Using the Chief Complaint Driven Medical History: Theoretical Background and Practical Steps for Student Clinicians

Abstract

This article was migrated. The article was marked as recommended. A previous short report presented an approach to teaching a focused medical history in the emergency department by using a chief complaint directed differential diagnosis guided streamlined series of questioning. It was proposed that such an approach teaches clinical expertise. The current article presents a review of a robust literature in the acquisition of cognitive expertise, and specifically how novices become experts through the acquistion of increasingly relevant and pertinent information. The review traces the development of several concepts such as exemplars illness scripts, problem representations, the use of semantic qualifiers and shows how the current proposed method incorporates those approaches. The method is applied specifically to two patient chief complaints commonly encountered in the emergency deparment and suggests how this approach would be useful in developing diagnostic ability in student physicians.