"Do you smoke?" - content and linguistic analysis of students' substance histories in simulated patient interviews

The use of tobacco, alcohol and other drugs has considerable health consequences. Substance histories are often only incompletely taken in everyday clinical practice. When learning to take a medical history in medical school, one of the learning objectives is to inquire about consumption behavior. The aim of this exploratory study was therefore to examine the content and language of substance histories taken by medical students.

From a simulation training of a first working day in hospital, 91 video films of medical histories were available, which advanced medical students had conducted with six patients with different consumer behavior. These interviews were verbatim transcribed and analyzed using content-structuring qualitative content analysis according to Kuckartz. For all substances, the reasons for the questions and the depth of the respective substance use were categorized and errors in the questions were examined. In addition, a linguistic analysis of the verbal ways in which the substances were inquired about was carried out.

The students most frequently asked about smoking (73.3%). In only 15.4% of the interviews were all substances asked about, in none were all substances asked about completely. A total of 112 protocol questions and 21 occasion-related questions were identified. Logical errors and double questions were found. Most of the questions were asked in a factual manner. However, questions in the categories "evasive" and "stigmatizing" were also found.

The content-related and linguistic deficits of medical students in the collection of substance histories identified in this study should be addressed in communication courses at an early stage of undergraduate medical studies.