Objectives — Focused History
| History | Physical Exam | Data Synthesis | Knowledge | Management Skills | Interpersonal Skills |
Explanation: By the end of the clerkship, you should be able to take a focused and structured history time after time. Start with chief complaint and history of present illness, then move on to past medical history. Your approach to taking a history should always be developmentally appropriate to the patients age (4 main groupings: infant, toddler, school age, teenager). The purpose of changing your approach is to make the patient comfortable and to get accurate information about the patient's illness. When interviewing a teenager, you should always speak to them alone at some point during the interview. Use the HEADSS acronym when taking an adolescent history (home life, education, activities, drugs, sex, suicide). D, S, and S are difficult to ask, but if you use open ended questions, act comfortable with these topics, and practice asking about them, you will get good at it.
Read the patient's chart or the nurse's triage note, so that you know the patient's chief complaint before you enter the room. This will allow you to think about questions that you want to ask during a focused interview and will give you a better chance to ask about pertinent positives and negatives. By the end of the rotation you should consistently be asking questions about pertinent positives and negatives.
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Observe interns, residents, and mentors when they take histories and focus your observations on the order of the exam, the content of the exam, and aspects of the exams that are tailored to the patient's developmental stage. You should have the opportunity to observe during inpatient admissions, ER/Clinic visits, your mentor's office/clinic visits, and teaching resident rounds. Use the computer cases to think about what questions you would ask and how you would structure your interview. You will have an opportunity to practice history taking during role plays in conference. Have a resident or an intern observe you taking a history and give you specific feedback. Pick up lots of charts, practice, and don't be afraid to feel awkward. In the outpatient clinic, each patient offers you an opportunity to start with a clean slate and practice your interviewing skills. Read the chart, and take a minute to think about what might be wrong with the patient based on their chief complaint. If you are unfamiliar with the disease and/or you can't think of pertinent questions to ask, take a minute to read from your pediatric handbook before you see the patient. By the second or third week, you should think about pertinent questions before the interview and bounce them off of the intern or resident to see what you are missing. This is an opportunity to show the intern what you know and to fill gaps in your knowledge.
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Feedback:
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