With the Medical Licensing Assessment coming into effect in 2024-2025, medical schools across the UK will be preparing to teach ME/CFS for the first time, and they will find themselves facing a conundrum: which class or subject area does the condition fit into, and which educators are best-qualified to teach it?
ME/CFS is a multisystem illness; research has shown that people with ME/CFS have abnormalities in their nervous, immune, and cardiovascular systems, and at the cellular level there are disturbances to the biochemical pathways which produce ATP.1 Moreover, ME/CFS can be viewed as a post-acute infection syndrome;2 it has historically occurred in outbreaks, and up to 75% of ME/CFS patients report an infectious onset.2 Its etiology is unknown.
All this suggests that ME/CFS could reasonably belong to any number of medical specialties or subject areas including cardiology, immunology, and infectious diseases. However ME/CFS tends to be viewed as an ‘orphan’ disease which has not been claimed by any medical specialty.
In practice, GPs are responsible for diagnosing and managing ME/CFS. Specialist ME/CFS services do exist in some parts of the UK, but (with a few exceptions) they are staffed by occupational therapists or nurses, not by doctors, and are unable to provide medical advice or treatment.
The GMC requires that training on ME/CFS be included in post-graduate programs on: Paediatrics Specialty Syllabus, Paediatric Rheumatology, Immunology Curriculum, Infectious Diseases curriculum, Tropical Medicine curriculum, Liaison Psychiatry, and Curriculum for Acute Internal Medicine.3
When it comes to undergraduate training, it seems that medical schools will have to decide for themselves which classes ME/CFS should be included in and who should teach it, perhaps in consultation with the Medical Schools’ Council.
References
1. Marshall-Gradisnik S, Eaton-Fitch N. Understanding myalgic encephalomyelitis. Science. 2022 Sep 9;377(6611):1150-1151. doi: 10.1126/science.abo1261. Epub 2022 Sep 8. PMID: 36074854. https://www.science.org/doi/10.1126/science.abo1261
2. Choutka, J., Jansari, V., Hornig, M. et al. Unexplained post-acute infection syndromes. Nat Med 28, 911–923 (2022). doi:10.1038/s41591-022-01810-6.
https://www.nature.com/articles/s41591-022-01810-6
3. Rosie King, personal communication.
ME/CFS Medical Education Campaign 