A Medical Student Curriculum on Functional Medical Disorders 2025 Butt et al

Andy

Andy

Retired committee member

ABSTRACT​


Background​

Functional medical disorders (FMDs) refer to persistent physical symptoms that cause impairment or disability, but which cannot be explained by routine medical testing. Negative perceptions towards FMDs exist amongst a variety of healthcare professionals, including medical students. The aim of this study was to develop and evaluate a course addressing FMDs for medical students in their first year of clinical training, which was integrated within the formal medical school curriculum.

Approach​

A multidisciplinary team of eight healthcare professionals delivered seven teaching sessions, each two hours in length, over six weeks. The curriculum was delivered via a combination of didactic teaching, small group tutorials and sessions with simulated patients. Pre- and post-course validated questionnaires assessed knowledge of, attitudes towards and confidence around irritable bowel syndrome (IBS). Students undertook a two-station objective structured clinical examination (OSCE), which assessed their ability to take a clinical history from and communicate a diagnosis to simulated patients with IBS and fibromyalgia.

Evaluation​

Twenty-seven students completed the pre- and post-course surveys, which demonstrated an increase in knowledge of FMDs at course conclusion (88.89% vs. 57.50%, p < 0.001). Students' confidence ratings increased in all (100%) domains relating to FMDs: pathophysiology, symptoms, investigations for diagnosis and communicating a diagnosis (p < 0.001, all analyses). There was a statistically significant improvement in attitude ratings towards FMDs in 11 of 12 (91.7%) questions. All (100%) students passed the OSCE.

Implications​

A course integrated within the formal medical school curriculum may be a helpful way to improve knowledge and reduce stigma around FMDs.

Open access
 
The question is whether this will benefit patients and reduce stigma for them.

For example, I find the idea that I'm continuing to suffer from symptoms and disability because I'm somehow failing to manage my emotional problems (this is roughly the idea in some models of unexplained medical symptoms) to be stigmatizing. I don't agree with this and don't want people in positions of authority going around telling this false story about myself.
 
The paper said:
Functional medical disorders (FMDs) refer to persistent physical symptoms that cause impairment or disability, but which cannot be explained by routine medical testing
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That's quite an expansive definition they got here. What even is "routine medical testing", and who decides what is and what falls in the specialist medical testing? Because that definition would include a lot of diseases that aren't discriminated as being fake, but can't be identified with routine testing.

But I can't get over how silly fake studies like this are: asking whether it's possible to present information, and have professionals repeat it back, then grade it based on how close to what they said in the first place the answers are. It's even more silly when done in the context of medical school, which almost entirely consists of that. It's such a fake "going back to basics", pondering deep philosophical questions such as "what is energy?" and "can one use energy?" in the context of whether al electric plug should be 10A, or 20A. It's so fake.

However, the silly crown here goes to the idea of whether teaching overt bigotry could possibly lessen the stigma that the bigotry imposes. They are literally pretending that up is down here, that it's not teaching and practicing psychosomatic ideology that is the cause of stigma caused by it, when it's literally all over their own literature that it's obviously the opposite.

Also, maybe an odd question but I expect the answer to this to be quite ridiculous: why would this training module have a basic explanation about what the biopsychosocial model is? We keep hearing about how modern health care is biopsychosocial, so clearly it must be taught throughout the entire curriculum, practical training and certification process? Obviously when doing specialized modules in computer science, no one takes the time to explain the basics of what binary is.

Of course the obvious answer to this is that it's complete BS that modern health care is biopsychosocial, mainly because BPS literally adds nothing, it's fully alternative medicine. I'm just very annoyed at how blatant the lies are. How everyone knows this is all BS but no one ever seems to find the courage to object to it. The emperor's clothes are magnificent, the training module vividly explains it, so everyone answers 'correctly' that the clothes are amazing. That is called... teaching. Good grief.

Also, weird, but somewhere in the paper there is a quote from... the paper. There is a self-congratulatory paragraph about why this study is great, then right below is the first sentence of that paragraph in large quotation marks. That's just weird. Whatever.
Jonathan Edwards said:
So it was entirely counterproductive, since what students need is humility, uncertainty and acknowledgement of ignorance.
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Professor, I am disappointed in you. Obviously the goal in life is to be more confidently incorrect. Confidence rules, we need more confidence men and women. Who needs to be correct, when we can simply have more people be more confidently incorrect? It's just common sense that it will lead to more people being correct.
 
The fourth reference is an error that needs to be corrected. It says these disorders account for 10% of the total NHS budget. The relevant study, which is itself a problem, said it was 10% of NHS expenditures on working age people. That's about 3% of the total NHS budget. Several papers had to be corrected when I pointed this error out. This one will also need to be corrected.
 
