Dolphin
Senior Member (Voting Rights)
Open Access
Original Article
Review began 06/09/2026
Review ended 06/25/2026
Published 07/01/2026
DOI: 10.7759/cureus.111890
Evaluation of an Invisible Illness Communication Strategy Curriculum Among Internal Medicine Interns
1 Maria Isabel Trejo Zambrano , Jillian Kyle 1, 2 , Rachel H. Vanderberg 1, 2 1. Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA 2. Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
Corresponding author: Rachel H. Vanderberg, vanderbergrh@upmc.edu
Abstract
Introduction: Patient-physician communication in invisible illness is challenging. Invisible illnesses (e.g., fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome, and disorders of gut-brain interaction) are clinical syndromes that are not readily visible or measurable by physical exam or diagnostic testing, and patients outwardly appear healthy. Patients with invisible illness often feel dismissed, while physicians often feel helpless or powerless when facing invisible illness. Invisible illness communication strategies can improve patient-physician relationships, patient and physician satisfaction, and patient outcomes, but are infrequently taught in medical education. We aimed to evaluate a novel invisible illness communication strategy curriculum using a pre-post study design.
Materials and methods:
Internal medicine (IM) interns (n = 35) participated in monthly small-group sessions. The curriculum was an interactive, one-hour, case-based workshop introducing an original communication framework, i.e., the 5 Es (Evaluate, Empathize and validate, Educate, set Expectations, and Engage in care). Interns completed paired pre- and post-surveys assessing attitudes, comfort with communication skills using a five-point Likert scale, and perceptions of the curriculum. The data were analyzed with paired t-tests and Cohen’s dᶻ.
Results:
All interns (35/35, 100%) completed both surveys. There was statistically significant improvement in comfort across all communication skills, with the largest effect size seen in increased comfort setting expectations (2.54 vs. 4.09, p < 0.01, Cohen’s dᶻ = 1.89). The curriculum was rated as excellent by 71% of interns. Helpful aspects of the curriculum included the practical framework, real-world phrasing, case-based discussion, and normalization of this challenging topic. Areas for improvement included dedicated time for practice conversations, additional invisible illness didactics, and emphasizing the patients’ perspective.
Conclusion:
The invisible illness communication strategy curriculum was well-received by IM interns and increased comfort levels across communication skills.
Categories: Medical Education Keywords: chronic pain, communication skills training, invisible illnesses, medical education, patient-provider communicatio
