Journal of Chronic Fatigue Syndrome
Vol. 14, #2, pp 25-30
Datum: Summer 2007
URL: http://jcfs.haworthpress.com
https://www.haworthpress.com/store/Toc_views.asp?sid=VFM80TB9VRP68PNCMXB826SAD1J53F63&TOCName=J092v14n02%5FTOC&desc=Volume%3A%2014%20Issue%3A%202
The effectiveness of early educational intervention in improving future
physicians' attitudes regarding CFS/FM
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Tony V. Lu, MD, MBA; Susan R. Torres-Harding, PhD; Leonard A. Jason, PhD
- Tony V. Lu is Assistant Professor of Medicine, Department of Medicine,
Loyola University Health System, Maywood, IL.
- Susan R. Torres-Harding is Assistant Professor of Psychology, Department
of Psychology, Roosevelt University, Chicago, IL.
- Leonard A. Jason is affiliated with the Department of Psychology, and
Director, Center for Community Research, DePaul University, Chicago, IL.
- Address correspondence to: Tony V. Lu, Family Health Center of LaGrange Park,
321 North LaGrange Road, LaGrange Park, IL 60526 (E-mail: Tlu1@lumc.edu ).
ABSTRACT
Objective
To assess the effects of an early educational intervention program's ability
to alter the perceptions and attitudes of future physicians regarding chronic
fatigue syndrome/fibromyalgia (CFS/FM), improve their understanding and
acceptance of these diseases, make them feel more comfortable in diagnosing
and treating patients.
Method
Third-year medical students were surveyed before and after an educational
intervention program. The three questions posed to the students in the survey
were: (1) How comfortable do you feel you are in diagnosing and treating
patients with CFS /FM?, (2) Do you consider CFS/FM legitimate illnesses?, and
(3) Do you want to treat patients with CFS/FM?
Results
The educational intervention program helped about half of the future
physicians feel comfortable in diagnosing and treating patients with CFS/FM
and improved by over 25% their willingness to treat patients with CFS.
Conclusion
An educational intervention program appeared to improve future physicians'
understanding and appreciation of CFS/FM, made them feel more comfortable
diagnosing and treating these diseases, and increased their willingness to
treat patients with CFS/FM.
KEYWORDS. Chronic fatigue syndrome, fibromyalgia, educational intervention
program, comfort in diagnosing and treating, willingness to treat
INTRODUCTION
Patients with chronic fatigue syndrome/fibromyalgia (CFS/FM) often have
symptoms and complaints regarding multiple organ systems without obvious
confirming laboratory abnormalities (1). They are sometimes unfairly
perceived by their physicians to be difficult patients who require both
pharmacological as well as non-pharmacological treatments (2). In addition,,
patients with CFS/FM often have difficulty finding a physician who
understands the complexity of their symptoms, accepts their illness as
legitimate, and is willing to treat them (3,4).
There has been little research into how to address the skepticism among
physicians that makes it difficult for patients with CFS/FM to obtain
treatment. The objective of this study was to determine whether an early
educational intervention would alter the perceptions and attitudes of future
physicians, improve their understanding and acceptance of these illnesses,
make them more comfortable in diagnosing and treating these patients.
Furthermore, the study also intended on determining whether this intervention
would help make the future physicians more willing to treat patients with
CFS/FM.
METHODS
Third-year medical students who have just completed their clinical rotations
were surveyed as to their perceptions and attitudes regarding CFS/FM and
their willingness to treat patients with CFS/FM. They were surveyed before
and after an educational program that involved a live-case presentation of a
patient suffering from CFS/FM. Students had the opportunity to interact with
and ask the patient questions concerning CFS/FM. Following the case
presentation, students were given a lecture with information on how to
accurately diagnose CFS/FM and on dispelling myths and misconceptions about
patients with CFS/FM. Topics covered in thelecture included CFS Fukuda
criteria (5) and FM diagnostic criteria (6), general CFS/FM prevalence rate
as well as prevalence rate by race, age and occupation and the prevalence of
CFS compared to other disorders (7). Subsequently, there was a panel
discussion on this case study where information on multiple pharmacological
as well as non-pharmacological modalities such as acupuncture, homeopathy,
mind-body-techniques and nutritional supplementation were offered. The goals
of the intervention were to help the students: (1) feel more comfortable
diagnosing CFS based on the Fukuda criteria and diagnosing FM based on the
American College of Rheumatology criteria, (2) increase familiarity with
various pharmacological options as well as non-pharmaco- logical treatment
options such as acupuncture, homeopathy, mind-body techniques and nutrition
used for the management of CFS and FM, and (3) understand how conventional
and various complementary and alternative medical approaches can be
integrated in the management of patients with CFS and FM.
