Using a Six-Domain Framework to Include Biopsychosocial Information in the Standard Medical History

Area of Science:

• Medical Education
• Public Health
• Health Informatics

Background:

• Traditional physician history-taking focuses on biomedical conditions.
• 21st-century health is influenced by nonbiomedical factors like chronic disease self-management and social determinants of health (SDOH).
• Current interventions to include nonbiomedical factors in history-taking are not widely adopted due to implementation challenges.

Purpose of the Study:

• To evaluate a 6-domain framework for medical student history-taking.
• To assess the framework's effectiveness in identifying nonbiomedical factors.
• To determine if the framework enhances team-based care and addresses patient barriers.

Main Methods:

• A 6-domain (biomedical/psychiatric conditions, behavioral health, living environment/resources, social support, functional status) history-taking approach was introduced to medical students.
• Students elicited information from each domain alongside traditional methods.
• Intervention students' notes were compared to a control group, and students evaluated the model.

Main Results:

• Intervention students provided significantly more information across nonbiomedical domains compared to controls.
• The 6-domain model facilitated the identification of actionable clinical information and barriers to care.
• Students reported enhanced team involvement (social workers, pharmacists, nurses) and improved care planning.

Conclusions:

• A domain-based framework enables medical students to identify patient-specific behavioral conditions and SDOH without lengthy checklists.
• Routine collection of behavioral and social determinants of health is essential for increasing physician awareness and skills in addressing these factors.
• This approach supports enhanced team-based care and tailored patient interventions.