Abstract
Taking an adequate history and competently examining a patient remain essential prerequisites for making a diagnosis. Four 5th year medical students who had completed 18 months of clinical teaching were assessed at the start and end of their ten-week paediatric term and compared with 4 experienced consultants. A videorecording was made of each patient encounter. The students' history was often incomplete, at times inaccurate and imprecise, despite earlier provision of a framework to obtain the necessary information. The students spent a great proportion of their time examining the child, yet their findings were questionable particularly if the child was uncooperative. The second recording made at the end of the student's paediatric term revealed a general improvement in their confidence and knowledge, though similar deficiencies were observed. The consultants, as expected, did better. They also showed a greater awareness of understanding the child within the context of his family. They spent more time interviewing the parent and child, offered a fuller explanation of the diagnosis and carefully reviewed the management. These findings further emphasize the need to improve and assess the clinical performance of students.
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Selected References
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- Barrows H. S., Norman G. R., Neufeld V. R., Feightner J. W. The clinical reasoning of randomly selected physicians in general medical practice. Clin Invest Med. 1982;5(1):49–55. [PubMed] [Google Scholar]
- Hampton J. R., Harrison M. J., Mitchell J. R., Prichard J. S., Seymour C. Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients. Br Med J. 1975 May 31;2(5969):486–489. doi: 10.1136/bmj.2.5969.486. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Korsch B. M., Gozzi E. K., Francis V. Gaps in doctor-patient communication. 1. Doctor-patient interaction and patient satisfaction. Pediatrics. 1968 Nov;42(5):855–871. [PubMed] [Google Scholar]
- Maguire G. P., Rutter D. R. History-taking for medical students. I-Deficiencies in performance. Lancet. 1976 Sep 11;2(7985):556–558. doi: 10.1016/s0140-6736(76)91804-3. [DOI] [PubMed] [Google Scholar]
- Menahem S., Julian J. C., Skoroplas A., Driver S. C. Video recording in paediatric medicine--technique and educational benefits. J Audiov Media Med. 1984 Oct;7(4):124–126. doi: 10.3109/17453058409155943. [DOI] [PubMed] [Google Scholar]
- Menahem S. The crying baby--why colic? Aust Fam Physician. 1978 Oct;7(10):1262–1266. [PubMed] [Google Scholar]
- Menahem S. Therapeutic concern for the "nonpresenting symptom" in pediatric practice. Child Psychiatry Hum Dev. 1983 Winter;14(2):87–96. doi: 10.1007/BF00707673. [DOI] [PubMed] [Google Scholar]
- Sanson-Fisher R., Fairbairn S., Maguire P. Teaching skills in communication to medical students--a critical review of the methodology. Med Educ. 1981 Jan;15(1):33–37. doi: 10.1111/j.1365-2923.1981.tb02312.x. [DOI] [PubMed] [Google Scholar]
- Stillman P. L., Fulginiti V. A., Rousseau E., Sabers D. L. Results of a survey of pediatric clerkship programs in American medical schools. Am J Dis Child. 1981 Apr;135(4):348–351. doi: 10.1001/archpedi.1981.02130280038013. [DOI] [PubMed] [Google Scholar]
- Stillman P. L., May J. R., Meyer D. M., Rutala P. J., Veach T. L., Montgomery A. B. A collaborative effort to study methods of teaching physical examination skills. J Med Educ. 1981 Apr;56(4):301–306. doi: 10.1097/00001888-198104000-00002. [DOI] [PubMed] [Google Scholar]
- Yonke A. M. The art and science of clinical teaching. Med Educ. 1979 Mar;13(2):86–90. doi: 10.1111/j.1365-2923.1979.tb00927.x. [DOI] [PubMed] [Google Scholar]