'Now please wash your hands': the handwashing behaviour of final MBBS candidates

The Handwashing Liaison Group has pointed out that "The failure of healthcare workers to decontaminate their hands reflects fundamentals of attitudes, beliefs and behaviours". Doctors are known to be poor at handwashing. This poor compliance may have its roots in a failure to learn this behaviour at medical college, where the influence of consultants and other role models may be critical. The handwashing behaviour of modern day medical students has not been previously studied. The Final MBBS Objective Structured Clinical Examination (OSCE) reflects learnt behaviours and attitudes of final year medical students 'absorbed' from role models within their training. We observed the handwashing behaviour of 187 candidates during the 1998 Final MBBS OSCE, at one clinical station, neurological examination of the lower limbs. Only 8.5% of candidates washed their hands after patient contact, although this figure rose to 18.3% with the aid of handwashing signs. These findings suggest that handwashing should become an educational priority. As student learning is highly focused by assessment (in-course or examination), we sug-gest that compliance with handwashing be built into undergraduate and Teaching Quality assessments with, for example, 'Hygiene marks' incorporated into OSCE or observed long case checklists. This study re-emphasizes the need for good clinical practice whenever teaching medical students.