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Acknowledgement Tanaya GandhiBackground Elevated serum vitamin B12 has been linked to malignancies, liver disease and increased mortality. Pseudo-hypercobalaminemia is a paradoxical state that arises where there are high levels of free floating, unconjugated B12 in the blood despite reduced levels of utilisable B12. This can result in the features of B12 deficiency including neuropsychiatric symptoms such as mood disturbances, anxiety and psychosis. Despite these significant clinical implications, particularly those related to pseudo-hypercobalaminemia, raised B12 is often overlooked in both primary care and medical education.Aim To assess General Practitioners’ (GPs) awareness of the clinical implications of elevated serum B12, including its associations with serious diseases and pseudo-hypercobalaminemia. Additionally, this study aimed to explore whether current medical education covers elevated B12 by surveying medical students on their awareness of its disease associations and clinical implications.Method A cross-sectional survey was distributed to 46 GPs and 50 medical students based in the UK, assessing their awareness of the causes and consequences of high serum B12 and their investigation and management plans for these patients.Results Among the 46 GPs, 89.1% recognised the links between elevated B12 and serious diseases such as malignancy, liver disease and myeloproliferative disorders. However, none demonstrated awareness of pseudo-hypercobalaminemia or its neuropsychiatric implications. While 63% of GPs would investigate patients with elevated B12, their approaches lacked standardisation. There was limited support amongst GPs in updating referral guidelines (34.8%). Additionally, 73.9% of GPs reported no formal training on elevated B12. Current medical students similarly had no awareness of pseudo-hypercobalaminemia and showed limited awareness of disease associations (26%) and a lack of formal education on elevated B12 (82%).Conclusions The study reveals substantial gaps in GP and medical student knowledge regarding elevated B12, particularly its role in pseudo-hypercobalaminemia and neuropsychiatry. Efforts to improve education in this field and updated national guidelines are therefore necessary to enhance patient care and clinical decision-making.