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

The main difference I noticed between my first and last H&Ps was that my last H&P contained much more detail and fluency than my first one. This is particularly evident in the HPIs and physical exam sections.

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

I think my last H&P demonstrates a greater familiarity with what follow up questions need to be asked. My last H&P is also much more detailed than the first. I feel that I was able to better formulate follow-up questions to pertinent positives the patients I took the history from in my last H&P, compared to the first.

• At which ways has writing an HPI improved?

The main difference I noticed from my fall H&P to the spring H&P was the improved fluidity in the latter. Initially, it felt a bit choppy to put together, but with practice, it seems to flow much better.

• 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 about performing a physical exam. I still feel some apprehension about inconveniencing the patient who might otherwise not want to be examined by a student, but this has greatly subsided since my first hospital visit. I would still like to improve in the speed of my physical exam, which is where I feel the weakest. Overall, I feel I am strongest in my technique in the different steps of the physical exam.

• 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 would like to get more practice with the cardiac examination. To this point, I have only listened to normal heart sounds, so I think it would be very beneficial for me to listen to and practice recognizing abnormal heart sounds.