and management skills, two articles considered paramedic safeguarding skills, two health education and learning sharing and one health information. There is valuable evidence for paramedic assessing and managing patients autonomously to reduce Emergency Department conveyance which is acceptable to patients and carers. Evidence for other paramedic skills is less robust, reflecting a difficulty with rigorous research in prehospital emergency care. CONCLUSIONS: This review identifies many viable extra skills for paramedics but the evidence is not strong enough to guide policy. The findings should be used to guide future research, particularly into paramedic care for elderly people