Developing a psychosomatic medicine curriculum for general practice residents: a proof-of-concept study using Kern’s Six-Step Approach

Abstract

Background

Psychosomatic disorders are highly prevalent in primary care worldwide, yet structured training for general practitioners (GPs) remains limited. This study applied Kern’s Six-Step Approach, grounded in the principles of competency-based medical education (CBME), to develop a globally relevant psychosomatic medicine curriculum and to evaluate its initial feasibility and effectiveness.

Methods

We applied Kern’s Six-Step Approach, grounded in the principles of CBME, to design a psychosomatic medicine curriculum for GPs.The curriculum comprised five core modules: (1) an overview of psychosomatic medicine; (2) clinical management of common psychosomatic conditions in primary care settings; (3) mental health prevention and rehabilitation; (4) Doctor-Patient communication and psychological counseling; and (5) self-care and professional development for GPs. A variety of evidence-based instructional methods were employed, including lectures, standardized patient (SP) interviews, Balint groups, and clinical rotations, to foster comprehensive competencies in psychosomatic medicine.

Results

We recruited 29 general practice residents. Among them, 26 completed the pre- and post-training assessments, and the average curriculum completion rate was 75.1%. Significant improvements were observed in exam scores of knowledge (p < 0.001), self-assessed knowledge (p < 0.001), faculty-rated communication performance using the SEGUE Framework (p < 0.001), and SP-rated communication satisfaction (p < 0.001). While clinical reasoning showed improvement, it did not reach statistical significance (p = 0.063). Overall self-assessed psychosomatic competency by GP residents increased significantly (p < 0.05), including knowledge (p < 0.001) and skills (p < 0.05). However, attitudes was not statistically significant(p = 0.103).

Conclusion

This study developed and piloted a structured psychosomatic medicine training framework in a hospital in Shanghai. The findings indicate that the program is feasible and that its modular design may be relevant beyond the Chinese context, offering a practical point of reference for adaptation in primary care settings facing similar constraints.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12909-026-09850-z.

Introduction

Mental health is a fundamental pillar of overall well-being [1]. Globally, approximately 1.1 billion people worldwide were living with a mental disorder, highlighting the substantial global burden of mental health conditions [2]. Importantly, many mental disorders manifest with prominent physical symptoms, and psychological factors often contribute to the onset and course of somatic conditions, highlighting the close link between mental health and physical health [3].

Psychosomatic disorders are characterized by the interaction among psychological, social, and biological factors in the development and course of physical illness. Typical psychosomatic symptoms include gastrointestinal complaints, cardiovascular complaints, headaches, sleep disturbances, and chronic pain syndromes. Moreover, psychosomatic disorders frequently coexist with depressive and anxiety disorders [4]. These conditions are significant and growing contributors to the global burden of disease [5].

The rising prevalence of psychosomatic disorders underscores the urgent need to strengthen service delivery [6]. The World Health Organization’s Mental Health Policy and Service Guidance Package advocates for the provision of mental health services within general hospitals and primary care systems [7]. Incorporating psychosomatic care into primary care offers several key advantages. GPs are uniquely positioned to simultaneously address both the somatic and psychological dimensions of illness, thereby improving diagnostic accuracy and treatment effectiveness [8]. It has been shown that depression screening in primary care settings facilitates the early and accurate identification of adult patients, including pregnant and postpartum women [9]. Additionally, collaborative care for people with depression and long-term conditions has demonstrated sustained clinical benefits over usual care as well as cost-effectiveness [10]. Furthermore, primary care settings may help mitigate the stigma associated with mental health referrals and are often more acceptable to patients [11].

