Based on information from four medical schools, medical schools rarely address ME/CFS in basic instruction or as case studies.
The University of North Carolina School of Medicine is ranked second in primary care in the 2017 U.S. News and World Report. Kurt Gilliland, PhD, is its assistant director of curriculum and evaluation. When interviewed, he stated that he didn’t know whether ME/CFS was in the curriculum, but added that the focus is on diseases appearing on the U.S. Medical Licensing Examination. Other neurological disorders are on the exam, including Parkinson’s and multiple sclerosis, but ME/CFS is not.
Along with basic anatomy and physiology, students receive clinical instruction, Gilliland said. Three hours a week, students also learn how to interact with patients, take a medical history, and conduct a physical to determine a diagnosis – all without covering an illness that affects approximately 1 million Americans.
The University of Nebraska Medical Center College of Medicine is ranked fifth in primary care in the 2017 U.S. News and World Report. Gary Beck Dallaghan, PhD, is its assistant dean for medical education and director of its Office of Medical Education.
“Students are trained on how to take complete histories and physical examinations,” he said. “They are coached on how to keep an eye out for things that may be a source of the illness.”
However, the preclinical curriculum doesn’t include ME/CFS. Dallaghan said rotations in clinics “will hit on this when a patient is either diagnosed with ME/CFS or is presently under treatment for it.”
This presumes, however, that the students in clinic will have a chance encounter with a patient who has ME/CFS – likely – but that the individual will have the diagnosis of ME/CFS – far less likely, since it has been estimated that approximately 80% of those with the illness go undiagnosed.
John O’Donnell, MD, MS, FACP, director for preclinical curriculum at Michigan State University College of Human Medicine, described his institution’s preclinical curriculum as “problem based.”
Students practice diagnosing illnesses with and without biomarkers while learning basic sciences by solving case studies, called paper cases. To prepare to diagnose illnesses not covered in paper cases, including ME/CFS, O’Donnell said students learn how to obtain a medical history and conduct a physical that includes asking questions about every organ system and about constitutional symptoms, meaning symptoms affecting overall well-being.
If College of Human Medicine graduates encounter an illness they cannot diagnose, “we expect them to go to what we consider to be reliable resources,” O’Donnell said. He said an example of such a resource is UpToDate, a subscription-based, online collection of medical information. It frequently cites journal articles and is written, edited, and reviewed by physicians, according to its About page.
Despite being an osteopathic medicine school, the College of Osteopathic Medicine at University of North Texas Health Science Center also has little coverage of ME/CFS in its curriculum. Osteopathic medicine schools grant the degree Doctor of Osteopathy, or DO, rather than MD. Their medical training is as rigorous as MD-granting schools’ training; what differs is their underlying philosophy, which focuses on integrating all techniques that serve the patient. The College of Osteopathic Medicine is ranked number two in primary care among osteopathic medicine schools in the 2017 U.S. News and World Report.
“[ME/CFS] is not something that we deal with significantly,” said Michael Oglesby, a professor of pharmacology and the second-year curriculum director, citing limited space and time in the curriculum of the first two years. He added that ME/CFS may be addressed in years three and four or during residency.
All students diagnose by combinations of history, physical examination, and then lab work. “The lab is the definitive diagnosis. The initial is almost always done off the history and physical,” Oglesby explained.
Differential diagnosis, considering possible causes of a set of symptoms to identify which best fits a clinical presentation, is taught primarily in years three and four, Oglesby said. Many illnesses have overlapping features, requiring physicians to conduct differential diagnosis when diagnosing illnesses like ME/CFS.
“That is why they are difficult to diagnose. They have very few distinguishing features,” Oglesby said.
This lack of training by some of the top medical schools in the country highlights the urgent need for better training for clinicians to help them understand the illness, diagnose ME/CFS swiftly and accurately, and provide sensible, symptom-based treatment recommendations while medical research continues to work towards a cure. Visit the #MillionsMissing protest demands to learn more.
To read the next article in our series on medical education in ME/CFS, click here.
#MEAction would like to thank Darla N. for her investigative reporting in this series! Read the stories in order by clicking on the links below: