As the second semester of PD progressed I found that by balancing the more friendly and conversational side of the history taking with the need to acquire an extensive amount of information I was able to create a more thorough history and physical while helping the patient become comfortable enough to be forthcoming with details that may not have been shared otherwise. Patients at times are excited by the opportunity to share their observations and feelings regarding their illness and may at times need some gentle redirection so that the best possible history can be taken to guide their management or treatment. In writing the history of present illness there has been some significant improvement that might not necessarily be apparent in the final product and that is a feeling of ‘flow’ when composing the history in comparison to the first semester of PD where making sure to include all the necessary elements required more thought and correction.

From the first semester to the last my ability to conduct a physical exam has made some major strides. As we prepared our comprehensive exams for the end of the semester the reasoning behind each step of the exam became more thoroughly understood as we separated the special exams from the main framework of a complete exam. As we enter clinical year I suspect this will be incredibly useful as there are often restraints on how much time we can afford the history and physical. Going head to toe in examination I realized that all the elements are beginning to click and I feel confident in my ability to efficiently examine patients throughout clinical rotations. Areas I feel I could improve upon are the clarity of explanations of physical maneuvers involved in the musculoskeletal and neurological exams that the patient will be asked to perform actively or participate in passively. Being able to communicate clearly instills trust and this is an area I aim to improve in the coming months.