title: A Pilot Study of the Chronology of Present Illness: Restructuring the HPI to Improve Physician Cognition and Communication.
abstract: BACKGROUND
  Patient history-taking is an essential clinical skill, with effects on diagnostic reasoning, patient-physician relationships, and more. We evaluated the impact of using a structured, timeline-based format, the Chronology of Present Illness (CPI), to guide the initial patient interaction.
  
  
  OBJECTIVE
  To determine the feasibility and impact of the CPI on the patient interview, written notes, and communication with other providers.
  
  
  METHODS
  Internal medicine residents used the CPI during a 2-week night-float rotation. For the first week, residents interviewed, documented, and presented patient histories according to their normal practices. They then attended a brief educational session describing the CPI, and were asked to use this method for new patient interviews, notes, and handoffs during the second week. Night and day teams evaluated the method using retrospective pre-post comparisons.
  
  
  METHODS
  Twenty-two internal medicine residents in their second or third postgraduate year.
  
  
  METHODS
  An educational dinner describing the format and potential benefits of using the CPI.
  
  
  METHODS
  Retrospective pre-post surveys on the efficiency, quality, and clarity of the patient interaction, written note, and verbal handoff, as well as open-ended comments. Respondents included night-float residents, day team residents, and attending physicians.
  
  
  RESULTS
  All night-float residents responded, reporting significant improvements in written note, verbal sign-out, assessment and plan, patient interaction, and overall efficiency (p < 0.05). Day team residents (n = 76) also reported increased clarity in verbal sign-out and written note, improved efficiency, and improved preparedness for presenting the patient (p < 0.05). Attending physician ratings did not differ between groups.
  
  
  CONCLUSIONS
  Resident ratings indicate that the CPI can improve key aspects of patient care, including the patient interview, note, and physician-physician communication. These results suggest that the method should be taught and implemented more frequently.
authors.affiliation: Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3552, Stanford, CA, 94305, USA. lmazer@stanford.edu.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Mazer
authors.affiliation: Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Lane 154, Stanford, CA, 94305, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Storage
authors.affiliation: Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3552, Stanford, CA, 94305, USA.|Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Lane 154, Stanford, CA, 94305, USA.|Research and Evaluation, Office of Medical Education, Stanford University School of Medicine, 1070 Arastradero Rd, Rm 219, Palo Alto, CA, 94304, USA.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Bereknyei
authors.affiliation: Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Lane 154, Stanford, CA, 94305, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Chi
authors.affiliation: Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Lane 154, Stanford, CA, 94305, USA.
authors.forename: Kelley
authors.initials: K
authors.lastname: Skeff
mesh_terms: D003266:Continuity of Patient Care / Q000592:standards*; D005240:Feasibility Studies; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008487:Medical History Taking / Q000379:methods*; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
keywords: clinical reasoning; communication; electronic health records