They're a bit out of date on FND too.

  1. Define functional neurological disorders: Define functional neurological disorders and distinguish them from organic neurological conditions based on the absence of structural abnormalities and the presence of neurological symptoms that are inconsistent or incongruent with known neurological diseases.
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Structural alterations in functional neurological disorder and related conditions: a software and hardware problem? (2019)

Reduced microstructural white matter integrity is associated with the severity of physical symptoms in functional neurological disorder (2025)

Incongruence in FND: time for retirement (2024)
 
Jon Stone discriminated as —

Inconsistency usually refers to inconsistency between movement, sensory or cognitive performance in a voluntary versus an ‘automatic’ scenario. This is the principle of Hoover’s sign of functional leg weakness, the tremor entrainment test for functional tremor and a range of cognitive tests in functional cognitive disorder.
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Incongruency, on the other hand, refers to a clinical feature that is not present in other superficially similar neurological conditions, or that apparently violates laws of anatomy, biology or physics. I have always struggled with incongruency in FND but now am breaking my silence, assisted by the intriguing case of a patient with ‘functional freezing of gait’ from Jorik Nonnekes and colleagues in this issue of Practical Neurology.
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So I guess incongruence is "this doesn't make sense given what we (think we) know". Inconsistent sounds ostensibly more straightforward in that behaviour is shown to be different under the voluntary vs automatic scenarios. However I think that's similar to incongruent in that we think the voluntary vs automatic pathways should behave the same with similar outputs but observe that they don't, ie incongruent with "what we know" - therefore "FND". In reality, that could perhaps be due to some problem with myelin or synapses that we haven't quite worked out.
 
Fibromyalgia s finally getting some proper research

Unlocking the mystery of fibromyalgia | Research | University of Liverpool

Understanding the biological basis for fibromyalgia could help transform treatment options for patients. Find out the research we're undertaking to achieve this.
www.liverpool.ac.uk www.liverpool.ac.uk

"Fibromyalgia (FMS) is a chronic pain condition affecting more than 2% of the UK population, characterised by widespread pain, fatigue and brain fog.
Like many other chronic pain conditions, it is often considered a “functional neurological disorder” but current treatments such as cognitive behavioural therapy and physical exercise have limited efficacy."


"Challenging convention
Dr Andreas Goebel, Director of the University’s Pain Research Institute and an Honorary Consultant in Pain Medicine at Walton Centre NHS Foundation Trust tells us “Fibromyalgia does not cause tissue destruction but is hugely debilitating and expensive - many people can’t function in their daily lives and can’t work.
"Like other unexplained chronic pains, fibromyalgia has often been thought of as psychological, with many patients told their pain symptoms are ‘all in their head.'
That a patient’s own antibodies could cause these symptoms and that this could be tested using ‘passive transfer’ experiments were ideas I first developed 20 years ago in Liverpool while researching complex regional pain syndrome (CRPS). These ideas went on to lay the groundwork for this landmark fibromyalgia study.”

Fibromyalgia patients from the Walton Centre’s Pain Management Programme donated blood for the project so that their antibodies could be extracted.
The researchers injected mice with these antibodies and observed that they rapidly developed an increased sensitivity to pressure and cold, as well as displaying reduced movement grip strength. In contrast, mice that were injected with antibodies from healthy people were unaffected, demonstrating that patient antibodies cause, or at least are a major contributor to the disease.

"Our work could also have potential for fundamental, disruptive developments in the understanding and treatment of other ‘unexplained’ symptom-based disorders, such as long Covid.”


(Sorry, with new update I can't see how to quote block on my iPad!) advice welcome)

Edited to add:
"Like other unexplained chronic pains, fibromyalgia has often been thought of as psychologicaL”. Seemingly on no grounds other than it’s unexplained. This is unacceptable “psychological of the gaps” explanation that has somehow taken over medicine and held back research for the chronically disabled (women). It’s not thought psychological because of positive evidence or because that which is supposed to work as psychological treatments work, to support a mysterious mind connection, but because it’s unexplained (and female predominant)
 
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Andy said:

ABSTRACT​


Background​

Functional medical disorders (FMDs) refer to persistent physical symptoms that cause impairment or disability, but which cannot be explained by routine medical testing. Negative perceptions towards FMDs exist amongst a variety of healthcare professionals, including medical students. The aim of this study was to develop and evaluate a course addressing FMDs for medical students in their first year of clinical training, which was integrated within the formal medical school curriculum.

