Final Reflection Paper
- What differences do you note between the two H&Ps?
My first HPI lacked a few details in comparison to my third HPI but overall, I did note many differences between the two. This is also supported by the grades I received for both HPI’s which were not too far off (0.5 difference).
2. In what ways has your history-taking improved? Are you eliciting all the important information?
Between the 1st and 3rd H&P, I have noted some bit of improvement in my history eliciting skills. After gaining experience from the previous spring semester with taking H&P’s I would say I felt more comfortable this semester with speaking to patients and gathering information. I think my first H&P this semester was decent (this is also supported by my grade), my 3rd H&P was also decent (both H&P’s scored high, with the 3rd being 0.5 higher than the first). In both scenarios, I think I have improved in my ability to ask more questions and follow up on additional information that patients may provide that appear pertinent. I do know, however, that for my third HPI I think I could have asked for more specific details from the patient to help separate items from each other on my patient’s problem list and differential list. For both H&P’s I try my best to elicit the HPI following the OLD CARTS format. I tried my best in both cases to obtain other information such as Fhx, PMhx, medication list, etc. but these were limited by each patient’s ability to recall the information and specific details such as date, medication doses, etc. On my 3rd H&P, I would note that I was able to obtain more information on social history than I did in the first H&P.
3. In what ways has writing an HPI improved? (Hint: look at the rubric scores)
For my 3rd H&P, I tried to be more detailed than I was in my 1st H&P regarding the physical exam sections. For example, In the 3rd H&P, for vitals, I made sure to note that it was both the R& L arm for the BP and the position in which it was taken. For the eye exam eye in the 3rd H&P, I made sure to document PERRLA as well as visual acuity, which I did not do on the first H&P. My 3rd H&P also included a more inclusive physical exam (with the exceptions of musculoskeletal, genitourinary, psych etc.) which was not the case with the first H&P. I will mention that for my plan and assessment, my plan was more thorough for my first HPI in comparison to my 3rd HPI, but I feel that this was because my patient had already received care and was awaiting discharge. I could have, however, included more in my plan such as medications, dosing, follow up, etc. for the third HPI. Based on the rubric for the assignment, I also seemed to improve in my noting of vital signs and physical exam aspects for the 3rd H&P.
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 that I have the knowledge basis on how to perform the physical exam components, but I feel that I could use much more practice to improve my proficiency at performing physical exams. I hope to gain this experience as we proceed to our clinical year. I feel most comfortable with performing the abdominal exam, but I feel the least comfortable with conducting a fundoscopic eye exam. I could also use more experience with identifying abnormal heart sounds such as murmurs. I hope that by the end of my clinical year I will be proficient in all the aspects of the physical exam
5. 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 in the last prompt, my skills on the fundoscopic exam and heart exam could use more work so I will try to get more experience over the clinical year. I have seen my HPI and note-taking skills improve significantly from my very first HPI in the spring so I am anticipating that with more experience during the clinical year I should see more significant progress in my skills overall.