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培养未来医生解释“医学无法解释”的躯体症状:对英国医学教育者对障碍和解决方案看法的考察。

Training tomorrow's doctors to explain 'medically unexplained' physical symptoms: An examination of UK medical educators' views of barriers and solutions.

机构信息

Manchester Centre of Health Psychology, School of Health Sciences, University of Manchester, Greater Manchester, UK; The Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Greater Manchester, UK.

Manchester Centre of Health Psychology, School of Health Sciences, University of Manchester, Greater Manchester, UK.

出版信息

Patient Educ Couns. 2018 May;101(5):878-884. doi: 10.1016/j.pec.2017.11.020. Epub 2017 Nov 28.

Abstract

OBJECTIVE

Co-occuring physical symptoms, unexplained by organic pathology (known as Functional Syndromes, FS), are common and disabling presentations. However, FS is absent or inconsistently taught within undergraduate medical training. This study investigates the reasons for this and identifies potential solutions to improved implementation.

METHODS

Twenty-eight medical educators from thirteen different UK medical schools participated in semi-structured interviews. Thematic analysis proceeded iteratively, and in parallel with data production.

RESULTS

Barriers to implementing FS training are beliefs about the complexity of FS, tutors' negative attitudes towards FS, and FS being perceived as a low priority for the curriculum. In parallel participants recognised FS as ubiquitous within medical practice and erroneously assumed it must be taught by someone. They recommended that students should learn about FS through managed exposure, but only if tutors' negative attitudes and behaviour are also addressed.

CONCLUSION

Negative attitudes towards FS by educators prevents designing and delivering effective education on this common medical presentation. Whilst there is recognition of the need to implement FS training, recommendations are multifaceted.

PRACTICE IMPLICATIONS

Increased liaison between students, patients and educators is necessary to develop more informed and effective teaching methods for trainee doctors about FS and in order to minimise the impact of the hidden curriculum.

摘要

目的

由器质性病变无法解释的共存躯体症状(即功能性综合征,FS)较为常见且会导致残疾。然而,FS 在本科医学培训中缺失或教授不一致。本研究旨在探讨其原因,并确定潜在的解决方案以改进实施。

方法

来自 13 所英国医学院的 28 名医学教育工作者参与了半结构化访谈。主题分析是迭代进行的,并与数据生成并行进行。

结果

实施 FS 培训的障碍包括对 FS 复杂性的信念、教师对 FS 的负面态度以及 FS 被视为课程低优先级。同时,参与者认识到 FS 在医学实践中无处不在,并错误地认为必须由某人教授。他们建议学生通过管理暴露来学习 FS,但前提是必须解决教师的负面态度和行为问题。

结论

教育工作者对 FS 的负面态度阻碍了对这种常见医学表现进行有效教育的设计和实施。尽管人们认识到需要实施 FS 培训,但建议是多方面的。

实践意义

为了制定针对 FS 的更具知情和有效的教学方法,以及为了最大程度地减少隐藏课程的影响,学生、患者和教育者之间需要加强联系。

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