One of the most crucial components of the clinical evaluation of a patient is obtaining a proper history. History taking should not only be about the current disease the patient is suffering from. A good history should paint a picture of how the patient’s personality, beliefs and environment affects the patient and his ailments and also aid in building rapport with the patient.
A history is in essence a conversation where like all conversations there is an exchange of information. But the flip side of this is that like all conversations no two histories are the same. Even if it’s taken by the same clinician from the same patient, the history might change according to the occasion. In that aspect it can be seen as an art which is quite hard to teach since how to hold a conversation and extract information can be seen as an inbuilt personality trait unique to individuals.
However numerous textbooks show a well structured series of questions in the form of a history template which teach a medical student just entering the ward for their clinical training, on what to ask, and how to gain the necessary information needed to build up the necessary differential diagnosis. This structured approach is the ideal method to teach history taking for novices, instilling in them the basics needed to get information from patients.
Other methods used are, the implementation of observed history taking, small group discussions including role-play, and interviews with real or simulated patients, followed by feedback and discussion. Recording history taking sessions either as audio or video followed by review have also been used with permission from the patients. Students in the pre-clinical years can gain from improving soft skills which help them to focus on interview skills while not focusing on diagnoses or management.
Students who are further in their medical education need to develop skills to get targeted histories relevant to the clinical scenario since management of time is of great importance. Adapting to emergency situations, inward patients, or clinic patients is a skill which is only gained through experience.
Taking the story of a patient and distilling it to absorb the important information is a skill which straddles the line between art and science and teaching of this needs to employ various methods to properly instill the skill in students of medicine.
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Shakya Weeraratne is a final year medical student in Sri Lanka.
References
Keifenheim, K.E., Teufel, M., Ip, J. et al. Teaching history taking to medical students: a systematic review. BMC Med Educ 15, 159 (2015). https://doi.org/10.1186/s12909-015-0443-x
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