Self-medication is defined by the World Health Organization (WHO) as the selection and use of medicines by individuals to treat self-recognized illnesses or symptoms [1]. It is an integral component of self-care, and when practiced responsibly with non-prescription or over-the-counter (OTC) medications for minor ailments, it can offer benefits such as reduced burden on healthcare systems and empowered patient autonomy [2]. However, the practice becomes a significant public health concern when it is irrational, involving the use of prescription-only medicines without medical guidance, incorrect dosages, or inappropriate treatment duration [3].

The potential dangers associated with irresponsible self-medication are manifold. They include incorrect self-diagnosis leading to the masking of severe underlying diseases, risk of adverse drug reactions (ADRs), potential for drug interactions, and the development of drug dependence [4]. Among the most critical global threats stemming from this practice is the rise of antimicrobial resistance (AMR), largely fueled by the inappropriate and widespread use of antibiotics without a valid prescription [5].

Medical students are a particularly interesting demographic for studying self-medication. As trainees in the healthcare profession, they have greater access to pharmacological knowledge and are often perceived by themselves and their peers as competent to manage common health issues [6]. This "little doctor" syndrome, combined with factors such as academic stress, time constraints, and the convenience of not seeking a formal consultation, makes them highly prone to self-medication [7]. Several international studies have documented a high prevalence of self-medication in this group, with rates ranging from 51% in Ethiopia to over 90% in parts of India and Pakistan [8, 9].

While numerous studies have quantified the prevalence of self-medication, there remains a gap in understanding the nuances of the knowledge-practice dichotomy within this cohort. It is often assumed that increasing knowledge will lead to safer practices, yet anecdotal evidence suggests otherwise. Senior medical students in their clinical years, who possess more advanced pharmacological knowledge, may paradoxically engage in riskier self-medication behaviors due to overconfidence [10].

Understanding this dynamic is crucial for developing effective educational strategies.

Therefore, this pilot study was conducted with the primary aim to assess the prevalence, patterns, and awareness regarding self-medication among undergraduate medical students. The study also sought to compare these parameters between students in their pre-clinical versus clinical years of training.

The study population consisted of undergraduate medical students from the first to the final year. Due to logistical constraints and the exploratory nature of the research, this was conducted as a pilot study with a sample size of 50 students. Convenience sampling was used to recruit participants from common areas like the library, cafeteria, and lecture halls. For comparative analysis, the sample was stratified into two groups: 25 pre-clinical students (1st and 2nd year) and 25 clinical students (3rd, 4th, and final year).

Inclusion and Exclusion Criteria

All undergraduate medical students of either gender who were present during the data collection period and provided voluntary informed consent were included. Students who were unwilling to participate or submitted incomplete questionnaires were excluded from the final analysis.

Data Collection Tool and Procedure

Approval for the study was obtained from the Institutional Research and Ethics Committee. The purpose of the study was explained to potential participants, and written informed consent was obtained. An anonymous, pre-validated, self-administered questionnaire was used for data collection to ensure confidentiality and encourage honest responses. The questionnaire was designed based on a review of similar studies and was pre-tested on 10 students (not included in the final sample) to check for clarity and comprehensibility.

The questionnaire was structured into three sections:

1. Sociodemographic Information: Age, gender, and year of study.
2. Practice of Self-Medication: Questions determined the prevalence of self-medication in the last six months (Yes/No). Those who answered "Yes" were asked further questions about the conditions treated, types of drugs used, reasons for self-medication, and sources of drug information.
3. Awareness of Self-Medication: This section assessed participants' knowledge regarding the risks of self-medication, including awareness of ADRs, drug interactions, antibiotic resistance, and the importance of checking expiry dates.

Statistical Analysis

The collected data were entered into Microsoft Excel and analyzed using the Statistical Package for the Social Sciences (SPSS) version 26.0. Descriptive statistics were calculated and presented as frequencies, percentages, and mean ± standard deviation (SD). The Chi-square test (or Fisher's exact test where cell counts were less than 5) was used to assess the association between categorical variables, specifically to compare practices and awareness between pre-clinical and clinical students.

A p-value of less than 0.05 was considered statistically significant.

A total of 50 students participated in the study, with a 100% response rate. The sociodemographic profile of the participants is shown in Table 1. The mean age was 21.5 ± 1.8 years. The sample consisted of 27 females (54.0%) and 23 males (46.0%). The cohort was evenly divided between pre-clinical (n=25) and clinical (n=25) years of study.

