title: Junior doctors' experiences of managing patients with medically unexplained symptoms: a qualitative study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Qualitative study using in-depth interviews analysed using the framework method.
  
  
  METHODS
  Participants were recruited from three North Thames London hospitals within the UK.
  
  
  METHODS
  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.
authors.affiliation: Research Department of Primary Care & Population Health, UCL, London, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Yon
authors.affiliation: Department of Sociology, University of York, York, UK.
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0002-5184-2764
authors.initials: S
authors.lastname: Nettleton
authors.affiliation: Research Department of Primary Care & Population Health, UCL, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Walters
authors.affiliation: Research Department of Primary Care & Population Health, UCL, London, UK.
authors.forename: Kethakie
authors.initials: K
authors.lastname: Lamahewa
authors.affiliation: Research Department of Primary Care & Population Health, UCL, London, UK.
authors.forename: Marta
authors.initials: M
authors.lastname: Buszewicz
mesh_terms: D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008131:London; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education* / Q000523:psychology; D008875:Middle Aged; D011361:Professional Competence; D036301:Qualitative Research; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000628:therapy*; D055815:Young Adult
keywords: JUNIOR DOCTORS; MEDICAL EDUCATION & TRAINING; MEDICALLY UNEXPLAINED SYMPTOMS; MENTAL HEALTH; PRIMARY CARE