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

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. (C) 2010 Elsevier Ireland Ltd. All rights reserved.