What are medical students taught about persistent physical symptoms? A scoping review of the literature.

BACKGROUND: Persistent Physical Symptoms (PPS) include symptoms such as chronic pain, and syndromes such as chronic fatigue. They are common, but are often inadequately managed, causing distress and higher costs for health care systems. A lack of teaching about PPS has been recognised as a contributing factor to poor management. METHODS: The authors conducted a scoping review of the literature, including all studies published before 31 March 2023. Systematic methods were used to determine what teaching on PPS was taking place for medical undergraduates. Studies were restricted to publications in English and needed to include undergraduate medical students. Teaching about cancer pain was excluded. After descriptive data was extracted, a narrative synthesis was undertaken to analyse qualitative findings. RESULTS: A total of 1116 studies were found, after exclusion, from 3 databases. A further 28 studies were found by searching the grey literature and by citation analysis. After screening for relevance, a total of 57 studies were included in the review. The most commonly taught condition was chronic non-cancer pain, but overall, there was a widespread lack of teaching and learning on PPS. Several factors contributed to this lack including: educators and learners viewing the topic as awkward, learners feeling that there was no science behind the symptoms, and the topic being overlooked in the taught curriculum. The gap between the taught curriculum and learners' experiences in practice was addressed through informal sources and this risked stigmatising attitudes towards sufferers of PPS. CONCLUSION: Faculties need to find ways to integrate more teaching on PPS and address the barriers outlined above. Teaching on chronic non-cancer pain, which is built on a science of symptoms, can be used as an exemplar for teaching on PPS more widely. Any future teaching interventions should be robustly evaluated to ensure improvements for learners and patients.

Serving the needs of our future population.

Less than 30% of doctors, across The Organisation for Economic Co-operation and Development (OECD) and within the UK are currently working in generalist careers. Our population is ageing and increasingly, multi-morbidity is becoming the norm rather than the exception. With an increasing proportion of graduates opting for specialist careers, how can we best equip them to deal with the challenges they are likely to face without an exponential rise in the cost of care or increasing risk to patients? We propose an approach by which community placements are present from the early years of medical training and to seek opportunities for interprofessional learning and teaching, with emphasis on continuity of care and holism. By involving students in longitudinal placements and encouraging them to develop relationships with patients and their carers, they will be more likely to understand the value of continuity and the need to undertake a whole person approach, rather than what Oldham described as 'body part' medicine. It is hoped that through teaching, training, and role modelling, more students might opt for generalist careers, or the effects of increasing specialisation might be mitigated.

Foundation Programme doctors as teachers.

BACKGROUND: Teaching is a core competency outlined in the Foundation Programme curriculum in the UK. This article reports data from a larger postal questionnaire study asking general practitioner (GP) trainers and GP programme directors in the Yorkshire & Humber Deanery whether Foundation Year 2 (FY2) doctors were undertaking teaching roles during primary care posts. We also aimed to explore their attitudes towards FY2s as teachers. METHODS: A questionnaire was designed asking whether FY2s had been present in the practice, and if so what teaching methods they had undertaken. The responder was then asked how comfortable they would feel with an FY2 doctor undertaking certain teaching roles. Responses were prompted using a nine-point Likert scale. RESULTS: The response rate was 74 per cent (216/291). Of the respondents, 37 per cent (80/216) stated that FY2s had been present in their surgery in the last 12 months; 16 per cent (13/80) went on to say that those FY2 doctors had undertaken teaching roles. Respondents felt more comfortable with FY2s undertaking the teaching of practical skills (median score 6, interquartile range 5-7, on the Likert scale) and giving one-to-one tutorials to medical students (median score 6, interquartile range range 4-7), but were uncomfortable with them clinically supervising medical students (median score 3, interquartile range 2-5) and giving one-to-one tutorials to fellow FY2s (median 4, interquartile range 2-5). DISCUSSION: With reduced hours resulting in a decrease in exposure to teaching experience during hospital rotations, it is important that these doctors are given adequate opportunities during primary care placements to improve skills in this area.