Approach​

A multidisciplinary team of eight healthcare professionals delivered seven teaching sessions, each two hours in length, over six weeks. The curriculum was delivered via a combination of didactic teaching, small group tutorials and sessions with simulated patients. Pre- and post-course validated questionnaires assessed knowledge of, attitudes towards and confidence around irritable bowel syndrome (IBS). Students undertook a two-station objective structured clinical examination (OSCE), which assessed their ability to take a clinical history from and communicate a diagnosis to simulated patients with IBS and fibromyalgia.

Evaluation​

Twenty-seven students completed the pre- and post-course surveys, which demonstrated an increase in knowledge of FMDs at course conclusion (88.89% vs. 57.50%, p < 0.001). Students' confidence ratings increased in all (100%) domains relating to FMDs: pathophysiology, symptoms, investigations for diagnosis and communicating a diagnosis (p < 0.001, all analyses). There was a statistically significant improvement in attitude ratings towards FMDs in 11 of 12 (91.7%) questions. All (100%) students passed the OSCE.

Implications​

A course integrated within the formal medical school curriculum may be a helpful way to improve knowledge and reduce stigma around FMDs.

Open access
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What a two faced agenda

This is a stigma they are systematizing and inculcating early on so no one can see the basics fir what they are as they are told what to see before they see it

I hate the word stigma as it’s a belittling of removing access to life, rights and existing in a constant stream of aggression and blocks at every little moment of our day so that we can’t survive and can’t keep ourselves safe

And this is what this person is selling whilst pretending to those having to do exams in it that it’s ’stigma reduction’ to siphon out the undesirables to never access any real services or get any normal conversation with anyone in any service but be talked at with ‘a special voice and patter’ and pretended to be listened to whilst notes are cherry picked and made up on them. Because their face fits to some description some person somewhere made up on someone they met once and didn’t think much of. So all from a similar demographic should be pushed out of life and community.

Sorry but this is about power and naming a few groups they want to take all rights from

They don’t deserve to even have the details listened to or looked at ‘it’s just a bucket’ and that message oozes through this as a big old agenda. Don’t let them access healthcare whatever they have. Cos they might also have this fictional thing so it’s not worth looking at their blood issue or bad knee. Both of which are worth fixing in wirthybothers.

It’s about rationing all right. But I’m not sure it’s about saving money. And sadly we’ve certain professions and specialties who have gone off the rails and focus on ‘dealing with and proposing how the undesirables should be chosen’ and not medical care or any of the economics to do with it.

They have to sell to the world there are people who are a problem for them in order to make their fortune as the bouncers and jailers etc ‘cheap at any cost’

There is always a line or two in these things that basically suggest a target to gatekeepers along with a description based on nothing medical eg one in ten of your patients and females 16-60yrs old. Then suggesting they make some trauma for their notes.

I cannot believe people are allowed to write such divisive political policies for such groups with no evidence that will affect them life long with no evidence or science first whatsoever, so they getaway with using bigotry as a theory to then prime people’s assessment of such groups. And manufacture answers they want.

That’s what this seems like.

It’s not a medical document it’s a nasty political ideology being implemented by weaponising the weaknesses of/for and power + lack of oversight of this massive industry of healthcare. Which pretends it’s deciding who is true or gets to exist as themselves based on medicine something. But it’s ten seconds judgement when someone enters an establishment having been singled out as prey by these types of targets.


Ps nearly all other workplaces are legally having to focus their training on telling people NOT to bring in these ‘biases’ and to become conscious and aware of their own bigitrues they’ve had mis sold to them.

What sort of profession of professional revels in instigating this nonsense instead in order to create embedded problems for entire generations?

I hope this acts as paperwork for lawyers to use against these people as evidence of taught systemic isolating and bigotry and removal from access to service ‘by ten second judgement without even looking at their issue’ etc - instead of their clear intentions to try and cover up deliberately baked-in discrimination, bigotry and other failures ‘by pretending it’s evidenced’ and as if it’s always been ok cos look these people we pick on, here’s some made up reasons why they deserve it, and it’s not just one of us that did it so how are you going to prosecute when it’s hard to pinpoint the blame to one person etc

I guess somehow someone is going to one day have to go after ‘all involved’ in certain cases (class action for all those fished out based on x initiatives?) and make sure all get tarred and have penalties - in order that within the profession and systems there starts being moral backstops because professionals are expected to take personal responsibility for the part they choose to play if they choose not to do the right thing instead or at least insist their disagreement is logged in notes if they are ordered to do it anyway.