Globally, insufficient psychosomatic competence among general practitioners has been recognized as a significant gap in primary care training.Evidence from Europe (Sweden, Austria, Denmark) [12–14] and Asia (China, Japan, Korea) [15–17] show insufficient training, low recognition of psychosomatic disorders, and difficulties translating theoretical knowledge into clinical practice, highlighting the urgent global need for enhanced education and systemic support. China currently faces a severe shortage of mental health services, with only 1.53 psychiatrists available per 100,000 residents [18]. Psychosomatic disorders are common among the Chinese population, creating a substantial demand for related services. In community settings, the detection rate of depressive disorders in outpatient clinics is 16.1%, [19] and the prevalence of insomnia related disorders is as high as 38.4% [20]. Furthermore, patients with physical illnesses frequently present with comorbid psychological conditions, necessitating integrated psychosomatic care from GPs [21, 22]. Alarmingly, GPs often lack sufficient competence in this field. One study found that only 17.6% could correctly recognize symptoms of depression, 12.6% identified appropriate screening methods, and 29.7% understood treatment principles, while 84.5% reported insufficient knowledge and skills for its diagnosis and management [23].

The Standardized Residency Training Program (SRTP) in China was established to reduce inequities in healthcare delivery across different practice levels by unifying postgraduate training. It has been implemented as a compulsory national policy since 2015 [24]. The program has significantly improved the training quality of young doctors. This improvement is largely attributed to the introduction of standardized evaluation criteria, which ensure that graduates from different programs attain the same measurable competencies. For each specialty, the standards specify training objectives, required rotation lengths, core training content, and reference materials [25].Although GP residency training programs in China include a clinical rotation in psychiatry, they have not sufficiently developed competencies in psychosomatic medicine [26]. While continuing medical education (CME) initiatives have achieved some progress, [27] these programs often lack a robust theoretical foundation. Furthermore, studies indicate that existing training programs aimed at enhancing GPs’competencies in psychosomatic medicine, though valuable, still face significant challenges. Common limitations include poorly defined training goals and objectives, fragmented and unsystematic curriculum content, minimal use of interactive teaching methods, and assessment systems that are poorly aligned with clinical practice [28, 29]. These deficiencies have hindered both the effectiveness of such programs and their broader adoption in clinical training.

Germany has systematically embedded the bio-psycho-social model into its healthcare system and everyday clinical practice. GPs receive basic psychosomatic care training consisting of 80 h of theoretical instruction, clinical practice, and communication skills development, aimed at enhancing early detection and basic management of psychosomatic disorders [30]. Importantly, this model has been widely implemented in GP training, where it has demonstrated substantial effectiveness in improving psychosomatic care delivery [31]. Germany’s model has also inspired countries such as China to adapt the bio-psycho-social framework to local contexts. These efforts have led to measurable improvements in physicians’ psychosomatic competencies. Previous studies confirm that this training approach is both practical and effective [32]. However, outside a few countries with established training systems, most in-service GPs worldwide have not received systematic psychosomatic medicine education across the continuum of medical education [33].

Against this global backdrop, structured training in psychosomatic medicine for general practitioners remains insufficient across many healthcare systems worldwide. In this study, we applied Kern’s Six-Step Approach to develop a competency-based psychosomatic medicine curriculum and to describe the process by which it was designed. The curriculum was piloted in a hospital in Shanghai as a proof-of-concept study within China’s standardized GP residency training system. The curriculum may also be applicable to primary care settings in China and other countries facing similar challenges.

Methodology

Six-step curriculum development overview

Competency-Based Medical Education (CBME) is an outcomes-driven approach to the design, implementation, assessment, and evaluation of medical education programs [34]. This study aimed to develop a psychosomatic medicine curriculum tailored to GP residents in China, following Kern’s Six-Step Approach. Kern’s framework encompasses six sequential steps: (1) problem identification and general needs assessment, (2) targeted needs assessment, (3) goals and objectives, (4) educational strategies, (5) implementation, (6) evaluation and feedback. Widely regarded as a foundational model, this approach facilitates the development of learner-centered, outcomes-driven curricula across various levels of medical education [35]. As illustrated in Fig. 1, this framework supports the development of learner-centered, clinically relevant curricula and is widely used in postgraduate medical education. In the context of psychosomatic medicine, it enables the alignment of training content with primary care demands, thereby enhancing GPs’ diagnostic and therapeutic competencies [36].

