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

My notes have become more thorough in the physical exam portion, as we have learned more throughout our PD course over the year. However, I noticed that my histories became a bit more concise, as I learned to mostly include just the pertinent information. I’ve also learned to go more in-depth in the ROS and physical exam portions of the particular body system(s) that the patient is complaining of.

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

Now that we have gone over even more diseases and conditions in our classes since the spring semester, my history-taking has improved in that I can formulate a wider range of differential diagnoses as I’m asking the patient questions. This allowed me to elicit the important information like pertinent positives/negatives in a more comprehensive manner than before.

• In what ways has writing an HPI improved?

Although I have been comfortable with writing HPIs for a few years, the process has become even easier and smoother for me since last semester. I now understand that I should include the pertinent data and organize the information in a way that “paints the picture” I am trying to portray.

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

Compared to the beginning of the year, I am more comfortable with taking charge and performing the exams. I felt a bit awkward in the first semester with meeting a new person, exposing their bodies (with permission of course), and practicing my physical exam skills on them; this was just a part of doing something I was not used to. Now, however, that awkward feeling is gone, and I feel much more confident with my purpose in the physical examination. I’ve also gotten better with explaining each step of the physical exam before I perform it, to ensure that the patient is comfortable.

I feel weakest about percussion as I haven’t nailed down a great technique, however, I plan to ask my future preceptors for their advice, as I’m sure I will be exposed to new/different techniques that may work better for me. I also haven’t mastered the flow of a physical exam, I find myself sometimes pausing to think about what to do next, or going out of the order I would like to go in. With more practice, I’m sure I will improve in this area.

• 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?

Like I mentioned earlier, I would like to get better with percussion of the abdomen and lungs. I will look to my preceptors for advice and practice. I will also work on getting the flow and rhythm of doing a routine physical exam down. I know that every provider has their own way and preferences, so I will need to find that myself with practice/trial and error. Lastly, another area of the patient interviewing process I’d like to improve on is my demeanor throughout the encounter. I’ve noticed that while I am eliciting information from the patient, I might come off dry because my mind is so occupied with formulating differential diagnoses and getting the important data. However, I’d like to become more skilled with thinking about the social interaction between me and the patient as well, to make the experience for the patient as pleasant as possible.