What differences do you note between the two H&Ps? I have noticed more detail in many areas including the HPI and Review of Systems. I’ve also definitely noticed a more robust social history with more pertinent and detailed information.

In what ways has your history-taking improved?  Are you eliciting all the important information? As we got more exposure to the hospitals and seeing more patients, I’ve noticed a more precise way the history has been taken, and I’ve also seen a more expanded history with more relevant information that was pertaining to the chief complaint at heart.

In what ways has writing an HPI improved? My HPI-writing has shown progress as I have become more adept at being more concise. I was little scattershot in the beginning, but as the hospital visits came and went, I became more cognizant to include more relative findings (like the pertinent positives and negatives) and leave anything more accessory to 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? With performing a physical exam, I feel more confident with the skills we learned early on like the hair, nail and skin exam, as well as the ear and eye examinations. I also believe I’m well versed in the lung and abdominal exam. I don’t feel the best at the heart exam, partly because I feel like I haven’t heard an abnormality in real life, but that’ll probably change in the near future. There are also a lot of nuances with the mouth and throat examinations that I’d like to get through more thoroughly.

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? I believe thinking of more targeted questions to patients about their chief complaint, and thinking more outside the box and not having blinders on are some of the areas I need a little bit more work on.