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

Compare to the fist H&P, the second one is more detailed, contains complete physical examinations, 5 differential diagnosis with explanation, plans, and a problem list. Overall, the second one reveals the growth over two semesters as I feel more comfortable with the pertinent ROS and the physical examination.

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

My history-taking skill has improved a lot when comparing to my first hospital visit. The first time, I was struggling to ask questions effectively within a limited time period, but now I can spend less time looking at the notes and more time interacting with the patient. Also, in the beginning, I was anxious to go up to a patient and start a conversation, but I feel I feel little more confident now to interact with the patient because I have learned to ask appropriate questions in an effective manner that helps to redirect patients. Furthermore, I am practicing asking the questions and pertinent ROS that directly correlate with patient symptom before covering all the other aspect of the ROS. Overall, I feel like, I am more conscious competence compare to the beginning of PA school.

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

I believe by HPI has gone through progressive growth over the 2 PD semester. I improved on placing information in a way that makes the patient story flow better and the thought process is better connected. Also, I am constantly practicing and improving to include pertinent positive and negative at the end of the HPI, which can guide to come up with a working list of differential diagnosis. I think a good HPI is start point in providing the best care to the patient by coming to with a relevant list of differential diagnosis.

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 the physical examination because I feel confident in my physical exam skills compare to the first semester. In the beginning, I was struggling in completing the physical exam correctly within the given time period. Also, while performing the exam, I had to think of every step before proceeding, but now it comes to more naturally and I can perform vital signs, the skin, HEENT, pulmonary, musculoskeletal, abdominal comfortably. However, I need to continue my skill of performing a cardiac and neuro exam because I have difficulty identifying different murmurs and following all the aspect of neuro examination.

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 practice all my didactic phase skills in a real-life setting. Performing a physical exam on a classmate could be different from performing on a patient who I first must build a good rapport in order to perform a PE comfortably. I want to work on my collecting a proper history, performing a thorough physical examination and look at the information to get a better picture of the patient situation to come up with an effective differential diagnosis. Furthermore, I hope to learn to order the correct labs and imaging to rule in and out differential diagnosis. Additionally, I want to work on plans and effective patient management.