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1. Medically unexplained symptoms (MUS) and
intercultural competences (IC)
An E-learning educational program for students in
health sciences

2. Prof. Márta Csabai
Clinical and health
psychologist, 30 years of
experience of medical and
psychology teaching, research
on MUS, and patient care
marta.csabai@psy.u-szeged.hu
Lilla Lucza
Psychologist, PhD student,
2 years of experience in
research and education on
MUS and intercultural
competencies
lilla950407@gmail.com
Moderators (from Hungary, University of Szeged)
General medicine
Dental
Pharmacy
Nursing
Physiotherapy
&
Psychology
STUDENTS
BSc / BA/ MSc / MA / one cycle
Master’s program
University of Porto, Lund University,
Université Paris-Saclay, Ludwig-
Maximilians University, University of
Szeged

3. Where are you from and what are you
studying?
Answer through Mentimeter!
• QR code
OR
• Link:
https://www.menti.com/fnp4os5zjp
OR
• Menti.com and voting code: 81 36 45

4. MUSIC
Searching for
existing
interventions
Competency
profile
Education
programs on
all levels
Needs
assessments
…to better prepare European
doctors for their daily clinical
encounters with culturally
different MUS patients…
Medical Education on Medically Unexplained Symptoms and
Intercultural Communication (MUSIC) project

5. Pre-course
questionnaire link
https://forms.gle/6ey5p
sVr83Nuhje49

6. Dilemmas of the doctor
Simulation?
Hypochondria?
Inadequate
diagnosis?
Does she just
imagine?
A mental result of
a physical
problem?
Physical
expression of a
mental
problem?
Design@ Bill Cayley, MD

7. Medically unexpalained symptoms OR…?
Scientific discussion for decades and yet there is no evidence-
based consensus. In many cases there is inconsistency and
conceptual confusion.

8. Background - MUS
• MUS* patients: in primary care 30-50% and the
treatment is difficult for doctors  Increasing need
for trainings (Johansen & Risor, 2017; Joyce et al., 2018; Maatz et al,
2016; Sirri et al., 2017; Weiland et al., 2015; Yon et al., 2015)
• Potential healthcare savings on time and money
(Burton et al., 2012; Croicu et al., 2014; Nimnuan et al., 2001; van der Weijden
et al., 2003; Verhaak et al., 2006)
• Cultural factors relate to MUS (e.g. non-Western,
refugee or ethnic minoritie background) + Global
changes (immigration and multicultural social
structure) (Löwe & Gerloff, 2018; Marek & Németh, 2020; Pop et al.,
2012; Rohlof et al., 2014; Valero-Garcés, 2014; Verhaak et al., 2006)
*MUS: even after proper
medical examinations the origin
remains unclear, somatic and /
or psychiatric pathology can be
adequately excluded (e.g.
headache, digestive problems).
 Can become chronic
syndroms in 20 to 30% of these
patients (e.g. irritable bowel
syndrome)
(Biopsychosocial factors)

9. Special challenges with MUS patients worldwide
Negative
emotions
Doctors: lacks of competence; shame; fear; frustration; helplessness;
anxiety; uncertenity
Patients: pain; not understood; lacks of empathy and acceptance
(Aiarzaguena, et al, 2013;
Czachowski et al., 2011;
Stone, 2014; Weiland et al.,
2015; Yon et al., 2015)
Problematic
attitudes
Doctors: not a real illness; because of laziness and bad coping; their own
fault and responsibility; patients need organic explanation
Patients: doctors need organic explanation
(Åsbring & Närvänen, 2003;
Brauer et al., ,2017; Kende et
al., 2005; Stenhoff et al.,
2015)
Lack of
knowledge
Appropriate level of investigations; Possible psychological comorbidities;
Explanations for patients' symptoms (only biological - immune or genetic-
reasons, only personality reasons); Long-term treatment strategies
(Stenhoff et al., 2015; Yon et
al., 2015)
Missing models
Accepted and congruent MUS explanatory models and treatment
strategies
(Aiarzaguena et al., 2007;
Czachowski et al., 2011;
Rosendal et al.,2005; Stone,
2014; Johansen & Risor, 2017)
Healthcare
system
General practitioner's negative image as professionals, Hard continuous
doctor–patient relationship; Limited resources and access to specialists;
Lacks of a multidisciplinary primary care team
(Czachowski et al., 2011,
Löwe & Gerloff, 2018)

10. What makes the
situation even
more challenging?

11. Tell us an example or experience!

12. Background - Intercultural Competence
• Cultural diversity  need for understanding,
sensitivity, and cultural competence (Pop et al., 2012;
Valero-Garcés, 2014)
• Communication barriers and other challenges in
the provider-patient relationship (Johnson et al., 2004;
Obeng et al., 2015; Valero-Garcés, 2014)
• WHO (2015) - Developing culturally sensitive
health care
• International scientific literature in recent years
draw attention to the key role of
in healthcare (Brislin & Horvath, 1997;
Leyerzapf & Abma, 2017; Marek & Németh, 2020; Pop et al., 2012; Zhang & Zhou,
2019)
is the ability to
mobilize our resources
(emotions, skills,
knowledge) to do well
in intercultural
situations
(Pop et al., 2012).

