In this post Marta Buszewicz discusses her recent trip to the WONCA European conference and her workshop on medically unexplained symptoms. 

It’s conference season and this is another blog about the benefits of travelling abroad to meet with colleagues. At the end of May I attended the WONCA Europe conference in Krakow, Poland. This had over 1,000 delegates, including from several non-European countries, as well as many European ones. The largest number of delegates came from Scandinavian countries and the Netherlands, with rather fewer from the UK.

I gave an oral presentation about our recent qualitative study exploring the distress and mental health difficulties experienced by a sample of English GPs and the barriers to getting effective support, which was well received. I also ran a workshop on the topic of ‘Encouraging clinicians to work effectively with people with medically unexplained symptoms’ which is the main topic for this blog.

I was concerned that this workshop might not be very well attended as it was placed late in the conference programme and there were many parallel sessions and workshops in each time slot. However, 20 clinicians attended from 8 different countries – (Belgium, Estonia, Finland, Indonesia, Israel, Moldova, Portugal and the UK) – which I was very impressed by, as well as the ability of most of those present to discuss complicated issues in English, despite it not being their first or sometimes even their second language.

I presented some background information about the high prevalence of medically unexplained / functional symptoms in primary care and a summary of findings from three qualitative studies conducted by members of PCPH – Mary Howman, Alex Warner and Katie Yon – exploring the attitudes of GP registrars, hospital clinicians and Foundation year doctors to working with such patients.

We then had time for a discussion about how to address the management of such patients, as well as the question of clinician attitudes. This is clearly a common issue internationally and no-one at the workshop had any difficulty identifying such presentations in the patients they see as GPs and quite often found them challenging. However, the discussion also brought up some interesting observations and perspectives from different countries.

Ideas I particularly took away included a clear wish from all those attending that this topic should be introduced from the beginning of the medical school curriculum, with the possibility of non-organic causes for patients’ symptoms and dealing with uncertainty being revisited throughout students’ training.

There was also an interesting discussion about working more effectively across the primary-secondary care interface, which is something which may be particularly relevant with such patients. There were clear differences in how easy it was to make good links with hospital specialists to enable discussions about individual patients – this seemed more likely in smaller less densely populated countries like Finland or Estonia. Several participants suggested that primary care clinicians probably had a better understanding of how to work with patients with unexplained symptoms and that there might be a role for them in educating the hospital clinicians! The importance of family history and past experiences of illness in taking a history from such patients was also emphasised and I’m not sure how often this is done.

I found discussing these issues with colleagues from different countries and health care systems very stimulating and thought-provoking and would strongly encourage junior researchers to present their work at international conferences where possible in order to get some new perspectives.

Krakow is a very beautiful city with a renowned mediaeval marketplace, a castle complex and cathedral on the banks of the river Vistula. The new state of the art conference centre is on the other side of the river and only 10 minutes walk from the castle and the beginning of the old town, so it was possible to include some cultural visits in my time there.

Rosie Webster a Research Associate within the Research Department of Primary Care and Population Health shares her thoughts on sharing knowledge of technology development in the E-Health Unit technology-sharing seminars.

Members of the E-Health unit at PCPH come from a variety of backgrounds: clinical, psychology, public health, sociology, and others. While we have extensive knowledge of health and human behaviour, we do not have specific in-house experts in technology. As a group, we have extensive experience in working to develop online interventions, and have a lot to offer with regard to experience. However, it can be difficult to efficiently share this knowledge between projects, especially when everyone is very busy.

Last year, a colleague in the E-Health unit (Kingshuk Pal) and I decided that there should be a more official way of sharing our knowledge and experience of working with technology. It makes sense for us to share what we have learnt during our experiences, to help future projects run more smoothly, and to prevent people from repeating any mistakes. We therefore established a quarterly half-day seminar series, the ‘E-Health unit technology-sharing seminars’.

Each seminar is organised by a different team of staff/PhD students, and has a different focus. The first seminar (in July last year) focussed on the theory that we use for intervention development, how to select your software developer, and technologies used to develop existing interventions within the E-Health unit. The second seminar focussed on online alcohol interventions.

The latest seminar was held recently (10^th April 2014). The first half of the seminar saw members of the E-Health unit talking about how they translated behaviour change techniques (standardised elements of an intervention) into online interactive features. It arose that there are often challenges in doing this – we may have ‘ideal’ intervention ideas, but various things can limit how this might be presented in practice (e.g. limits of the technology, time, and money!).

The highlight of this section were the presentations from the HeLP-Diabetes group, who had invited one of their software developers to come and speak with them. This gave a unique insight into the challenges of developing online interventions. Charlotte Dack reported how she developed clear Powerpoint wireframes of a goal-setting tool, to demonstrate how she expected the activity to work. Their software developers then talked about the development process of this tool, highlighting the challenges of fitting Charlotte’s ideas into the set templates provided by the development platform. This issue seemed to come up repeatedly – software developers often don’t create ‘bespoke’ websites, they use set templates. Features that fit into these templates are very straightforward to develop, but anything outside of that provides a bit of a challenge. This may explain why, when we feel something is very simple to create, developers often tell us it’s much more complex than we expect! The team also spoke of the importance of face-to-face meetings, and prioritising which elements are important/essential/’nice to have’, and why.

The second half of the seminar saw insights from computer science about the best ways to communicate ideas. Anne Hsu from Queen Mary’s University talked about systems analysis: defining the requirements of the system, specifying all the potential scenarios of use (use cases), and how the system should respond. Geraint Jones from UCL interaction centre (UCLIC) then highlighted the importance of drawing when it comes to translating your ideas. Nic Marquardt (also UCLIC) then extended this, by delivering an exciting workshop encouraging us to get sketching and storyboarding our ideas. These sketches should start as hand-drawn and rough –by getting down ideas down quickly, with minimal effort, you explore more potential ideas, rather than being strongly invested in one idea that may not be the best.

During the discussion, it was pointed out that as E-Health researchers, we should be aware of these basic skills and processes in computer science. Presenters from the latter half of the seminar kindly offered to share information about useful resources; however, it’s important that we engage in learning about these things. These seminars provide a useful starting point, but it’s important to continue the conversation, and for E-Health researchers to take an interest in learning about the basics of computer science.

Another way to facilitate learning and knowledge sharing is to maintain connections and communications with other departments. These seminars seem to be an excellent way of doing this. The seminar was originally planned to be internal, with attendees from the E-Health unit. This quickly spread to the department of clinical, educational, and health psychology, who also use online platforms for behaviour change. We now also have a lot of input (and attendees) from UCLIC, who do a lot of work in human-computer interaction. For the most recent seminar, the contribution from UCLIC really helped to increase the technological knowledge of the group. UCLIC have kindly offered to be involved in the organisation of the next seminar, and we hope that the knowledge sharing fostered by these seminars can be of mutual benefit to both groups. I’d also be keen to hear of anyone else within UCL, working in E-Health from a computer science perspective. The more we can learn from each other, the better!