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

The last HPI is more concise compared to the first one.  The last H&P has a more detailed family history and social history. In the first H&P, the patient’s complaints from HPI are noted again in ROS. There is less repeating information on the third H&P.

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

On my first hospital visit, I brought a checklist with me to remind myself about all the information I should obtain from the patient.  I still brought the list with me, but I found myself relying less on the list as we got more practice on hospital patients and during clinical correlation. I get more comfortable eliciting OLDCARTS components during HPI, asking PMH, surgical history, medications, family, and social history. I have become more familiar with each category of ROS. I need to keep in mind to always ask about patients’ reactions when they report an allergy. Also, there are more pertinent positives and negatives that I could have asked.

• In what ways has writing an HPI improved?

It took me less time to write an HPI. For the first HPI, I spent a lot of time organizing all the information into a paragraph. It becomes easier because the first one can be used as a template.

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

I am comfortable performing general inspection, skin, hair, nails, head, ear, sinuses, neck, part of the eye, chest and lung exams. I need more practice on heart exams, especially about identifying and describing murmurs. I also need to get more familiar with neuro exams since there are a lot of steps. I feel the weakest about fundoscopy. I practiced on patients and on family members; I can’t really see anything besides red reflex.

• Which of the specific areas will you target as needing particular focus in future patient visits when you start the clinical year?

I need to ask the patient’s reaction to an allergen and try to rely less on the checklist for ROS. I would focus more on the physical exams that I am not too comfortable with; I need to practice more so I can perform a full physical exam in a coherent way.