Following the clues: Teaching medical students to explore patients’ contexts

Abstract

Objective-Physicians often overlook important contextual clues that patients give during an encounter. The objective of our study was to increase medical students' knowledge and skills in identifying contextual issues.Methods-Six consecutive learning experiences, including a standardized patient (SP) encounter and activities designed to trigger reflection, were implemented within a first year Introduction to Clinical Medicine course. Evaluation of the intervention was measured through self-confidence, attitudes, SP history checklist, and student and small group facilitator evaluations.Results-Standardized patient encounters, coupled with activities designed to trigger reflection, can help students identify patients' contextual clues. Students' confidence in eliciting patient clues significantly increased after the intervention. Our results suggest that some contextual clues were more difficult for students to elicit.Conclusion-Multi-faceted approaches that include activities to trigger reflection are effective in teaching students to recognize and respond to contextual clues, however, more research is needed.Practice Implications-While students elicited most clues in this study, they struggled with identifying some clues. These results suggest the need for additional research and educational development in this area.

How Well Do Doctors Know their Patients? Factors Affecting Physician Understanding of Patients’ Health Beliefs

“…77,78 In ongoing work, we have been developing educational interventions to help physicians follow patients' cues and efficiently understand the significance and meaning of this information. 79 The protocols used in this study to measure understanding may be useful when evaluating such educational interventions.…”

Thoughtful questions in the history as new pedagogy for teaching patient centred care: A pilot study in an Australian Rural Clinical School (RCS).

“…Essentially this amounts to the student amassing a large amount of information about various symptoms and obtaining a detailed understanding of past medical history. The students, in the majority of cases pursue the history checklist at the expense of not following up on tantalizing clues that the patients give in passing as to what might really be going on [21]. In some cases, the patients actually get frustrated with the student for ignoring information that they want to tell the student.…”

“…The point of this initiative is that despite the plethora of innovative learning tools, they all amount to being surrogates for actual bedside teaching on real patients by experienced senior clinicians [21].…”

The clinical history

“…Events in the patient's history unfolded in a milieu of hopes, fears and relationships unique to that individual 4 . Therefore, all history must be understood in its temporal and psychosocial context 2 , 9 . Often, the solution to a puzzling diagnostic problem lurks in the time preceding the patient‐defined beginning of their story, or in the psychosocial events surrounding it.…”

“…4 Therefore, all history must be understood in its temporal and psychosocial context. 2,9 Often, the solution to a puzzling diagnostic problem lurks in the time preceding the patient-defined beginning of their story, or in the psychosocial events surrounding it. Thus, the clinician's understanding should encompass the patient's important relationships, as well as significant life changes in preceding years.…”