ObjectivesTo 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.DesignQualitative study using in-depth interviews analysed using the framework method.SettingParticipants were recruited from three North Thames London hospitals within the UK.ParticipantsTwenty-two junior doctors undertaking the UK foundation two-year training programme (FY1/FY2).ResultsThe 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.ConclusionsThere 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.
ObjectivesMedically unexplained symptoms (MUS) present frequently in healthcare, can be complex and frustrating for clinicians and patients and are often associated with overinvestigation and significant costs. Doctors need to be aware of appropriate management strategies for such patients early in their training. A previous qualitative study with foundation year doctors (junior doctors in their first 2 years postqualification) indicated significant lack of knowledge about this topic and appropriate management strategies. This study reviewed whether, and in what format, UK foundation training programmes for newly qualified doctors include any teaching about MUS and sought recommendations for further development of such training.DesignMixed-methods design comprising a web-based questionnaire survey and an expert consultation workshop.SettingNineteen foundation schools in England, Wales and Northern IrelandParticipantsQuestionnaire administered via email to 155 foundation training programme directors (FTPDs) attached to the 19 foundation schools, followed by an expert consultation workshop attended by 13 medical educationalists, FTPDs and junior doctors.ResultsThe 53/155 (34.2%) FTPDs responding to the questionnaire represented 15 of the 19 foundation schools, but only 6/53 (11%) reported any current formal teaching about MUS within their programmes. However, most recognised the importance of providing such teaching, suggesting 2–3 hours per year. All those attending the expert consultation workshop recommended case-based discussions, role-play and the use of videos to illustrate positive and negative examples of doctor–patient interactions as educational methods of choice. Educational sessions should cover the skills needed to provide appropriate explanations for patients’ symptoms as well as avoid unnecessary investigations, and providing information about suitable treatment options.ConclusionsThere is an urgent need to improve foundation level training about MUS, as current provision is very limited. An interactive approach covering a range of topics is recommended, but must be delivered within a realistic time frame for the curriculum.
Engaging black and minority‐ethnic (BME) individuals in therapy and maintaining a positive therapeutic alliance can be a complex task, especially when challenging a family's core belief system. This study examines how therapists working within a specialist cultural service in London, UK were able to question a family's core cultural belief system whilst building and maintaining a strong therapeutic alliance. Video‐assisted semi‐structured interviews were carried out with two family members and their two therapists, and analysed using thematic analysis. The findings suggest that core beliefs can be effectively challenged within the context of a strong therapeutic alliance if topics are approached in a sensitive and respectful manner, by trusted therapists who have a degree of knowledge and awareness of their own cultural positioning, as well as an understanding of their clients’ culture. We propose that engaging with culture in this way can strengthen alliance and facilitate positive change. Practitioner points Core cultural belief systems can be effectively challenged by therapists within the context of a positive therapeutic alliance Topics need to be approached sensitively with a degree of authenticity, curiosity and respect Respectfully challenging core beliefs while being aware of one's own cultural construction and positioning, can strengthen the therapeutic alliance and promote positive change
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