What do medical students learn? What are medical students taught about Persistent Physical Symptoms? A scoping review of the literature

Problem

Persistent Physical Symptoms (PPS) are physical symptoms for which there is either no underlying organic cause or the disability caused by the symptoms is disproportionate to the organic pathology. PPS are common and present to nearly every medical specialty, indeed they constitute the primary reason for consulting with a general practitioner in up to 45% of cases.

Doctors and patients are frequently left feeling dissatisfied and frustrated with consultations where PPS present. Focussed communication skills training may improve the satisfaction of consultations for both patients and clinicians and the need for a ‘curriculum of explanation’ has been identified by previous research. It was unclear what teaching and learning had been taking place in this area.

Approach

The review used a systematic scoping approach with narrative thematic synthesis of the findings. The search strategy was designed around 3 concepts: persistent physical symptoms (including terms such as medically unexplained symptoms); undergraduate medical students; and teaching and learning

Searches were conducted in three databases: Medline, PsychINFO, and Web of Science. Further citation analysis was undertaken, as well as a search of the grey literature using Google. Titles and abstracts were reviewed and extracted by one researcher

Findings

290 records were identified. After removing duplicates and screening for relevance, using specified inclusion and exclusion criteria, 38 full text articles were reviewed.

52 educators across medical schools in the UK were interviewed in 2 separate studies. Authors found that the topic of PPS was either overlooked or taught opportunistically in the undergraduate medical curriculum. Four studies found that students internalised negative messages about patients with PPS, this was the result of implicit messaging from clinical role models. One of these studies found that students did not feel equipped to challenge their clinical tutors when negative attitudes were inferred. 11 teaching interventions on chronic pain have taken place across medical schools in Europe, the US, and the UK, but there was no record of teaching for other types of PPS. In one case teaching was integrated over 4 years, but in the remaining studies the intervention was a workshop or short course distinct from the main teaching curriculum. Nine studies used student evaluation as a measure for success and two studies used attitudinal questionnaires as a marker of improvement.

Consequences

Given the prevalence of PPS, more consideration needs to be given to the inclusion of this topic in undergraduate teaching curricula. A broader range of conditions such as chronic fatigue, or functional neurological problems should be considered for inclusion. There is a particular need to counter negative messages that students receive about patients with PPS and to equip them with the skills needed to challenge negative role-modelling.