33 states and the District of Columbia currently allow medical marijuana (MMJ). But it’s a confusing landscape: The qualifying conditions for MMJ prescriptions vary by state (there’s no recognition for medicinal weed at the federal level), and researchers continue to explore new applications, include relief for chronic pain and treatment for post-traumatic stress disorder. Meanwhile, the next generation of doctors isn’t getting the appropriate training in discussing medical marijuana with patients let alone prescribing it.

That’s according to a new survey published online in the journal Drug and Alcohol Dependence. Researchers at Washington University School of Medicine in St. Louis conducted a nationwide study of more than 100 medical school deans who oversee the curriculum at their schools. A majority (66.7 percent, to be exact) said their graduates were not at all prepared to prescribe medical marijuana, while 25 percent said their graduates were not even qualified to answer patient questions about medical weed.

The students themselves were even less confident. Researchers queried more than 250 medical residents and fellows at Washington University School of Medicine who’d attended med schools around the country and were now in the earliest stages of their careers in St. Louis. A vast majority (89.5 percent) felt they weren’t prepared to prescribe MMJ, and more than 35 percent felt not at all prepared to answer patients’ questions.

It’s worth noting that the med school deans had more confidence in their students’ preparedness than the students themselves. Though they may be overestimating how well their schools address MMJ: Among residents and fellows, 84.9 percent reported receiving no medical marijuana education in med school or during their residencies. That gibes with the survey’s review of med school curricula, which found that only 9 percent of schools in the Association of American Medical Colleges (AAMC) curriculum database reported teaching anything about medical pot.

Granted, MMJ is a fast-changing and controversial field. That’s difficult territory for med schools used to teaching established material. The study authors say that’s no excuse—students need to be informed. “You address the controversy,” Carolyn Dufault, a co-investigator and an assistant dean for education at Washington University, said in a statement. “You say, ‘This is what we know,’ and you guide students to the points of controversy. You also point out where there may be research opportunities.”

In other words, educators should acknowledge that politics and the law may have outrun medical consensus, then give students the tools they need to make sense of what we do know, and translate that knowledge for their patients.

“Medical education needs to catch up to marijuana legislation,” Laura Jean Bierut, senior author and a member of the National Advisory Council on Drug Abuse, said in a statement. “Physicians in training need to know the benefits and drawbacks associated with medical marijuana so they know when or if, and to whom, to prescribe the drug.” That seems like the very least to ask of the next generation of doctors.