Fig. 1.

Six-step approach for psychosomatic medicine training curriculum development for GP residents in China

Step 1—problem identification and general needs assessment

Based on above, we identified that China is currently facing a severe shortage of mental health resources, with a substantial demand for psychosomatic medicine services at the primary care level. As the cornerstone of primary health care, GPs have limited competency in identifying and managing psychosomatic disorders [23]. SRTP represents a critical period for enhancing the competencies of GPs [25]. Therefore, it is imperative to integrate psychosomatic medicine training into GP residency programs, encompassing both theoretical instruction and practical application, to cultivate clinical reasoning and operational skills essential to psychosomatic care. In response to this need, we developed and implemented a training program in psychosomatic medicine to enhance GPs’ knowledge, attitudes, and skills required for effective practice [28]. We designed the curriculum for GP residents using Kern’s Six-Step Approach, guided by the principles of CBME. The subsequent sections present the detailed process and outcomes of curriculum development.

Step 2—targeted needs assessment

A targeted needs assessment survey was conducted among 140 GP residents from four residency training bases in Shanghai using convenience sampling. The survey was performed prior to curriculum development and aimed to identify residents’ baseline competencies, learning needs, and training expectations regarding psychosomatic medicine services. The questionnaire included items assessing residents’clinical exposure to psychosomatic problems, perceived importance of training content, self-rated competence, and training needs related to psychosomatic care. Findings revealed that while a substantial proportion of residents encountered patients with sleep or emotional problems secondary to physical illness, only 60.0% reported being able to manage such cases appropriately. Furthermore, only 47.5% demonstrated familiarity with core concepts and knowledge of psychosomatic medicine, and 64.6% were able to correctly identify common psychosomatic conditions. Notably, only 21.4% of respondents expressed satisfaction with their own psychosomatic care capabilities. A majority (66.4%) agreed that systematic training in psychosomatic medicine was essential during residency. These results indicated a clear gap between clinical demands and residents’ perceived competencies as well as their confidence in delivering psychosomatic care [37].

Step 3—goals and objectives

Through this training program, GP residents were expected to achieve the following goals:

First, to acquire knowledge and skills for the prevention, diagnosis, treatment, and rehabilitation of common psychosomatic disorders in community settings and to strengthen their diagnostic reasoning regarding psychosomatic conditions and related psychiatric comorbidities. Second, to develop systems thinking and a holistic medical perspective, including awareness of the importance of early screening for psychiatric disorders, appropriate referral to specialists, and the ability to conduct preliminary psychological assessments. Third, to enhance practical competencies in psychosomatic care, particularly in applying basic communication techniques and psychological interventions to provide effective support for patients with psychosomatic concerns, thereby improving their capacity to deliver mental health services in primary care.

To ensure constructive alignment between CBME, educational activities, and assessment methods, the curriculum was mapped according to Harden’s curriculum mapping framework [38]. The resulting curriculum map (Table 1) explicitly links competency outcomes, learning opportunities, assessment strategies, and credit hours across all modules, providing a transparent representation of how intended competencies are developed and evaluated throughout the curriculum.

Table 1.

Training curriculum for psychosomatic competency for GP residents

Module Content	Learning Opportunities	Credit Hours	Learning Outcomes	Assessment
Overview	Lecture	1 h (required) + 1 h (elective)	Knowledge	Written Exam
Clinical Management of Common Psychosomatic Conditions in Primary Care Settings	Lecture	11 h(required)	Knowledge Attitudes, Skills	Written Exam, SOAP Record, Clinical Rotation
	Discussion on Typical Psychosomatic Medicine Cases	6 h(required)
	General Practice-Psychiatric Joint Teaching Wards Round	6 h (elective)
Mental Health Prevention and Rehabilitation	Lecture	2 h (required) + 1 h(elective)	Attitudes, Skills	Written Examination, Clinical Rotation
Doctor-Patient Communication and Psychological Counseling	Lecture	1 h (required) + 5 h(elective)	Knowledge Attitudes, Skills	SEGUE, SP Satisfaction, Multi-source Feedback
	SP Interview	6 h (required)
Self-care and Professional Development of GPs	Lecture	2 h (elective)	Attitude	Portfolio Record
	Balint Groups and Parallel Charts	6 h (elective)
Total	48 h (27 required credit hrs, 21 elective hrs)

