1. What differences do you note between the two H&Ps? The History of Present Illness (HPI) in my third history and physical (HP3) is more thorough and complete than that in my first history and physical (HP1). HP1 lacks relevant medical history (e.g. has the chief complaint [CC] happened before?), pertinent positives and negatives from more relevant ROS, and information that would paint a clearer picture of the CC (e.g. is the abdominal pain positional? When was the last bowel movement?). I also misunderstood what was expected of the ROS section of HP1, and so it lacks a complete ROS. Overall, HP3 is better and more exhaustive, but it still requires a lot of work. 
2. In what ways has your history-taking improved?  Are you eliciting all the important information? I think small improvements in my clinical knowledge have helped me understand the correct approach to history-taking a bit better, and because of that, my history-taking is slightly more thorough and I am able to elicit more important information than I did during my first hospital visit. However, I do think that I have a tendency to choose a “path” (e.g. body system, 1 differential diagnosis, etc.) earlier than I should, preventing me from gathering all the information I need before I can begin narrowing my differential down. 
3. In what ways has writing an HPI improved? (hint: look at the rubric scores). I’ve shown improvement in including important/pertinent components and I also feel that I have improved very slightly with the language used in an HPI. I find the HPI to be the most difficult section, because I have a lot of trouble determining what is important enough to require further probing beyond what the patient tells me (e.g. during my 3rd hospital visit, the patient reported that daily activities resulted in fatigue, but I did not ask what type of activities specifically).  
4. 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 comfortable with my current skills in performing a physical exam. Even though it is difficult to say how well I can perform the skills if I have only practiced on healthy individuals without abnormalities, I feel confident that my skills are in a place that is good enough to improve with repetition. Although I absolutely need more practice, I do feel strongest in: the abdominal exam, the eye exam, and the thorax and lung exam. I feel weakest in: the neck/thyroid/trachea exam, as well as generally being able to conduct a physical exam thoroughly without the prompt of a professor in an examination situation.

Physical Diagnosis II: H&P 3