title: Training Medical Specialists to Communicate Better with Patients with Medically Unexplained Physical Symptoms (MUPS). A Randomized, Controlled Trial.
abstract: BACKGROUND
  Patients with medically unexplained physical symptoms (MUPS) are prevalent 25-50% in general and specialist care. Medical specialists and residents often find patients without underlying pathology difficult to deal with, whereas patients sometimes don't feel understood. We developed an evidence-based communication training, aimed to improve specialists' interviewing, information-giving and planning skills in MUPS consultations, and tested its effectiveness.
  
  
  METHODS
  The intervention group in this multi-center randomized controlled trial received a 14-hour training program to which experiential learning and feedback were essential. Using techniques from Cognitive Behavioral Therapy, they were stimulated to seek interrelating factors (symptoms, cognitions, emotions, behavior, and social environment) that reinforced a patient's symptoms. They were taught to explain MUPS understandably, reassure patients effectively and avoid unnecessary diagnostic testing. Before and after the intervention training, specialists videotaped a total of six consultations with different MUPS patients. These were evaluated to assess doctors' MUPS-focused communicating skills using an adapted version of the Four Habit Coding Scheme on five-point Likert scales. Participants evaluated the training by self-report on three-point Likert scales. Doctors in the control group received training after completion of the study.
  
  
  RESULTS
  123 doctors (40% specialists, 60% residents) and 478 MUPS patients from 11 specialties were included; 98 doctors completed the study (80%) and 449 videotaped consultations were assessed. Trained doctors interviewed patients more effectively than untrained ones (p < 0.001), summarized information in a more patient-centered way (p = 0.001), and better explained MUPS and the role of perpetuating factors (p < 0.05). No effects on planning skills were found. On a 3-point scale the training was evaluated with 2.79.
  
  
  CONCLUSIONS
  MUPS-focused communication training increases the interviewing and information-giving skills of medical specialists. We recommend that the training is incorporated in postgraduate education for medical specialists and residents who frequently encounter patients with MUPS.
  
  
  BACKGROUND
  Dutch Trial Registration NTR2612.
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Institute of Psychology, Faculty of Social Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: Weiland
authors.affiliation: Department of General Practice and Elderly Care Medicine, VU University Medical Centre Amsterdam, Amsterdam, the Netherlands.
authors.forename: Annette H
authors.initials: AH
authors.lastname: Blankenstein
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Jan L C M
authors.initials: JL
authors.lastname: Van Saase
authors.affiliation: Institute of Psychology, Faculty of Social Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands.
authors.forename: Henk T
authors.initials: HT
authors.lastname: Van der Molen
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of General Practice and Elderly Care Medicine, VU University Medical Centre Amsterdam, Amsterdam, the Netherlands.
authors.forename: Mariël E
authors.initials: ME
authors.lastname: Jacobs
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Faculty of Psychology, Open University, Heerlen, the Netherlands.
authors.forename: Dineke C
authors.initials: DC
authors.lastname: Abels
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Faculty of Psychology, Open University, Heerlen, the Netherlands.
authors.forename: Nedim
authors.initials: N
authors.lastname: Köse
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands; NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Faculty of Health Science, Buskerud and Vestfold University College, Drammen, Norway.
authors.forename: Sandra
authors.initials: S
authors.lastname: Van Dulmen
authors.affiliation: Clinical Trial Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: René M
authors.initials: RM
authors.lastname: Vernhout
authors.affiliation: Institute of Psychology, Faculty of Social Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Institute of Pedagogical Sciences, Faculty of Social Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands.
authors.forename: Lidia R
authors.initials: LR
authors.lastname: Arends
mesh_terms: D000328:Adult; D003142:Communication; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D066107:Social Skills; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D013038:Specialization