Step 4—educational strategies

We structured the curriculum into five core modules: (1) an overview of psychosomatic medicine; (2) clinical management of common psychosomatic conditions in primary care settings; (3) mental health prevention and rehabilitation; (4) doctor-patient communication and psychological counseling; (5) self-care and professional development of GPs. To deliver these modules, we employed a variety of instructional methods, including lectures, standardized patient (SP) encounters, Balint groups, a structured reflective discussion method that helps physicians explore doctor-patient relationships and emotional responses arising from clinical encounters.and clinical rotations [39]. We provided the didactic content through a hybrid format that combined online and offline sessions. As clinical educators, we developed case-based materials based on psychosomatic presentations commonly encountered in general practice. We also trained SPs to participate in role-playing scenarios, during which faculty modeled patient interviews and guided learners in small-group discussions. Through these activities, we aimed to strengthen residents’ skills in history taking, doctor-patient communication, and clinical reasoning. To further support professional identity formation and reflective practice, we organized Balint groups that encouraged residents to develop self-awareness, deepen their understanding of the doctor-patient relationship, and relieve occupational stress.

Step 5—implementation

To ensure adequate resources, institutional support, and stakeholder engagement, we adopted a three-step approach for implementing the new curriculum. First, we conducted a resource assessment by meeting with key stakeholders, including residency program directors, education administrators, faculty members, hospital leadership, and GP residents, to evaluate the course’s feasibility, resource requirements such as faculty, facilities, and funding, and learners’ interest in the training. Second, we secured administrative and logistical support by scheduling protected time for faculty and residents, assigning teaching responsibilities, arranging instructor compensation, and providing appropriate teaching spaces. Finally, we launched the course by developing a detailed teaching plan and piloting the curriculum with a small group of GP residents. We then collected feedback from both faculty and trainees and used it to refine the program before preparing the revised version for broader implementation within the SRTP.

Step 6—evaluating and feedback

We evaluated the curriculum on three main areas: training effectiveness, course attendance, and curriculum satisfaction. To assess training effectiveness, we applied a pre- and post-test design, using written examinations to measure theoretical knowledge, standardized patient (SP) encounters to evaluate doctor–patient communication and clinical reasoning, and self-assessment scales to gauge competencies in psychosomatic care. We recorded residents’ attendance throughout the course, and at the end of the program, we asked participants to complete a satisfaction survey on the curriculum.

Preliminary evaluation of the training program: a pilot study

Study participants

In our study, we included 29 GP residents enrolled in a university-affiliated residency training program. The cohort was predominantly female (86.21%), with a mean age of 24.55 years. Most residents held a bachelor’s degree (68.97%), whereas 31.03% had a master’s degree. The distribution of training years was relatively balanced, with 37.93% in their first year, 24.13% in their second year, and 37.93% in their third year of residency training. In terms of job satisfaction, 31.03% of the residents reported dissatisfaction with their profession, 44.83% expressed a neutral attitudes, and only 24.14% reported being satisfied.

Research methods

We followed the approach of previous educational intervention studies that employed pre- and post-training assessments to evaluate changes in learners’competencies [40]. In our program, we adopted a pre-post intervention design consisting of three phases. Preparation included training needs assessment, goal setting, teaching strategy development, and faculty team formation. Intervention involved a range of training activities such as theoretical instruction, interactive teaching, standardized patient (SP) simulations, and reflective learning. Evaluation was conducted through pre- and post-training knowledge tests, skills assessments, SP ratings, and learner feedback surveys.

