Evaluating the medical history: observation versus write-up review

The ability to develop a medical history data base relevant to the total care of a patient is a requisite skill for clinical problem-solving. Assessment of this skill by faculty members in medical students has been based on direct observation of the student-patient encounter as well as on evaluation of the student's written patient history. In the study reported here, both methods were compared by the authors for the same student-patient interview. Preceptor ratings of the students' data-elicitation skills were correlated with their ratings of the students' interview-process skills and the time spent by the preceptor observing the interview. A criterion-based, checklist scoring of the student's write-up was not correlated with preceptor ratings. In this study, the authors suggest that a criterion-based evaluation of the student's patient write-up is a less faculty-intensive and more reliable method of evaluating medical student data-collection skills than direct observation of the student-patient encounter.