Primary Care Research Group, Division of Population Health, School of Medicine, University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, UK.
BMC Med Educ. 2024 Jun 4;24(1):618. doi: 10.1186/s12909-024-05610-z.
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.
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.
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.
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.
持续性身体症状（PPS）包括慢性疼痛等症状和慢性疲劳等综合征。它们很常见，但往往得不到充分的管理，给医疗系统带来痛苦和更高的成本。缺乏对 PPS 的教学已被认为是管理不善的一个促成因素。
作者对文献进行了范围界定审查，包括截至 2023 年 3 月 31 日之前发表的所有研究。系统方法用于确定医学本科生正在接受哪些关于 PPS 的教学。研究仅限于英语出版物，并且需要包括本科医学生。不包括关于癌症疼痛的教学。在提取描述性数据后，进行了叙述性综合分析以分析定性发现。
在排除后，从 3 个数据库中总共发现了 1116 项研究。通过搜索灰色文献和引文分析，又发现了 28 项研究。经过相关性筛选，共有 57 项研究纳入了综述。最常教授的疾病是慢性非癌症疼痛，但总体而言，对 PPS 的教学和学习普遍缺乏。造成这种缺乏的因素包括：教育者和学习者认为该主题很尴尬，学习者认为症状背后没有科学依据，以及该主题在教学课程中被忽视。教学课程与学习者在实践中的经验之间的差距通过非正式来源得到解决，但这有使 PPS 患者遭受污名化的风险。
各学院需要找到方法，增加 PPS 的教学，并解决上述障碍。以症状科学为基础的慢性非癌症疼痛教学可以作为更广泛的 PPS 教学的范例。任何未来的教学干预措施都应进行严格评估，以确保学习者和患者的改进。
