Training Medical Specialists to Communicate Better with Patients with Medically Unexplained Physical Symptoms (MUPS). A Randomized, Controlled Trial

BackgroundPatients 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.MethodsThe 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.Results123 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 p = 0.001), and better explained MUPS and the role of perpetuating factors (p ConclusionMUPS-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.Trial RegistrationDutch Trial Registration NTR2612背景：躯体症状无法用医学解释（medically unexplained physical symptoms, MUPS）患者在普通门诊与专科门诊中的占比可达25%至50%。内科专科医师与住院医师常难以应对无明确病理基础的患者，而部分患者也会感到自身未被充分理解。本团队开发了一项基于循证医学的沟通培训项目，旨在提升专科医师在MUPS患者诊疗中的问诊、信息采集与诊疗规划能力，并对该培训的有效性进行了验证。 方法：本项多中心随机对照试验的干预组接受了14小时的培训课程，其中体验式学习与反馈环节为核心内容。培训借助认知行为疗法（Cognitive Behavioral Therapy）相关技术，引导医师探寻与患者症状强化相关的关联因素，包括症状、认知、情绪、行为与社会环境。培训内容还包括向患者清晰解释MUPS的相关知识、有效安抚患者，以及避免不必要的诊断性检查。在培训前后，受试者均需录制共6次与不同MUPS患者的诊疗过程，随后采用经改编的四习惯编码方案（Four Habit Coding Scheme）结合李克特5级量表，对医师针对MUPS的沟通技能进行评估。受试者还通过李克特3级量表的自评问卷对本次培训进行评价。对照组医师则在本研究结束后接受该培训。 结果：本研究共纳入11个专科的123名医师（其中40%为专科医师，60%为住院医师）与478名MUPS患者；最终98名医师完成研究（完成率80%），共评估了449份诊疗录像。经培训的医师在患者问诊环节表现优于未受训医师（p=0.001），且能更清晰地向患者阐释MUPS及症状维持因素的作用（p。 结论：针对MUPS的沟通培训可有效提升专科医师的问诊与信息采集能力。我们建议将该培训纳入常接触MUPS患者的专科医师与住院医师的毕业后教育体系。 试验注册：荷兰试验注册库（Dutch Trial Registration）编号NTR2612