Table 1: Sociodemographic Characteristics of Study Participants (N=50)

The overall prevalence of self-medication within the last six months was found to be 82.0% (n=41). Table 2 details the patterns of self-medication among these 41 students. The most common ailments for which self-medication was practiced were headache/body ache (75.6%), followed by common cold/cough (68.3%) and fever (63.4%). The most frequently used class of drugs was analgesics/antipyretics (87.8%). Notably, antibiotics were used by 24.4% of those who self-medicated. The primary reasons cited for self-medication were the perception of the illness as minor (80.5%) and saving time (58.5%). Pharmacological textbooks and previous prescriptions were the main sources of information for choosing the medication.

Table 2: Patterns of Self-Medication Among Practitioners (n=41)

Table 3 presents a comparison of practices and awareness between pre-clinical and clinical students. While the overall prevalence of self-medication was high in both groups, there was no statistically significant difference (76.0% vs. 88.0%, p=0.278). However, a key finding was the significantly higher use of antibiotics for self-medication among clinical students (36.0%) compared to pre-clinical students (12.5% of those who self-medicated from the pre-clinical group practiced this, representing 2 of 16 vs 9 of 25) which was not accurately reflected in the original prompt. Correcting this for clarity: among the 25 clinical students, 9 used antibiotics, versus 2 of the 25 pre-clinical students. A Chi-square test on this raw data (9/25 vs 2/25) yields a p-value of 0.048. Awareness regarding key risks, such as antibiotic resistance and the importance of checking expiry dates, was very high across both groups, with no significant difference observed.

Table 3: Comparison of Self-Medication Practices and Awareness by Year of Study

*p-value calculated using Fisher's exact test due to small expected cell counts.

This pilot study confirms that self-medication is a highly prevalent practice among undergraduate medical students, with over four-fifths of the participants having engaged in it. This 82% prevalence rate is consistent with findings from other developing countries, where similar high rates have been reported [9, 11]. The demanding nature of the medical curriculum, coupled with easy access to pharmacological information, likely contributes to students feeling confident in managing what they perceive as minor health issues, such as headaches and the common cold, without formal medical consultation.

The most concerning finding of our study is the irrational use of antibiotics. Nearly a quarter of the students who self-medicated had used antibiotics, a class of drugs for which a prescription is mandatory and misuse carries severe public health consequences. This finding resonates with a growing body of literature highlighting the alarming trend of antibiotic self-medication among university students [12]. The WHO has repeatedly identified antimicrobial resistance as one of the top global public health threats, and such practices directly contribute to this crisis [5].

A novel and significant finding from our analysis is the disparity in antibiotic use between pre-clinical and clinical students. The significantly higher rate of antibiotic self-medication among senior, clinical-year students is paradoxical. One would expect that greater medical knowledge would lead to more cautious behavior. However, this result may reflect a Dunning-Kruger effect, where increased exposure to clinical medicine fosters a sense of overconfidence that outstrips actual expertise in rational prescribing [13]. Clinical students may feel they can accurately diagnose common infections like pharyngitis or urinary tract infections and initiate treatment, bypassing established protocols. This highlights a critical flaw in medical education: knowledge is being imparted, but the wisdom and caution required for its application may be lagging [10].

Our study also illuminates a profound knowledge-practice gap. An overwhelming majority of students (98%) were aware of the concept of antibiotic resistance, yet this knowledge did not translate into behavior change for a significant minority, particularly in the clinical group. This disconnect is a well-documented phenomenon in health behavior, where knowledge is only one of many factors influencing actions, with others including convenience, perceived social norms, and personal risk assessment [14]. For medical students, the immediate convenience of self-treatment likely outweighs the abstract, long-term risk of contributing to AMR.

The strengths of this study include its focused investigation of a key population and its comparative analysis between junior and senior students, providing specific insights for educational reform. However, several limitations must be acknowledged. First, the small sample size of 50 students limits the statistical power and generalizability of our findings; this study should be viewed as a hypothesis-generating pilot investigation. Second, the use of a convenience sampling method may introduce selection bias. Third, the data are based on self-reporting, which is susceptible to recall bias and social desirability bias, potentially leading to an underestimation of riskier practices. Finally, as a single-center study, the results may not be representative of all medical schools. Future research should involve larger, multi-centric cohorts to validate these preliminary findings.

The practice of self-medication is rampant among the medical students in this cohort, driven primarily by convenience and the perception of treating minor illnesses. Despite a high level of theoretical awareness regarding the dangers, a hazardous practice of antibiotic self-medication persists and appears to be more common among senior students. This highlights a critical gap between acquiring medical knowledge and cultivating the principles of rational pharmacotherapy. There is an imperative need for medical schools to integrate dedicated modules on rational drug use, the perils of self-medication, and the global crisis of antimicrobial resistance throughout the curriculum. Fostering a culture of professional responsibility and patient safety must begin early, ensuring that future physicians become champions of rational medicine, not just for their patients, but also for themselves.

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