What are medical students taught about Persistent Physical Symptoms?  A scoping review of the literature

Background: 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. Methods 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 is currently 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. Results A total of 1116 studies were found by 3 databases. 28 further 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. There was a widespread lack of teaching and learning on PPS. Where teaching did take place, this was most commonly about chronic pain. PPS are viewed as awkward by educators and learners. Learners think that there is no science behind the symptoms. PPS is overlooked in the undergraduate teaching curriculum. The gap between the taught curriculum and learners’ experiences in practice is being addressed through informal sources and some students are taking on stigmatised attitudes towards sufferers of PPS. Conclusions Current suggestions for improvements in teaching are insufficient to address issues such as stigma and the poor understanding that educators and learners have about PPS. They also do not address barriers to implementation such as a lack of ownership of the topic and packed teaching curricula. Further empirical evidence is needed to demonstrate how to best teach and evaluate teaching about PPS.