Do junior doctors at Foundation level receive sufficient training about patients presenting with physical symptoms with no clear organic basis?

In this months post Katie Yon and Dr Marta Buszewicz talk about their recent study of medically unexplained symptoms amongst junior doctors.

Straight after qualifying, junior doctors in their first two foundation years of training are expected to see and manage patients alone. Up to 40-50% of the patients that doctors see will have unexplained symptoms, i.e., there is no clear physical basis for their symptoms (often termed medically unexplained symptoms or MUS). Treating these patients can be challenging, as there is often no clear treatment plan or referral pathway. The complex nature of such presentations and the difficulties in their management can lead to frustration amongst both patients and clinicians, and can also result in doctors ordering expensive and unnecessary investigations in an attempt to identify the cause of their patients’ symptoms. There is currently very little teaching provided at undergraduate and postgraduate level on this subject, which is surprising given the high number of patients seen across all specialities.

Our recent study aimed to improve teaching for newly-qualified junior doctors on this topic using a number of methods. We used in-depth interviews to explore the junior doctors’ feelings about working with such patients and to find out what they knew about their management. We also investigated what teaching they were currently receiving on this topic, and what their postgraduate tutors thought about expanding this. The overall aim was to develop an educational intervention for doctors at this stage of their training.

In our interviews, the junior doctors were very frank when talking about the challenges they had faced when looking after patients with medically unexplained symptoms, and spoke about the impact of these difficulties on their own attitudes and management choices. They were very keen to gain more training in this topic, particularly during the first two Foundation Years post-qualification, as this is the time when they first have intensive exposure to patients as junior doctors. Both they and their postgraduate tutors gave a number of recommendations for teaching about this topic, in particular emphasising the importance of an interactive approach based around group discussions and clinical cases.

To our knowledge, our study is the first to look at junior doctors’ experiences of managing patients with such symptoms and to identify their training needs in this area. Most of the training described within the literature currently takes place with more senior doctors, but our study shows that junior doctors and their tutors consider that this teaching is required at an earlier stage. As a result of this study, we hope to raise awareness about the lack of training that junior doctors currently receive in this important area, and to encourage their tutors to integrate teaching about medically unexplained symptoms into core Foundation level curricula.

We will keep you updated about upcoming publications, in which our findings will be explained in greater detail. If you have any questions about the study please contact Katie Yon (Katherine.Yon.12@ucl.ac.uk) or Marta Buszewicz (M.Buszewicz@ucl.ac.uk).

This study is funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR). The views expressed are those of the author and not necessarily those of the NIHR, the NHS or the Department of Health.