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

While the first H&P hits on most of the key points, the third flowed quite a bit better when I was piecing it together.  In comparing the two I also found that my ROS was much more complete than in the first history that I took and that I was able to illicit a more thorough list of pertinent positives and negatives.

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

One of the biggest struggles when first taking a history was maintaining a nearly conversational tone while running through the often numerous questions I had for the patient.  From the first history I took to the third, I noticed a marked improvement in this with just the two previous patient interactions for practice.  Of course, this is most likely from my becoming more comfortable with the histories while simultaneously being more comfortable going through them with the patient. 

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

Without a doubt being able to write the HPI has become significantly better.  Not close to perfect, but the understanding of what should be included and the order in which to present that information is becoming more natural.

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

As far as making progress goes, I’m rather pleased with my abilities as they are at this point.  I certainly feel that the smoothness and flow could improve greatly, however.  While I’m actually performing the series of exams there is still a hint of “stop-start” to them.  While it might only be painfully obvious to me and not to the patient, this is something I want to spend some time ironing out in the future.

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? 

I look forward to unifying the exam with the more personal side of the patient interaction.  I get the sense that, at this point, there is still a distinct introduction and exchanging niceties phase that is followed by the aforementioned stop-start rhythm that comes from an eagerness to “hit the key points.”  An abundance of practice in the clinical year should help with this.