UK medical schools fail to provide adequate training on eating disorders

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EatingA study of all Britain’s medical schools has revealed that medical students receive less than two hours of training on eating disorders over four to six years of undergraduate study, which experts and the UK’s eating disorder charity Beat warn is putting patients’ lives at risk.

The research is the first comprehensive analysis of the extent of training on eating disorders in the UK. Surveying all medical schools in the country, it finds that the average teaching and assessment time on eating disorders in undergraduate courses amounts to just 1.8 hours, and one in five medical schools do not offer any training on eating disorders at all.

Of the 33 universities offering medical degrees, only six offered placements in specialist eating disorder units for children, and seven in units for adults, and even these placements were limited to six to twelve students. This means just 1% of doctors have the opportunity for clinical experience on eating disorders, and even see how the theory translates to clinical practice.

The research also highlights the severe lack of specialist training posts, with just 17 such posts dedicated to training clinicians to treat eating disorders. Sufferers of eating disorders should be referred to specialist services and should not be treated in general mental health units, but the lack of specialist training placements will only add to shortage of specialist clinicians.

This research comes in the wake of a UK 2017 Parliamentary and Health Service Ombudsman (PHSO) inquiry into the deaths of three people with eating disorders, which concluded that lack of training was one of the factors that contributed to the tragedies.

The lead author of the research, Dr Agnes Ayton at Oxford Health NHS Foundation Trust, said: “Tragedies such as those outlined in the PHSO inquiry should not happen, people should not die from eating disorders and the lack of eating disorder training for our doctors is contributing to the risk to patient safety.

“Too often under-trained doctors only look at the physical symptoms like weight, or do not recognise that someone is ill at all. Patients end up not getting the treatment they need and suffer unnecessarily.

“Medical schools are treating eating disorders as a niche subject, despite the fact that they affect 1.25m people in the UK and cost the NHS hundreds of millions of pounds. Improved training would save lives at a minimal cost to the NHS.”

People suffering with an eating disorder have told Beat how doctors’ knowledge of eating disorders, or lack of it, can be the difference between continuing to suffer and recovery. In a survey of 1,700 people in 2017, only 42% felt that their GP understood eating disorders and only 34% believed their GP knew how to help them with their illness.

One sufferer described her first visit to a GP who had clearly had little or no training on eating disorders: “They told my mum that my not eating was a phase I would grow out of and sent us away with a meal plan cut from the back of a cereal box. (…) Since then I’ve had staff in general psychiatric wards tell me that I don’t look like I have an eating disorder, which has been very triggering and difficult.”

Others spoke of doctors whose understanding of eating disorders enabled them to make appropriate referrals. One patient described this as: “…a huge help to my recovery and a major factor in me not requiring inpatient treatment later on.”

Beat’s director of external affairs, Tom Quinn said: “We know that the best way of dealing with an eating disorder is early treatment. All doctors should leave medical school equipped to recognise eating disorders and stop them in their tracks by making appropriate referrals.

“We are calling on the General Medical Council to review training of eating disorders for junior doctors as recommended by the PHSO. We need to see questions on eating disorders in all medical students’ exams. Only with adequate training covering the psychological and physical aspects of these serious mental illnesses can doctors protect patient safety.”

Abstract
Background: Eating disorders affect 1%–4% of the population and they are associated with an increased rate of mortality and multimorbidity. Following the avoidable deaths of three people the parliamentary ombudsman called for a review of training for all junior doctors to improve patient safety.
Objective: To review the teaching and assessment relating to eating disorders at all levels of medical training in the UK.
Method: We surveyed all the UK medical schools about their curricula, teaching and examinations related to eating disorders in 2017. Furthermore, we reviewed curricula and requirements for annual progression (Annual Review of Competence Progression (ARCP)) for all relevant postgraduate training programmes, including foundation training, general practice and 33 specialties.
Main outcome measures: Inclusion of eating disorders in curricula, time dedicated to teaching, assessment methods and ARCP requirements.
Results: The medical school response rate was 93%. The total number of hours spent on eating disorder teaching in medical schools is <2 hours. Postgraduate training adds little more, with the exception of child and adolescent psychiatry. The majority of doctors are never assessed on their knowledge of eating disorders during their entire training, and only a few medical students and trainees have the opportunity to choose a specialist placement to develop their clinical skills.
Conclusions: Eating disorder teaching is minimal during the 10–16 years of undergraduate and postgraduate medical training in the UK. Given the risk of mortality and multimorbidity associated with these disorders, this needs to be urgently reviewed to improve patient safety.

Authors
Agnes Ayton, Ali Ibrahim

Beat material
BMJ abstract


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