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Improving teaching about medically unexplained symptoms for newly qualified doctors in the UK: findings from a questionnaire survey and expert workshop
  1. Katherine Yon1,
  2. Stephanie Habermann1,
  3. Joe Rosenthal1,
  4. Kate R Walters1,
  5. Sarah Nettleton2,
  6. Alex Warner1,
  7. Kethakie Lamahewa1,
  8. Marta Buszewicz1
  1. 1 Research Department of Primary Care and Population Health, UCL, London, UK
  2. 2 Department of Sociology, University of York, York, UK
  1. Correspondence to Katherine Yon; katherine.yon.12{at}


Objectives Medically unexplained symptoms (MUS) present frequently in healthcare, can be complex and frustrating for clinicians and patients and are often associated with overinvestigation and significant costs. Doctors need to be aware of appropriate management strategies for such patients early in their training. A previous qualitative study with foundation year doctors (junior doctors in their first 2 years postqualification) indicated significant lack of knowledge about this topic and appropriate management strategies. This study reviewed whether, and in what format, UK foundation training programmes for newly qualified doctors include any teaching about MUS and sought recommendations for further development of such training.

Design Mixed-methods design comprising a web-based questionnaire survey and an expert consultation workshop.

Setting Nineteen foundation schools in England, Wales and Northern Ireland

Participants Questionnaire administered via email to 155 foundation training programme directors (FTPDs) attached to the 19 foundation schools, followed by an expert consultation workshop attended by 13 medical educationalists, FTPDs and junior doctors.

Results The 53/155 (34.2%) FTPDs responding to the questionnaire represented 15 of the 19 foundation schools, but only 6/53 (11%) reported any current formal teaching about MUS within their programmes. However, most recognised the importance of providing such teaching, suggesting 2–3 hours per year. All those attending the expert consultation workshop recommended case-based discussions, role-play and the use of videos to illustrate positive and negative examples of doctor–patient interactions as educational methods of choice. Educational sessions should cover the skills needed to provide appropriate explanations for patients’ symptoms as well as avoid unnecessary investigations, and providing information about suitable treatment options.

Conclusions There is an urgent need to improve foundation level training about MUS, as current provision is very limited. An interactive approach covering a range of topics is recommended, but must be delivered within a realistic time frame for the curriculum.

  • Medical education & training
  • Medically unexplained symptoms
  • Junior doctors
  • Foundation years

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  • Acknowledgements The authors would like to thank all the foundation training programme directors who took the time to complete the questionnaire and all the participants who attended the workshop.

  • Contributor MB, SN, KRW, JR and AW developed the study protocol. All authors attended the workshop. KY collected the data. KY, MB, SN, KRW, KL and SH analysed the data and interpreted the results. KY and SH drafted the report. All authors have read and approved the manuscript.

  • Funding This work was supported by the National School of Primary Care Research (NSPCR) within the National Institute for Health Research (NIHR). Award Number: 157946.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funder has had no role in the study design, collection, analysis and interpretation of data, writing of the manuscript or decision to submit for publication.

  • Competing interests MB, KW, JR and AW provide lectures on the topic of MUS for fourth-year and fifth-year medical students and foundation year doctors in the Department of Primary Care and Population Health, UCL.

  • Ethics approval UCL Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement An anonymised summary of the workshop discussion points and participant comments is available upon request. An anonymised summary of all of the quantitative and qualitative questionnaire responses received is also available upon request from the corresponding author.