The psychosomatic medicine curriculum comprised 48 total hours, including 27 required and 21 elective hours. These 48 h were designed to be delivered throughout the three-year general practice residency training period and were integrated into existing clinical rotations in psychiatry, internal medicine, neurology, and general practice/community health service institutions. For the purpose of this proof-of-concept pilot study, only selected core components of the curriculum were implemented and evaluated.

Research instruments

SEGUE communication skills assessment tool

The SEGUE Framework, originally developed by Gregory Makoul, is a checklist-based rating scale designed to facilitate both the teaching and assessment of communication skills among medical learners. It has been adopted by numerous medical schools and training programs for over 25 years and is endorsed by leading academic institutions for evaluating communication skills during residency training [41, 42]. Owing to its demonstrated feasibility, high reliability, and strong overall consistency, the SEGUE Framework was selected as the assessment tool for this study. Previous studies reported an inter-rater reliability of 0.796, overall consistency of 0.929, and kappa coefficients ranging from 0.66 to 0.92. The framework consists of 25 items grouped into five domains: Set the Stage (S), Elicit Information (E), Give Information (G), Understand the Patient’s Perspective (U), and End the Encounter (E). Each item is scored dichotomously, with a response of “Yes” assigned 1 point and “No” assigned 0 points. The total score ranges from 0 to 25, with higher scores reflecting better communication skills. A Chinese version of the SEGUE Framework, translated by Li Juan and widely used among Chinese medical students and physicians, was employed to assess participants’ communication competencies [43, 44].

Psychosomatic competency evaluation index system for GPs

We evaluated the psychosomatic competency of GPs using “the index system for ability of GPs in psychosomatic medicine service,” a system that was developed in previous research based on the competency iceberg model, which conceptualizes competence as comprising visible elements such as knowledge and skills, as well as deeper characteristics including self-concept, traits, and motivation [45]. The development of the index system employed competency modeling methods [46], which provided a systematic approach to defining the competencies required for effective performance. This structured process integrates literature review, behavioral event interviews, and Delphi expert consultations, a structured consensus-building method involving multiple rounds of anonymous expert feedback to achieve agreement among experts [47]. The final scale contained 27 items across three dimensions: knowledge (7 items), attitudes (9 items), and skills (11 items). Knowledge refers to GPs’ understanding of psychosomatic medicine, including mental health service systems, common psychosomatic disorders, psychological counseling, and behavioral medicine. Attitude refers to psychosomatic medicine-related professional attributes, such as empathy, patient-centeredness, holistic and systems thinking, respect for patient diversity, teamwork, and attention to physicians’ own psychological well-being. Skills refer to the clinical competencies required for psychosomatic care, including history taking, psychological assessment, psychosomatic case management, counseling, health education, follow-up services, and crisis intervention. Previous validation studies demonstrated excellent internal consistency, with Cronbach’s α coefficients of 0.956, 0.938, and 0.966 for the knowledge, attitudes, and skills domains, respectively, and 0.968 for the overall scale [28].

Results

We recruited 29 general practice residents, and 26 completed both the pre- and post-training assessments. Over the six-month pilot period, participants completed 30 instructional hours delivered through a blended learning approach integrating online and offline learning. The average curriculum completion rate was 75.1% (Table 2).

Table 2.

Training completion status of GP residents in pilot study

Competency Dimension	Teaching Method	Credit Hours	Average Completion Rate
Knowledge	Lectures(Online)	15 h (10 sessions)	94.3%
Skills	Discussions on Typical Psychosomatic Medicine Cases (Online)	9 h(6 sessions)	54.6%
	Balint Groups (Offline)	3 h(3 sessions)	60.9%
Knowledge, Skills, Attitude	SP Interviews (Offline)	3 h(3 sessions)	55.2%
Total		30 h	75.1%

Average Completion Rate = (Total completed hrs per item) / (Total hrs per item) / (Number of Practitioners)

