The contextual interview: a cross-cutting patient-interviewing approach for social context

Area of Science:

• Medical Education
• Health Equity
• Patient Interviewing

Background:

• Current patient interviewing methods in medical education inadequately capture the dynamic biopsychosocial model.
• Traditional social history taking does not fully address evolving factors influencing health inequities and social determinants of health.
• There is a need for real-time reassessment of patient social context to understand health support access.

Purpose of the Study:

• To introduce the Contextual Interview (CI), a novel patient interviewing approach.
• To evaluate the integration of patient contextual data in medical education milestones.
• To highlight the need for enhanced training in eliciting social context during patient interviews.

Main Methods:

• Qualitative review of Accreditation Council for Graduate Medical Education Milestones for primary care specialties.
• Coding of milestones based on the acknowledgment, assessment, synthesis, and application of patient contextual data.
• Analysis of the extent to which milestones reflect real-time patient contextual understanding.

Main Results:

• Approximately 20% of reviewed milestones met criteria for reflecting patient-facing contextual data.
• The review underscores a gap in current medical training regarding social context elicitation.
• The Contextual Interview (CI) is presented as a practical, semi-structured approach for gathering social context.

Conclusions:

• The Contextual Interview (CI) offers a deliberate method to enhance clinicians' understanding of patient social contexts.
• There is a clear need for more intentional training in patient interviewing to incorporate social determinants of health.
• Future research should explore adapted versions of the CI for undergraduate and graduate medical education.