To the Editor: In Australia, the rising cost of the Pharmaceutical Benefits Scheme (a comprehensive system for subsidising prescription medicines for the whole population) has led to the Australian Government instituting a number of cost-saving strategies.

One of these strategies is to encourage the use of generic medicines. However, generic prescribing is a contentious issue among Australian prescribers. The debate has centred on issues related to bioequivalence, quality and safety.1,2 Further, previous studies have shown that changing existing prescribing behaviour is difficult.3,4

To avoid the difficulty of having to change existing prescribing behaviour, education about the benefits of generic prescribing should be aimed at medical students, who are the prescribers of the future.5 To explore and evaluate senior (final-year) medical students’ perceptions of and knowledge about generic medicines and generic prescribing, we undertook a nationwide, web-based survey of senior medical students in Australian universities from 18 June to 18 September 2004. Of 1497 senior medical students in 10 universities throughout Australia, 400 (26.7%) responded to the survey.

The first part of the questionnaire required students to select the correct bioequivalence limits allowed by the Therapeutic Goods Administration when comparing a generic medicine with a brand-name medicine. We compared responses to detect differences according to sex, graduate (students with a Bachelor or higher degree on entry to medical school) versus non-graduate status, and between the 10 universities using Fisher’s exact test. For the first question, six options were given, with the correct answer being 80%–125%. Most respondents (64%) did not answer the question, and only three (0.8%) answered it correctly. Responses to other individual questions in the web survey are shown in the Box. Seventy-one per cent of respondents (287) thought that they needed more information on how bioequivalence tests are conducted. More than 90% of respondents did not believe that generic medicines registered in Australia are equal in terms of quality and efficacy to their brand-name counterparts. A similar proportion of respondents thought that generic medicines would cause more side effects than brand-name medicines. Eighty-seven per cent highlighted pharmacists as one of the most important health care professionals to advise them on generic medicines. Almost 92% of respondents agreed that their future prescribing habits would be likely to be influenced by their senior colleagues and medical consultants. More than 60% believed that their respective university did not adequately cover the topic of cost-effective prescribing in their medical curriculum.

Our survey clearly shows that medical students in Australia need to be better taught about issues relating to generic medicines and generic prescribing. Modifying existing curricula to include education about generic medicines will be a critical strategy towards promoting rational use of generic medicines by medical practitioners.