Evaluating Medical Students’ Patient Interviewing Skills: a Biopsychosocial Model

The case method for teaching analytical and problemsolving skills has been proven to be quite effective, especially in the professions such as law, business, and medicine. Particularly in medicine, the write-up of the patient’s medical history has long served as the cornerstone for developing clinical problem-solving and health care management skills. The patient’s physical examination, subsequent laboratory evaluation and treatment strategies are usually directed by the information obtained during the history-taking interaction with the patient (Hampton, Harrison, Mitchell, Pritchard, & Seymour, 1975). Nevertheless, the specific skills associated with the elicitation and documentation of a patient’s history for problem formulation and hypothesis testing frequently receive less emphasis in medical education than does the more technologically-based laboratory test approach to human illness (Engel, 1976). Likewise, despite increased understanding of the importance of environmental, social, and behavioral factors in preventing disease and controlling morbidity (Jones, 1979; Cohen & Brody, 1981), medical students are also not adequately instructed as to how the medical history can be utilized to identify such patient problems (Aloia & Jonas, 1976). Medical schools have been slow to incorporate the above concepts and skills in their teaching primarily due to past dependence on a biomedical or “diseaseoriented” model of patient care as contrasted with the newer biopsychosocial “whole person” model (Williamson, Beitman, & Katon, 1981; Breslow, 1978; Nardone, Rueler, & Girard, 1980). Limited understanding of the importance of risk factor identification and preventive medicine has also contributed to the lack of faculty support for this aspect of teaching. In addition, increasing enrollments and demands on faculty’s time have also taken their toll in relation to amount of time and emphasis placed on new orientations and skill development in medical education. Consequently, medical student facility with strategies of preventive medicine, history-taking and problem-solving skills in the clinical setting is highly variable. In 198 1, The University of Michigan Medical School initiated a pilot curriculum project focusing on the importance of the medical history in clinical problemsolving and its role in preventive medicine as an integral part of undergraduate clinical training. Specific objectives included: