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Objective: Taking a psychiatric history is a key educational objective in the psychiatry clerkship. Medical students arrive on psychiatry clerkships unprepared for the unique challenges of psychiatric interviewing. This paper describes an interviewing course for psychiatry clerks that combines practice, observation, and feedback in a small group setting. Methods: A quasi -experimental cohort design with medical student self-ratings as the dependent variable. Results: Students' self-perceived skill in interviewing and differential diagnosis improved more than students who did not have the interviewing course. Students' self-perceived skills also correlated significantly with the number of times they observed interviews. Conclusion: Clerkship directors in psychiatry should provide students with opportunities to practice interviewing skills, observe interviews, and receive feedback. (Academic Psychiatry 2004; 28:66-70)
Medical students are taught the fundamental components of interviewing patients as part of the preclinical curriculum, yet many are unprepared for the challenges of the psychiatric interview. Preclinical interviewing courses are insufficient to meet the needs of clinical students in psychiatry because patients interviewed in the preclinical years often present a limited array of problems and do not portray the types of patients seen in psychiatric services (1). Students need to feel comfortable dealing with more difficult situations such as extremes of emotion or breaks with reality (2). Interviewing skills must be continually developed (3,4) and integrated in the curriculum (5) because skill, especially empathy, has been shown to decline in the clinical years of medical training (6). Deficiencies in interviewing skill can result in failure by physicians to recognize psychiatric problems in the their medically ill patients (7, 8).
Taking a psychiatric history is a key educational objective in psychiatric clerkships (8) because it is a primary source of diagnostic information and serves as the foundation of the therapeutic relationship. Despite the importance of the interview, medical students often receive little practice and receive only ad hoc feedback on their interviews from psychiatric residents and attendings. Some psychiatry departments offer instruction during their clerkships aimed specifically at eliciting a psychiatric history, although the type and amount of instruction varies widely. The effectiveness of interviewing courses offered on psychiatry clerkships has rarely been documented.
At the Northwestern University Feinberg School of Medicine (NUFSM), unpublished clerkship data collected in 1999 show that 50% of students...