The rise and fall of students' skill in obtaining a medical history.

A gradual shift towards a more humanistic conception of medicine has occurred in recent years. Along with this shift have come attempts by medical educators to include interviewing and communication skills as part of the medical curriculum. The current study evaluates the effectiveness of a clinical medicine curriculum which emphasizes interviewing skills. Between 1992 and 1994 and 292 graduates of the University of Connecticut School of Medicine participated in five clinical skills teaching and assessment programmes during the four years of medical school. During each of these five programmes, the students' interviewing skills were rated using the Arizona Clinical Interview Rating Scale (ACIR). The raters were standardized patients with whom they had just completed a medical encounter. Results show that students' development of skills differed, with closure items showing the greatest increase and social history items showing the greatest decline, with an overall initial increase and then a decline in interviewing skills over the four years. Explanations for these findings include the de-emphasis of communication skills during the clinical years and the culture of medicine to which students are exposed during these years.