Before and after the introduction of the program, students filled out a three
item questionnaire using the following questions: (1) How comfortable do you
feel you are in diagnosing and treating patients with CFS /FM?, (2) Do you
consider CFS/FM legitimate illnesses?, and (3) Do you want to treat patients
with CFS/FM? Each question was answered using a rating scale (very
comfortable to very uncomfortable) or by binary responses (is or is not
legitimate). Forty-three third-year medical students returned their pre- and
post-survey questionnaires. Of those 43 students, 65% were female and 25%
were male. The ethnic composition of the class was 0.8% Latino, 2.3% African
Americans, 3.8% Asians, and 93% Caucasians.
RESULTS
The first analysis involved students' comfort in diagnosing and treating
patients with CFS and FM. Prior to the intervention, none of the students
felt very comfortable and almost half of the students (48.8%) felt
uncomfortable in diagnosing and treating patients with CFS/FM. After the
intervention, the number of students who felt uncomfortable in diagnosing and
treating CFS/FM was reduced from 21 to 10 or 23.3%. This change in percentage
was tested using the Wilcoxon Signed Ranks test, which was found to be
statistically significant (z =-3.500, p<.001).
The next question assessed whether students felt that CFS and Fibromyalgia
were legitimate disorders. Initially, 72.1% of the students reported that
they felt that CFS was a legitimate disorder, with 27.9% of the students reporting that CFS was not a legitimate disorder. After the intervention, 81.4% reported that CFS was a legitimate disorder, compared to 18.6% who did not report that CFS was a legitimate disorder. The intervention changed the perception of 4 out of 12 students (33.3%) who previously had felt that CFS was not a legitimate illness. Similarly, 81.4% of students reported that they
felt that FM was the legitimate disorder prior to the start of the
intervention, and 18.6% of the students did not initially feel that FM was a legitimate disorder. After the intervention, 90.7% reported that FM was a legitimate disorder, compared to 9.3% who did not feel that FM was a legitimate disorder. The intervention changed the perception of 4 out of 8 (50.0%) students to feel that FM was a legitimate illness. However, the
differences in perception before and after the intervention were separately
tested for CFS and FM using the McNemar test, and changes in perception for
CFS (p=.22) and FM (p=.22) were not found to be statistically significant.
A third set of analyses was conducted to assess pre and post intervention
changes regarding the willingness of students to treat patients with CFS and
FM. Prior to the intervention, only 37.2% expressed willing to treat a
patient with CFS, and this number increased after the intervention to 53.5%
of the students. Similarly, only 39.5% were willing to treat patients with FM
prior to the intervention, and after the intervention, this number increased
to 55.8%. Seven more students (25.9%) were willing to treat patients with CFS
from the 27 who were initially unwilling to treat CFS. Similarly, for FM, 7
more students (26.9%) were willing to treat patients with FM from the 26 who
were initially unwilling. The change in willingness to treat either CFS or FM
was tested separately using the Wilcoxon Signed Ranks test, and was found to
be statistically significant for both CFS (z =-2.65, p<.01) and for FM
(z=-2.65, p<.01).
DISCUSSION
An educational intervention helped future physicians feel more comfortable in
diagnosing and treating patients with CFS/FM. This educational intervention
also improved their willingness to treat patients with CFS and FM. The four
important features of this educational intervention included: (1) providing
accurate facts on CFS/FM; (2) dispelling myths and misconceptions about
patients with CFS/FM; (3) presenting a live case to allow face-to-face
interaction with a patient with CFS/FM; and (4) increasing students'
awareness of multiple pharmacological and non-pharmacological treatment
options.
