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

When comparing the two H&Ps, the second one goes a bit deeper. It is not only added more body systems, but also the problem list, assessment, and plan. The biggest difference is that we have to list our differential diagnosis. During this H&P, I can practice how to choose an appropriate testing to rule out possibilities and confirm a final diagnosis.

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

My history-taking skill is also improved comparing with the first semester. For example, after considered “pertinent”, I know which questions should be asked for different patient. When I did my first history-taking, I did not have too much interaction with my patient, because I have to focus on my note and textbook to figure out that question I should ask. But now, I can complete all my questions without following the order of the note and within a short time.

In what ways has writing an HPI improved? (hint: look at the rubric scores)

Based on the rubric scores, the second H&Ps count for a slightly higher percentage of the total grade. Therefore, when I wrote my HPI during the second semester, I paid more attention on the completeness, logical flow, and quality of the thinking. And I am better able to understand what information is considered “pertinent” and should be put in the HPI.

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

Now I feel more comfortable for performing a physical exam. I am able to perform full routine physical exam correctly. I feel strongest about the vital sign, skin, HEENT, musculoskeletal, abdominal, and neurology. However, I still need to improve my skills for the cardiac exam, such as identify different type of heart murmurs, as well as the fundoscopic exam skills.

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?

In the clinical year, I hope to improve my skill on diagnosis and treatment, such as make an appropriate lab, exam and imaging order, provide correct medication prescription. And also, I hope during the clinical year, I have more chance to practice some clinical skills, such as suturing, placing foley cath, lumbar puncture, injection, and drainage.