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.1291Samenvatting
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.
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