What differences do you note between the two H&Ps? Including the longer History and Physicals that we have had to extend on from last semester, as well as adding differentials and an assessment and a plan, I have included increased clearer details on my the HPI and Review of Systems. Additionally, my social history has been reflecting more relevant and detailed information.

In what ways has your history-taking improved?  Are you eliciting all the important information? As we got even more exposure to the hospitals and seeing more patients, I’ve noticed the amount of pertinent information grew between my first and my third HPI. The information and story flowed more naturally and more important information was taken and less crucial details were left out.

In what ways has writing an HPI improved? I have made strides in my HPI-writing, improving my ability to be more concise but include what was absolutely necessary in the narrative. Initially, I was somewhat haphazard with my writing and what information I was soliciting, but with each subsequent hospital visit, I became more aware of incorporating relevant findings, such as pertinent positives and negatives, while reserving less cardinal details for the Review of Systems.

What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about? As mentioned last semester, with performing a physical exam, I feel more confident with the hair, nail and skin exam, as well as the ear and eye examinations. I also believe I am well versed in the lung and abdominal exam and I feel more comfortable with the heart exam. There are many nuances with the musculoskeletal exam and peripheral vascular system that I need to see more in a clinic setting to get more comfortable with it. I also need to physically do genitourinary and rectal examinations on patients to feel a lot stronger in those areas

Of course, we expect you to get stronger in all areas, but which of the specific areas will you target as needing particular focus in future patient visits when you start the clinical year? Last semester I mentioned that I need to think of more targeted questions to ask patients about their chief complaint, and I still believe that I need to refocus in that area. Getting the ball rolling is not my stronger suit, but once the questions start going that’s when I start shining.