Can a Modified Medical History Performed (in a Virtual Setting) by Medical Students Provide a More Efficient and Accurate History?
Abstract
Learning Objectives: To determine whether a history elicited by using an modified format of questions, i.e. past medical history prior to history of present illness, can reduce the amount of time necessary to obtain vital historical elements compared to the traditional history-taking format in a virtual environment.
Introduction: History-taking and communication skills are essential for accurate and efficient diagnosis in Emergency Medicine. The traditional history begins with the patient’s chief complaint, followed by the history of present illness, past medical, surgical, social history, medications, and allergies. We propose an alternative history-taking method to obtain the medical history before eliciting the history of present illness to obtain key historical elements more efficiently.
Educational Objectives: To determine whether a history elicited by using a modified format of questions can reduce the time necessary to obtain vital historical elements while preserving complete assessment compared to the traditional history-taking format; history of present illness before medical history.
Design: The study enrolled 3rd and 4th-year medical students randomized to alternative history or traditional history taking methods. Students were placed in a Zoom room with a standardized patient who provided epigastric pain, flank pain, or syncope narrative. The virtual histories were recorded and later reviewed for comprehensiveness and timing. Results: Most students were 4th-year medical students (74.8%) who completed family medicine and internal medicine rotations (54.2%). The average time for history was 609 seconds vs. 617 seconds for the alternative and traditional groups, respectively (p-value 0.76). The alternative history elicited 14 of the 19 key elements of the history more than 70% of the time compared to the traditional (12 of 19).
Conclusion: This pilot study demonstrated that an alternative history method elicits more key elements than traditional history. It establishes that randomized simulated patient studies can be utilized in a virtual environment in place of in-person. Further studies can continue using the virtual environment to determine whether this history-taking method is effective for more medically complex emergency department patients.