**5. Conclusions**

UK medical education in ME/CFS is currently inadequate and appears not to have progressed over the past two decades. Of the medical schools responding, 41% do not teach the subject at all. Data on the 59% of the medical schools that do cover ME/CFS show that education is delivered by multiple medical specialists, mostly by lectures of one-hour duration, which is not always examinable and often takes place without any exposure to patients with the disease.

Differences in beliefs of medical specialists concerning the pathogenesis of ME/CFS need to be set aside in the interest of improving the clarity of what is taught at undergraduate level with renewed focus on diagnosis and management, acknowledging and believing the patient and their families, as well as treating patients with care, empathy and compassion.

Many medical schools (64% of respondents) acknowledge the need to improve education and training of healthcare professionals by expressing a strong appetite for more teaching aids and materials that convey the complexity of this disease. The GMC and MSC are encouraged to use their considerable influence to bring about change in medical schools' curricula in ME/CFS.

**Author Contributions:** Conceptualization, N.M. and G.L.; methodology, G.L.; software, G.L.; validation, N.M., G.L. and J.M.; formal analysis, G.L.; investigation, N.M.; resources, N.M.; data curation, G.L.; writing—original draft preparation, G.L.; writing—review and editing, N.M., J.M. and B.M.; visualization, J.M.; supervision, J.M.; project administration, N.M. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding. Funds to cover publication costs were received from an anonymous donor.

**Institutional Review Board Statement:** This study relates to medical education, all answers in relation to Section 4 of the school of medicine board ethics review were 'No' and the data collected do not directly relate to human subjects, material or data (as per the Helsinki Accord) or to living persons (as per the UK Data Protection Act).

**Informed Consent Statement:** Informed consent was obtained from all schools responding to the study and no respondent has withdrawn informed consent to the Survey Monkey questionnaire.

**Data Availability Statement:** The anonymous data presented in this study are available on request from the corresponding author.

**Acknowledgments:** We would like to thank Clare Owen, Jenny Higham and Steve Riley for their interest in this study and the support and guidance of the Medical Schools' Council (MSC) in the creation and dissemination of the questionnaire. We would like to thank Forward ME, the CFS/ME research collaborative (CMRC), Cardiff University, Liz Forty and the medical school's deans and directors who responded to the questionnaire. Finally, we would like to thank the peer reviewers for their time spent giving constructive feedback and support.

**Conflicts of Interest:** N.M. is a member of Forward ME, chair of the Education working group of the CMRC (CFS/ME research collaborative) and author of the online education module with StudyPRN. B.M. is a patient member of the ME/CFS Priority Setting Partnership steering group. There are no financial conflicts of interest to declare.
