What differences do you note between the two H&Ps?
The difference I noted between my first and third H&P is that my HPIs became more concise. Rather than writing everything the patient states, they now consist of impertinent information. My medical terminology broadened and the physical exam/  ROS became more extensive. The H&P is more organized and logical. 

In what ways has your history-taking improved?  Are you eliciting all the important information?
As the semester progressed and my clinical medicine knowledge increased my history taking skills improved. In the beginning I was unsure of which specific ROS questions to write in the HPI. However, by my third HPI I was able to elicit the important information related to my differential diagnosis. This helped gear my H&P towards certain diagnoses’. I also gained confidence in speaking to patients which allowed me to be more relaxed while asking sensitive information such as sexual history/ married/ single etc. 

In what ways has writing an HPI improved? (hint: look at the rubric scores)
My HPI has improved because now I am more concise and discuss the pertinent and important information. My first HPI was very choppy and did now flow. It consisted of information that was not imperative. By my third HPI I sharpened my skills to use OLD CARTS and was able to easily ensure that parts were incorporated in the HPI. 

What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?
Performing a physical exam is an aspect that I am still not fully comfortable with. I think as time progresses on and I am able to perform a PE on more patients it will improve. However, I currently feel very perplexed while performing a physical exam. Before visiting the patient I run through the PE in my head a few times and I still find myself running through papers figuring out what I missed. I feel the weakest about the cardiac exam such as  listening to murmurs. Recognizing abnormal pathologies from a physical exam is something I lack and also feel weak about. However, I am more confident in performing vitals and being able to visualize any skin abnormalities. 

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?
For my future patient visits I want to focus on being more organized while conducting a physical exam and being more comfortable asking sensitive questions. I notice myself being scared and nervous to ask about the sexual history and how the patient would react. I also want to become better at asking precise ROS questions related to my differential diagnosis. I also want to improve my skills on being able to recognize abnormal physical exam findings.