By incorporating these four principles into the design of the educational
intervention program, the intervention was able to help about 50% of the
future physicians feel comfortable in diagnosing and treating patients with
CFS/FM. This early intervention program also improved future physician's
willingness to treat patients with CFS by at least 25.9% and patients with FM
by 26.9%. Even though 33% more accept CFS as a legitimate illness and at
least 50% more accept FM as a legitimate illness after the intervention, the
changes in perception for CFS and FM were not found to be statistically
significant. This was probably due to the fact that a high percentage of the
students felt that CFS and FM were legitimate disorders from the start (72%
for CFS and 81% for FM). This intervention did not seem to significantly
further improve the perception that CFS and FM were legitimate disorders.
Future research should determine whether administering this early educational
program to a group of physicians with a higher initial skepticism about the
legitimacy of CFS and FM as real medical conditions alters their attitude.
Furthermore, it would be useful to know which features of the educational
intervention have the strongest impact and whether more direct patient
encounters and case presentations alter future physicians' acceptance of
CFS/FM as legitimate illnesses warrenting treatment.
It appears that early educational intervention could improve future
physicians' understanding and appreciation of CFS/FM, make them feel more
comfortable in diagnosing and treating those patients and increase their
willingness to treat patients with CFS/FM. This could improve their ability
to care for patients with CFS/FM; help these patients find validation and
treatment, improving their overall satisfaction with the medical profession
as well as their personal well-being; and increase our understanding of a
complex medical problem that is more pervasive than commonly understood.
REFERENCES
1. Jason LA, Fennell P, Taylor RR. Handbook of chronic fatigue syndrome & fa-
tiguing illness. New York, NY: John Wiley & Sons, Inc., 2003.
2. Asbring P, & Narvanen AL. Ideal versus reality: Physicians perspectives on
patients with chronic fatigue syndrome (CFS) and fibromyalgia. Social
Science & Medicine 2003; 57: 711-720.
3. Looper KJ & Kirmayer LJ. Perceived stigma in functional somatic syndromes
and comparable medical conditions. Journal of Psychosomatic Research 2004;
57: 373-378.
4. Green J, Romei J, & Natelson BJ. Stigma and chronic fatigue syndrome.
Journal of Chronic Fatigue Syndrome 1999; 5: 63-75.
5. Fukuda K, Strauss SE, Hickie I, Sharpe MC, Dobbins JG, & Komaroff A. The
chronic fatigue syndrome: A comprehensive approach to its definition and
study. Annals of Internal Medicine 1994; 121: 953-959.
6. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL,
et al. The American College of Rheumatology 1990 criteria for the
classification of fibromyalgia. Report of the multicenter criteria
committee. Arthritis Rheum. 1990; 33: 160-172.
7. Jason LA, Richman JA, Rademaker AW, Jordan KM, Plioplys AV, Taylor RR,
McCready W, Huang C & Plioplys S. A community-based study of chronic
fatigue syndrome. Archives of Internal Medicine 1999; 159: 2129-2137.
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(c) 2007 The Haworth Press
* * *
Too many doctors are of the impression that there are no tests that prove CFS/FM, therefore, they cannot be legitimate diseases. 20+ years after Peterson/Cheney determined there were abnormalities on MRIs, it's still something known only within the CFS community. WHY?????
What little is taught about CFS in medical school tends to reflect the professor's own opinion, and not the facts. The professor learned back in the 1980s when he was in medical school that it was a disease affecting only spoiled Yuppie women, or depressed menopausal women, and that's what he's teaching, oblivious to the scads of evidence that this is not true.
We need more professors likeLenny Jason who set out to prove to the students that what they may have learned from some other professor is inaccurate. Textbooks need to be changed (rumor has it that there's only one paragraph about CFS, and it's inaccurate information).
I know most patients are hard-pressed to get through life as it is, but perhaps some of our healthier/more mobile patients could pay a personal visit to their nearest medical school to answer students' questions and enlighten them to the facts -- the 5000+ research studies showing objective, quantifiable abnormalities, the neurological involvement that wouldn't be apparent on basic blood tests, etc. If their professors aren't teaching them the truth, then the patients have to.
* * *
On a related topic:
From Joanne joanne@BRAYDEN.ORG :
Medscape Continuing education credits for doctors
CME
Therapeutic Advances for Fibromyalgia and Implications for Clinical Practice
Daniel J. Clauw, MD; Don L. Goldenberg, MD; and Hartej Sandhu, MD, discuss
some of the recent therapeutic advances for fibromyalgia and their
implications for clinical practice
http://www.medscape.com/viewprogram/8307
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