1.What differences do you note between the two H&Ps? 

There are a few differences that I noted when comparing my first H&P to my last H&P. The first difference that I noted was in my first H&P I lacked certain details pertaining to the patient’s history. While in my last H&P I completed a thorough history and uncovered certain parts of the history that were pertinent to the case, I was not as extensive in my first H&P. Secondly, the HPI in the first case did not contain all of OLDCARTS. Although it covered much of the case and conveyed the pertinent information, it was wordy and contained unnecessary information. My last H&P was more succinct and all of OLDCARTS was addressed.

2. In what ways has your history-taking improved? Are you eliciting all the important information?

My history-taking has improved in the way that I began to more seamlessly ask questions and use the patient’s answers to guide me to the next question. In the beginning, my history taking was more robotic and more confined to the history-taking outline I had prepared. At the end of the semester I was able to use a more natural flow of conversation and effectively ask all of the important questions regarding the patient’s history. Throughout my visits at the hospital, I learned how to distinguish which facts were most important to determine and how to efficiently elicit all of the necessary information. I also was able to focus on speaking in a manner that the patient would understand and using terminology that the patient was comfortable with to elicit the most appropriate responses.
3. In what ways has writing an HPI improved?

While my HPI originally was not as concise as I could have made it, I noticed that my HPI became more succinct as I visited the hospital each time. I learned how to navigate deciding which information to include and in which order to incorporate it. The flow of the HPI has become more natural to me. I have also noticed that it is easier to ensure I include all of OLDCARTS in my description. 

4. What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?

I feel relatively confident in my ability to do a physical exam, however I am aware that I have room to improve. Practicing the physical exam with my peers and working towards the exams in Physical Diagnosis helped me hone in on my strengths and put effort toward improving my weaknesses. I feel most confident with vitals such as blood pressure, heart rate, and respiratory rate. I find the certain focused exams to be relatively difficult, but I have worked on improving my skills throughout the hospital visits. I find that reviewing the components of each exam in my head helps me conduct a more efficient and smooth exam.

5. 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? 

One area that I will focus on is conducting a smooth history and exam more naturally and completely. I think that it is very important for patients to feel comfortable throughout the duration of the interview and much of this comes from a competent provider. Through feeling comfortable during the interview and relying less on my notes, I can speak more directly to the patient and ensure a smoother flow of conversation. The goal of this would be to conduct a conversation with the patient, rather than a question and answer session and develop a trusting relationship with the patient.