13. is an important part and a main determinant of
a higher-level of IC (Chen, 1997; Chen & Starosta, 1996; Hammer et al., 2003)

14. Treatment recommendations
• A detailed exploratory diagnostic interview: exploring patient’s ideas, concerns, and
expectations
• Biopsychosocial approach and the importance of cultural background
• Limiting unnecessary investigations and diagnostic tests
• Explaining and understanding in communication: providing a targeted and tangible
explanation, psychoeducation
• Patient-centredness, personalized treatment
• Provide some practical and constructive advice regarding daily lives
• Clarifying the most appropriate treatment options
• Involvement of other professionals, psychologists, therapists  multidisciplinary
treatment
(Brownell et al., 2016; Cooper et al., 2017; Czachowski et al., 2011; Edwards et al., 2011; Löwe & Gerloff, 2018; olde
Hartman et al., 2017)

15. E-learning program on
medically unexplained
symptoms (MUS) and
intercultural competencies (IC)

16. Main features of the program
Issues behind:
• Not enough time in medical training
• Teachers’ uncertainties and negative attitudes
• COVID-19 pandemic  online teaching
• International online availability (through the project website)
• Our primary target groups: university BA/MA students (medical / psychology / physiotherapist)
• 30-hour course
• Due to research ethics and legislation: the program doesn’t store personal data and answers 
CREAT YOUR OWN DOCUMENT TO TAKE NOTES!!!
Finset, 2018; Joyce et al., 2018; Lyles et al., 2003 Stenhoff et al., 2015
A freer-to-use and
more widely available
e-learning program in
English that helps the
teachers too

17. About the program
Program developers:
Prof. Márta Csabai (coordinator and Modul 4)
Dr. Melinda Látos (Modul 1)
Dr. Ágnes Kuna (Modul 4)
Lilla Lucza (Modul 2, Modul 3 and corrections)
+ IT specialist (technical execution)
Built up according to:
• Didactic and interactive parts
• Target knowledge, attitudes and skills
• Cooperative and individual learning
• In classroom settings under the guidance
of a teacher or by yourself
• To the widest possible audience
Task options:
„DID YOU KNOW?”
„MAKE YOUR OWN NOTES”
„TEAMWORK”

18. Title of the Module Aim of the Module
Number of
exercises
Exercise types
Module 1
Health, culture and doctor-
patient relationship
Mobilization of existing
knowledge and attitudes,
Arouse interest
7
case descriptions and their evaluation, own
health assessment and development, true-
false statements, role-play and reflection,
opinion-forming and discussion
Module 2
a) MUS, b) IC,
c) Empathy,
d) Patient-centeredness
Deepen individual
knowledge and
proficiency, Self-
reflection: own attitudes
and skills
a) 2
b) 2
c) 2
d) 2
reviewing informative didactic texts,
forming opinions and discussions, testing
one's own attitudes and skills with
measurement tools, reflection
Module 3
a) Explaining MUS in
context
b) MUS management
Deepen individual
knowledge and
proficiency, Attitude and
skill development
a)4
b)3
reviewing literature, true-false statements,
opinion-forming and discussion, personal
case discussion, role-play, use of guidelines,
creation of dialogues
Module 4
What happens when cultures
meet? Doctor-patient
encounters in cultural
context
Mobilization of existing
knowledge and attitudes,
Attitude and skill
development
8
opinion-forming and discussion, sorting
possible scenarios, character building,
playing with characters, role play, evaluating
statements, analyzing interviews, creating
situational dialogues, true-false statements
Structure of the e-learning program modules

20. „MAKE YOUR OWN
NOTES” & „TEAMWORK”

21. YOUR ONLINE
STUDY GROUP
• Breakout room partners –
10 minutes
• Ask for each other’s
contact information!
• E.g. create group chats
/mailing list / Google drive /
Facebook group…

22. + http://mups-music-
learn.eu/

23. How to go through the e-learning program
Step 1: You complete each
module on your own while
taking notes for yourself.
Step 2: After completing all
modules individually, the online
study group meets for a longer
period of time and goes through
all the exercises related to the
teamwork parts of the program.
Step 1: You complete the first
module / Module 1 on your own
while taking notes for yourself.
Step 2: After completing the first
module individually, the online study
group meets for a shorter period of
time and goes through the the
teamwork parts of Module 1.
Then similarly with Module 2,3, &
4…
OR

24. Breakout
rooms 
Online study
groups
Group1: Mohsen, Thanh Binh, Valentin, Zaid, Rita
Group2: Ali Moll., Bálint, Iman, Nizar, Margarida
Group3: Mariam, Réka, Rona, Vijayalakshmee
Group4: Samuel, Osama, Ali Mir.

25. Additional suggestions
• Take your own notes in a separate (word) document while you are working on your own, so
later you can share your ideas and solutions with your online study group during your teamwor.
• No classroom and groupleader  so you and your online study group can skip some inadequate
teamwork exercise part.
o Modul 1 - Exercise 4-5; Modul 3A – Exercise 1; Modul 3B – Exercise 1
• Be aware:
o Module 3A – Exercise 3: the task instruction is not visible: „Choose a study that has aroused
your interest from the bibliography of the article 3A ('Explaining Medically Unexplained
Symptoms' and read it! „
o Module 3B: the last dialog writing exercise slipped below the „Modul complete!” part. You'll
find it at the bottom.
o Modul 3B - True-false Exercise: D is false, the system incorrectly marks it as correct

26. Your input
interest
autonomy
independence
responsibility
cooperation
communication
openness
acceptance
feedback

27. Webinar 2
• 24 November 2021, 3 PM, 1.5 hours via
Zoom
• Participants will have the opportunity to
discuss their experiences, provide feedback
and ask questions. A post-course
questionnaire will also be completed to
assess satisfaction and effectiveness.
• Upload to Coospace: a short, half-page
feedback on your online study group work
experiences. How was it to work with your
fellow students?
• Deadline: 22 December 2021, 3 PM

28. https://www.mups-music.eu/index.php/english/project
Thank you for your kind attention!