I believe that a strong sense of growth and improvement can be detected from comparing my H&P from first semester to that of the second. The first H&P is noticeably lacking in completion of physical exam documentation, as seen by its conclusion with the chest and lung exam. When analyzing the second H&P, the third and final one of Physical Diagnosis II, it becomes clear that there is further development to the physical exam documentation. For instance, essential elements of the physical examination have been introduced in this H&P including heart, abdomen, GU, vascular, musculoskeletal and nervous system evaluations. Additionally, the assessment and plan section along with problem list and differential diagnoses are included, providing a thorough examination of the patient, in addition to providing potential treatment options for the individualized case.

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

I believe that my history-taking skills have improved over the course of the two semesters of Physical Diagnosis. At initial hospital visits I felt somewhat uncomfortable asking patients for such personal information (i.e. sexual history, GU issues) as it was the first time I was encountering such sensitive topics. However, as I gained more experience as well as confidence at each site visit I believe that not only did I myself become more comfortable in history-taking, but the patient also felt more at ease. In doing so, I have been able to elicit the essential information in order to obtain an accurate diagnosis and ultimately provide the necessary treatment. Of course there is always room to improve, and I strive to be able to put the patient at ease as early on in the encounter as possible so that critical information is shared at onset.

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

Although the HPI is a difficult skill to master, I would like to believe that over the course of hospital visits and in-class practice exercises that I have been able to become more proficient in constructing it. In original HPIs I found it difficult to ensure that I had a good “flow” when including the essential aspects of the HPI, particularly with “OLDCARTS” as well as knowing which aspects are pertinent to include in the HPI specifically. However, I do believe that over time my HPIs have become more concise, yet all-inclusive, especially in relation to inclusion of pertinent positive and negative findings.

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

I certainly feel more comfortable in performing a physical exam on a patient than I did at the onset of PD and PA school in general. I appreciated having our practical exams over the course of the past year to ensure that my physical exam skills were put to the test and that I was given the opportunity for constructive criticism in distinct areas. I feel strongest in my physical exam skills from first semester (i.e. skin, hair, head, nails, eyes, ears, nose, mouth, etc.) as I have bene practicing them the most and for the longest. On the other hand, I do feel weak in regards to the rectal and genital exams as practicing them on mannequins is not the same as real patients. I do look forward to opportunities in clinical year with patients to improve these skills in particular.

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? 

Aside from the rectal and genital exams as mentioned above, I believe that I will need to specifically focus on establishing the most accurate list of differentials as possible. I appreciate the opportunity we are receiving specifically in our Clinical Correlations course to have real-life cases to practice these essential skills. Additionally, I believe I would need to focus on performing my physical exam smoothly and efficiently on future patients in clinical year. While being timed for our lab practical exams is certainly a great first step, I anticipate that patient visits during clinical year will also assist in dealing with this focused concern. I look forward to the near future of clinical year to put all the critical skills learned from my didactic year courses into real-life practice!