These systems are trying to be black boxes it feels from listening eg to Maeve’s inquest by pretending it’s all just a mess

but there are papers on these functional things eg from college initiatives that seem to suggest schemes on various wards with designated staff to swoop in and swoop away certain ‘fubctionals’ even if normal staff thought better. So such staff currently operate under that tyranny themselves if they want to do their job morally and wisely instead .

Or sneaky policies that are about excluding minority groups from treatment based on face doesn’t fit papers suggesting they get a different special path etc

Those who put these in place should be able to read science properly so they aren’t being conned by ideologists or if they aren’t then able to make choices not based on science but use fake papers to pretend it is etc. And they should be open to prosecution for it and have to justify it in a court that is also scientifically literate enough to see through this for the bringing in of bigotry that it is.

I don’t know how that is put together but it’s long overdue that there are proper swift ombudsman stopping this crap at source

And it obviously overlaps with further afield policy eg in insurance or other services. But is at class action / policy level yet left for individuals left harmed to fight a defensive system on their own
 
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This was authored by a Nottingham team.

The paper is published in 'The Clinical Teacher'. This seems to be a Wiley publication, with Wiley being Cochrane's publisher, the one who didn't seem to mind slapping a new publication date on the Larun et al review. This is from the webpage with the paper:

Screenshot 2025-06-29 at 10.00.56 pm.png

Strangely, there is a phrase beside the ASME logo "Cochrane Gracing". I don't know what that means, I can't seem to find out. It could be interesting to check out what other sorts of papers 'The Clinical Teacher' publishes.
 
This study was approved as an educational evaluation by the University of Nottingham and was exempt from formal research ethics review (FMHS 44-1023).
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We've been seeing quite a bit of this lately - both
1. a focus on inculcating BPS ideas in the next generation of medical students, and
2. no ethics approval required, because the research is deemed to be an evaluation. And, I guess it is, it's not really research, despite being published as such.

But, there are certainly ethical issues here that could have done with a review. Can you teach medical students any old made up thing and then require them to regurgitate what they have learned back in the assessments of learning? The medical students are mostly going to want to pass their assessments, so they will probably write what is expected, including about how wonderfully useful they found it all.
 
It strikes me that there is a basic fallacy in the idea of biopsychosocial or functional illnesses that goes something like this:

There cannot be any biopsychosocisl diseases or illnesses. There can only be biopsychodocial circumstances for an individual person's illl health.

This is because the idea of a disease or illness that affects many people is defined only by some common causal step P. P may come about through a range of paths like A>C>F>P or B>C>G>P or many other variants. P may also give tise to a range of effects P>R>V>Y+Z or P>Q>W. But the disease concept is simply the step P.

Someone with TB may have caught it working in a clinic in rural India. But being in rural India is no more TB than it is skin cancer or amoebiasis. TB is just being infected with M. tb. Someone with diabetes may have become overweight working in a cake shop but diabetes is only impaired glucose tolerance.

The point of this is that you cannot invent a disease that has no defined P or even a syndrome with no reason to posit a P. Any biopsychosocial story is not a P so cannot provide a distinct disease concept. It is by definition a mirage.

This educational material is written by people wanting students to take seriously nothing more tha a trick of the light on hot sand - and in this case deliberately induced by the profession to lure unsuspecting travellers.

If there is such a thing as irritable bowel syndrome it is either bio or psycho or social- not all three. And it cannot be defined simply as unexplained because there is no reason to think unexplained illnesses are all the same P.
 
Utsikt said:
I’m able to make sense of all of the rest of the comment, but what do you mean here?

What does a psycho or social disease look like?
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Twitter/X usage is a social disease. Gambling might be a psychological disease. Or voting for certain political parties. I might agree with you that irritable bowel syndrome is unlikely to be a social disease but I cannot form an opinion because nobody knows what the name means. And that is because it has no P. Only a mirage of having a P.

"ME" as defined by Acheson may have been a pathological psychological state of doctors suggesting to patients that they had some weird polio-like illness. The illness only existed in journals. Perhaps irritable bowel syndrome is something similar, but it is deliberately bereft of any defining concept.
 
Thank you.
Jonathan Edwards said:
Twitter/X usage is a social disease. Gambling might be a psychological disease.
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So they are psycho or social because they mostly relate the concepts «psycho» and «social»?

Although wouldn’t gambling be a physical disease through addiction mechanisms in the brain? I also think the same could be said for most social media usage, it’s mostly designed to keep our attention through various means like frequent and instant gratification, emotions that makes us react (mostly anger and fear).

It could almost be argued that social media usage is more of a technological disease than a social one.
 
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