The training significantly enhanced both theoretical knowledge and psychosomatic service competencies among GPs. Written test scores improved (65.46 ± 12.61 vs. 56.38 ± 9.71; p = 0.005), as did communication performance measured by the SEGUE framework (69.19 ± 9.34 vs. 52.59 ± 10.45; p < 0.001). Standardized patient satisfaction also increased markedly (85.44 ± 8.88 vs. 60.37 ± 23.61; p < 0.001), while SOAP record scores showed a nonsignificant upward trend (p = 0.063). Self-assessed comprehensive competency demonstrated significant gains (71.31 ± 9.19 vs. 64.24 ± 12.78; p = 0.002), with particular improvement in knowledge and skills. These findings suggest that the program effectively strengthened core psychosomatic medicine competencies, especially in knowledge acquisition and communication, while clinical reasoning remains an area for further development. Detailed results are provided in Tables 3, 4 and 5.

Table 3.

Evaluation methods for GP residents’ psychosomatic competency

Competency Dimension	Specific Competency	Evaluation Methods	Evaluation Tools
Knowledge	Core Knowledge of Psychosomatic Medicine	Written Exam	Written Exam Score
Skills	Clinical Reasoning	Writing SOAP Record after SP Interview	SOAP Record Score
Attitude	Doctor-Patient Communication Skills	Communication Performance during SP Interview	faculty-rated communication performance using the SEGUE Framework & SP’s Satisfaction Score with Communication(0-100)
Comprehensive Competency	Overall Psychosomatic Competency	Self-Assessment completed by GP Residents	Psychosomatic Competency Evaluation Index System for GP Residents

Table 4.

GP residents’ competency scores before and after training

Variables	Pre-test	Post-test	Mean Difference (95% CI)	t	P	Cohen’s d
Written Test Score	56.38 ± 9.71	65.46 ± 12.61	9.08(3.04, 15.11)	3.099	0.005	0.61
SOAP Record Score	47.22 ± 12 21	54.76 ± 12.41	7.54(-0.44, 15.52)	1.945	0.063	0.38
SEGUE Framework Score	52.59 ± 10.45	69.19 ± 9.34	17.08(13.50, 19.69)	11.023	0.000	2.16
SP’s Satisfaction Score with Resident Communication	60.37 ± 23.61	85.44 ± 8.88	24.50(16.32, 33.83)	5.887	0.000	1.15

Data are mean ± SD. Paired differences and 95% CIs are from paired‑samples t‑tests. Cohen’s d = t/√n (n = 26)

Table 5.

GP residents’ self-assessment of psychosomatic medicine competency scores before and after training

Variables	Pre-test	Post-test	Mean Difference (95% CI)	t	P	Cohen’s d
Total Score of Comprehensive Competency	64.24 ± 12.78	71.31 ± 9.19	7.35(2.73, 11.42)	3.348	0.002	0.66
Knowledge Score	18.73 ± 4.38	22.65 ± 4.60	3.92(1.96, 5.59)	4.337	0.000	0.85
Skills Score	34.31 ± 8.96	38.27 ± 5.40	3.96(0.43, 7.20)	2.325	0.028	0.46
Attitude Score	32.96 ± 6.10	35.00 ± 4.24	2.04(-0.43, 4.35)	1.691	0.103	0.33

Data are mean ± SD. Paired differences and 95% CIs are from paired‑samples t‑tests. Cohen’s d = t/√n (n = 26)

Discussion

The existing training programs in psychosomatic medicine for GPs suffer from several issues, including incomplete learning objectives, fragmented content, monotonous teaching methods, and an overemphasis on theoretical assessment [28, 29], all of which undermine their effectiveness. In contrast, this study adopts the “Six-Step Approach” to curriculum development, which effectively addresses these challenges through three key strengths. First, it is oriented towards enhancing physicians’ practical competencies, following a rigorous, evidence-based development process to ensure a comprehensive and coherent curriculum. Second, by conducting in-depth needs assessments, it accurately identifies physicians’ real-world training requirements, making the content highly relevant to clinical practice. Finally, the course development adopts a closed-loop design that integrates needs assessment, goal setting, instructional implementation, and multidimensional evaluation. This cycle enables timely identification of problems during implementation and allows for targeted adjustments and improvements, thereby ensuring training effectiveness and promoting continuous improvement [48].

