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Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study

OBJECTIVES: To explore junior doctors’ knowledge about and experiences of managing patients with medically unexplained symptoms (MUS) and to seek their recommendations for improved future training on this important topic about which they currently receive little education. DESIGN: Qualitative study...

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Autores principales: Yon, Katherine, Nettleton, Sarah, Walters, Kate, Lamahewa, Kethakie, Buszewicz, Marta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679901/
https://www.ncbi.nlm.nih.gov/pubmed/26628528
http://dx.doi.org/10.1136/bmjopen-2015-009593
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author Yon, Katherine
Nettleton, Sarah
Walters, Kate
Lamahewa, Kethakie
Buszewicz, Marta
author_facet Yon, Katherine
Nettleton, Sarah
Walters, Kate
Lamahewa, Kethakie
Buszewicz, Marta
author_sort Yon, Katherine
collection PubMed
description OBJECTIVES: To explore junior doctors’ knowledge about and experiences of managing patients with medically unexplained symptoms (MUS) and to seek their recommendations for improved future training on this important topic about which they currently receive little education. DESIGN: Qualitative study using in-depth interviews analysed using the framework method. SETTING: Participants were recruited from three North Thames London hospitals within the UK. PARTICIPANTS: Twenty-two junior doctors undertaking the UK foundation two-year training programme (FY1/FY2). RESULTS: The junior doctors interviewed identified a significant gap in their training on the topic of MUS, particularly in relation to their awareness of the topic, the appropriate level of investigations, possible psychological comorbidities, the formulation of suitable explanations for patients’ symptoms and longer term management strategies. Many junior doctors expressed feelings of anxiety, frustration and a self-perceived lack of competency in this area, and spoke of over-investigating patients or avoiding patient contact altogether due to the challenging nature of MUS and a difficulty in managing the accompanying uncertainty. They also identified the negative attitudes of some senior clinicians and potential role models towards patients with MUS as a factor contributing to their own attitudes and management choices. Most reported a need for more training during the foundation years, and recommended interactive case-based group discussions with a focus on providing meaningful explanations to patients for their symptoms. CONCLUSIONS: There is an urgent need to improve postgraduate training about the topics of MUS and avoiding over-investigation, as current training does not equip junior doctors with the necessary knowledge and skills to effectively and confidently manage patients in these areas. Training needs to focus on practical skill development to increase clinical knowledge in areas such as delivering suitable explanations, and to incorporate individual management strategies to help junior doctors tolerate the uncertainty associated with MUS.
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spelling pubmed-46799012015-12-22 Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study Yon, Katherine Nettleton, Sarah Walters, Kate Lamahewa, Kethakie Buszewicz, Marta BMJ Open Medical Education and Training OBJECTIVES: To explore junior doctors’ knowledge about and experiences of managing patients with medically unexplained symptoms (MUS) and to seek their recommendations for improved future training on this important topic about which they currently receive little education. DESIGN: Qualitative study using in-depth interviews analysed using the framework method. SETTING: Participants were recruited from three North Thames London hospitals within the UK. PARTICIPANTS: Twenty-two junior doctors undertaking the UK foundation two-year training programme (FY1/FY2). RESULTS: The junior doctors interviewed identified a significant gap in their training on the topic of MUS, particularly in relation to their awareness of the topic, the appropriate level of investigations, possible psychological comorbidities, the formulation of suitable explanations for patients’ symptoms and longer term management strategies. Many junior doctors expressed feelings of anxiety, frustration and a self-perceived lack of competency in this area, and spoke of over-investigating patients or avoiding patient contact altogether due to the challenging nature of MUS and a difficulty in managing the accompanying uncertainty. They also identified the negative attitudes of some senior clinicians and potential role models towards patients with MUS as a factor contributing to their own attitudes and management choices. Most reported a need for more training during the foundation years, and recommended interactive case-based group discussions with a focus on providing meaningful explanations to patients for their symptoms. CONCLUSIONS: There is an urgent need to improve postgraduate training about the topics of MUS and avoiding over-investigation, as current training does not equip junior doctors with the necessary knowledge and skills to effectively and confidently manage patients in these areas. Training needs to focus on practical skill development to increase clinical knowledge in areas such as delivering suitable explanations, and to incorporate individual management strategies to help junior doctors tolerate the uncertainty associated with MUS. BMJ Publishing Group 2015-12-01 /pmc/articles/PMC4679901/ /pubmed/26628528 http://dx.doi.org/10.1136/bmjopen-2015-009593 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Medical Education and Training
Yon, Katherine
Nettleton, Sarah
Walters, Kate
Lamahewa, Kethakie
Buszewicz, Marta
Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study
title Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study
title_full Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study
title_fullStr Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study
title_full_unstemmed Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study
title_short Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study
title_sort junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study
topic Medical Education and Training
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679901/
https://www.ncbi.nlm.nih.gov/pubmed/26628528
http://dx.doi.org/10.1136/bmjopen-2015-009593
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