Can British medical students pass their final examinations without washing their hands?

Editor - As the hand washing liaison group points out, most doctors do not wash their hands often enough.¹ We decided to investigate how easy it is for British medical students to pass their final examinations without washing their hands. In late August 1999, one of us (MT) telephoned the teaching hospital most closely associated with each of the 24 British medical schools and questioned, in turn, the duty preregistration house physician and house surgeon.

MT asked when and where each doctor had qualified and then asked: "Did you wash your hands in between examining most patients in the short case section of your final?" We wrote to the deans of the 24 British medical schools and asked which of the following two statements best described the position of their medical school in relation to hand washing in the short case section of the final examination: "The students are expected to wash their hands between each patient." Or: "This is left to the discretion of individual examiners."

We interviewed 45 of the 48 doctors in our sample. There was at least one respondent from 22 of the 24 British medical schools. All but one doctor had qualified in 1999. Only three of the 45 respondents reported that they washed their hands between examining "most patients" during the short case section in their final examinations.

Fifteen of 24 deans responded to our questionnaire. Only four of the 15 reported that students were expected to wash their hands after each patient.

It is disturbing that almost all our sample of recent British medical graduates were able to qualify as doctors without washing their hands in between examining "most patients."

These findings, combined with the results of our survey of undergraduate deans, show that few British medical schools have a strict policy about hand washing in final examinations. Our findings are a manifestation of the widespread apathy that many doctors feel about routine hand washing. Our survey is small but included graduates from all but two of the medical schools in the United Kingdom. We did not observe behaviour directly, but we see no reason why those surveyed should have underestimated how often they washed their hands. All but one interview was within three months of the doctor's final examinations. The microbiological risks in examinations are probably low. There are, however, two further reasons for hand washing: as an act of courtesy, and to ensure that it becomes automatic (and is not forgotten when it is microbiologically important). The hand washing liaison group has called for an explicit standard whereby hands should be decontaminated before each patient contact.¹ For this simple standard to have any chance of being adopted, medical schools need to insist that students wash their hands in between examining patients. Surely it should not be possible for medical students to pass their final examinations without doing so.

M Thorpe, locum paediatric registrar

B W Lloyd, paediatric consultant, Royal Free Hampstead NHS Trust, London NW3 2QG
Email: blloyd@rfhsm.ac.uk


studentBMJ 2000;08:45-88 March ISSN 0966-6494

1. Hand Washing Liaison Group. Hand washing. BMJ 1999;318:686.