This program adopts a flexible “online-plus-offline” teaching model, which not only addresses the challenges of residents’ irregular working hours and heavy workloads but also enables participants to apply their knowledge in both hospital and community settings [49]. The curriculum is specifically designed to meet the practical needs of community mental health services and to address physicians’ competency gaps in China. It goes beyond knowledge transmission, placing strong emphasis on the development of practical skills and attitude. Notably, modules on GP residents’ self-care and personal growth are incorporated to support their long-term development [50, 51]. Furthermore, to minimize participants’ burden, training content is seamlessly integrated into daily rotation activities. For instance, psychosomatic medicine cases are introduced into case discussions across different clinical departments, allow ing learners to apply what they have learned without adding extra workload.

The program also employs a multi-method assessment strategy, including theoretical exams, standardized patient (SP) encounters, and validated self-evaluation tools. This comprehensive approach aligns with real-world clinical needs and strengthens physicians’ capacity to provide integrated psychosomatic care.

This study has several limitations. First, as a single-center proof-of-concept pilot study, the sample size was relatively small, and no control group was included, which may limit the generalizability of the findings and the interpretation of the observed effects. Second, although the curriculum was designed as a 48-hour program across the three-year GP residency training period, only 30 h were implemented and evaluated during the six-month pilot phase, which may have limited the development of some competencies.

Third, although the written examination was developed by a multidisciplinary expert panel and aligned with the psychosomatic medicine competency framework, it has not undergone independent external validation. Finally, several implementation challenges were encountered, including limited faculty resources and insufficient coordination during interdisciplinary rotations. Future studies should address these issues and further evaluate the curriculum in larger, multicenter settings.

Conclusion

In conclusion, we developed a psychosomatic medicine training program for GPs using a Six-Step Approach, tailored to real-world needs. The program combined online and offline learning and integrated hospital- and community-based practice. Following the training, participants demonstrated marked improvements in knowledge acquisition, doctor–patient communication, and overall competency, with standardized patients particularly recognizing their enhanced communication skills. This study presents a structured framework, which may offer guidance to similar initiatives in other settings, especially in low and middle income countries. Future research efforts may include strengthening faculty development, fostering interdisciplinary collaboration within healthcare institutions, and evaluating contextual adaptation in diverse healthcare and sociocultural environments. Together, these steps may help support the development of core psychosomatic competencies among GPs and contribute to improving psychosomatic care in primary care practice.

Authors' contributions

Author Contributions: Lei Huang, Zhujian Shao, and Xuanlin Chen contributed equally to this work and are co-first authors. Lei Huang contributed to conceptualization, methodology, supervision, funding acquisition, writing the original draft, and writing-review and editing. Zhujian Shao contributed to conceptualization, methodology, and writing-review and editing. Xuanlin Chen contributed to formal analysis, visualization, and writing-review and editing. Wei Zhang contributed to data curation, investigation, and validation. Xue Xiao contributed to methodology and resources. Chen Wang contributed to investigation and supervision. Zhang Jidong contributed to methodology and resources. Jiahui Jiang contributed to formal analysis and visualization. Jessica Thai contributed to formal analysis and writing-review and editing. All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work. Yongzheng Chen and Yuan Gao jointly supervised this study and are co-corresponding authors. Yongzheng Chen contributed to methodology, project administration, resources, and writing-review and editing, while Yuan Gao contributed to methodology, funding acquisition, project administration, resources, and writing-review and editing.

Funding

This study is supported by Shanghai Tongji Hospital Outstanding Young Talents Program (HBRC2301) ,Project of Reform of Teaching Content and Curriculum System in Undergraduate Education of Higher Education Institutions in Guizhou Province (GZJG2024178), Key Projects of the Ministry of Education in 2019 under “The 13th Five-year Plan”for National Educational Science (DIA190409).

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The study was approved by the Institutional Review Board of Tongji Hospital, Tongji University (Ethics No. K-W-2023-002), and conducted in accordance with the principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their involvement in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.