Analysis of clerkship student-patient interviews in underserved clinics

Third-year family medicine clerkship students at our urban medical school are assigned to clinics in diverse settings, where they are required to video record one patient interview. Our research goals were to describe student communication behaviors and compare the frequency of these behaviors at clinics serving primarily uninsured patients to clinics with primarily insured patients.

Eighty-seven student-patient recordings were reviewed and analyzed.

Seventy-two percent of students performed general interviewing skills at an adequate or outstanding level; however, only a small number of students asked contextual questions about patients' use of social services (7%), barriers to care (6%), or patients' cultural/spiritual values and health concerns (13%), regardless of clinic type (underserved or insured). In visits with female patients, all students were more likely to show a personal interest in the patient (88% versus 71%). In visits where there was gender concordance between the patient and student, the students were more likely to face the patient (98% versus 73%).

This study indicates that, even though third-year students may have adequate general interviewing skills, they may need additional training and practice in obtaining contextual information about patients in all clinical settings. These findings also suggest that the gender of the patient, as well as gender concordance between patient and student, play a role in student-patient interactions.