Determining the essential components of the history of presenting illness - a qualitative content analysis of core clinical texts
DOI:
https://doi.org/10.22024/UniKent/03/ajpp.1291Abstract
Background: Mnemonics are utilised in medical education settings, as well as clinical and hospital settings, to act as aides-memoire to enable students and healthcare practitioners to commit concepts to memory, or use in their working memory, whilst consulting patients. This study explores the use of mnemonics in history-taking, with particular interest in identifying the essential components of the initial part of the medical interview - the History of Presenting Illness (HPI), also known as the history of presenting complaint. A mnemonic currently in use for assisting medical students learning to take a HPI is “SOCRATES,” which was designed for, and is useful when, gathering information related to pain specifically. In the authors’ experience, this mnemonic is used as a default history-taking tool by inexperienced students first learning to conduct an HPI. The researcher aims are to identify the essential components of the HPI by performing summative content analysis of the core clinical textbooks of one United Kingdom (UK) medical school, then collating the most frequently represented domains into a new mnemonic to aid general history-taking.
Methods: a qualitative content analysis was undertaken. 23 presentations within the areas of clinical practice outlined in the General Medical Council’s (GMC’s) Medical Licensing Assessment (MLA) content map were randomly identified. Core clinical textbooks were then reviewed for content related to history-taking of these 23 presentations. Each line of text was transferred to an Excel spreadsheet, and content analysis undertaken to identify recurring themes. Text was reviewed for key words, or descriptive categories henceforth referred to as “domains” (e.g. “burning” pain would be categorized in the domain of “nature/character”). Statistical analysis was performed within Excel to rank each domain according to frequency of representation.
Results: A total of 170 units of data were analysed and extracted from the core clinical texts. It was found that the domains that occurred with the highest frequency were as follows, in decreasing order of representation: associated symptoms, site/location, functional aspects, character/nature, onset, timing, triggers, severity, exacerbating factors, ameliorating factors, and progression of symptom. Further analysis was undertaken to compare to the domains featured in the “SOCRATES” Mnemonic. SOCRATES was found to contain an extra (unwarranted) domain that wasn’t repressed across the dataset, namely “radiation”. SOCRATES was lacking three key domains that were represented in the data, namely: “triggers,” “functional implications,” and “progression.”
Conclusions: A new mnemonic that encompasses all essential components of the HPI as determined by the data collected for this study, such as “SSTOP TEACh As Fun,” might be better suited to general history-taking than SOCRATES. Future studies might explore the practical use of a new mnemonic in educational or clinical settings to determine whether it is easy to use and effective for general history-taking purposes.
Downloads
Veröffentlicht
Zitationsvorschlag
Ausgabe
Rubrik
Lizenz
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
AJPP requests that, as the creator(s)/author(s) of the manuscript you are submitting, that you assign certain rights to the manuscript to the AJPP in exchange for undertaking to publish the article in electronic form and, in general, to pursue its dissemination throughout the world. The rights the AJPP requests are:
- The right to publish the article in electronic form or in any other form it may choose that is in keeping with its role as a scholarly journal with the goal of disseminating the work as widely as possible;
- The right to be the sole publisher of the article for a period of 12 months;
- The right to make the article available to the public within a period of not more than 24 months, as determined by relevant journal staff of the AJPP;
- The right to grant republication rights to itself or others in print, electronic, or any other form, with any revenues accrued to be shared equally between the author(s) and the journal;
- The right to administer permission to use portions of the article as requested by others, seeking recompense when the AJPP sees it as warranted;
- The right to seek or take advantage of opportunities to have the article included in a database aimed at increasing awareness of it;
- As the author(s), the AJPP wishes you to retain the right to republish the article, with acknowledgement of the AJPP as the original publisher, in whole or in part, in any other pbulication of your own, including any anthology that you might edit with up to three others;
- As the author(s), the AJPP wishes you to retain the right to place the article on your personal Web page or respository of your university or institution. The AJPP askes that you include this notice: A fully edited, peer-reviewed version of this article was first published by the Advanced Journal of Professional Practice, <Year>, <Volume>, <Issue>, <Page Numbers>.
- You retain the right to unrestricted use of your paper for yourself or for your own teaching purposes.
BY AGREEING TO THE FOREGOING, YOU CONFIRM THAT THE MANUSCRIPT YOU ARE SUBMITTING HAS NOT BEEN PUBLISHED ELSEWHERE IN WHOLE OR IN PART, AND THAT NO AGREEMENT TO PUBLISH IS OUTSTANDING.
SHOULD THE ARTICLE CONTAIN MATERIAL WHICH REQUIRES WRITTEN PERMISSION FOR INCLUSION, YOU AGREE THAT IT IS YOUR OBLIGATION IN LAW TO IDENTIFY SUCH MATERIAL TO THE EDITOR OF THE AJPP AND TO OBTAIN SUCH PERMISSION. THE AJPP WILL NOT PAY ANY PERMISSION FEES. SHOULD THE AJPP BE OF THE OPINION THAT SUCH PERMISSION IS NECESSARY, IT WILL REQUIRE YOU TO PURSUE SUCH PERMISSSION PRIOR TO PUBLICATION.
AS AUTHOR(S), YOU WARRANT THAT THE ARTICLE BEING SUBMITTED IS ORIGINAL TO YOU.
Provided the foregoing terms are satisfactory, and that you are in agreement with them, please indicate your acceptance by checking the appropriate box and proceed with your submission.
