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

I think the major difference between the two H&Ps was just how much additional information I was able to extract. I was able to cover everything I wanted to in the second interview, even though I had about half the time.

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

In my second history-taking session I think I did a better job at leading the conversation towards the items I needed to cover. Part of that was I had a more compliant patient, but I also felt that I interjected more frequently, while still letting the patient speak freely when appropriate.

When I reviewed the second patient with the supervising PA, we did talk about a few items I had missed, such as asking about substantia nigra (in an obese patient), but that was more due to a knowledge gap than forgetting a part of the interview.

In what ways has writing an HPI improved?

I got feedback that I was including irrelevant information in the first H&P (such as the cancer history of uncles/aunts), but received no such criticism in the second. I also feel that I am writing more parts of the history spontaneously, without having to rely so much on the lab templates.

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

I do not feel super confident about taking histories yet. I think the biggest part is that I rely on a template that I draw out beforehand. I wouldn’t be able to just drop in on a patient and take an acceptable interview. I also feel uncomfortable doing the ROS, because it’s so repetitive and I feel guilty about losing the patient’s interest.

I do feel a little more confident in my physical exams, especially after having studied them for the lab exams.

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? 

When I start clinicals, I would like to be able to do most of the interview without using a template, including the ROS. I would also like to feel comfortable with retaining most of what the patient says without having to jot it down.