1. Despite both these H&P’s being from Pre-Admission Testing, I note many differences. While I did include pertinent negatives in my earlier HPI, they were very specific and direct to the chief complaint and I did not consider more systemic symptoms that may be related. In my last HPI, I expanded the list of pertinent negatives to be more inclusive. My last history regarding medications was also more specific, as I included last dose.
2. As my medical knowledge has increased, I find myself asking more relevant questions. Having a better understanding of pathophysiology has helped me to understand how certain symptoms are related and differentials I should consider when I see these symptoms. Now I am eliciting almost all of the important information, more efficiently and confidently.
3. My HPI writing is now more organized and efficient and less is left out. I used to take a long time to write it, struggling with choosing the correct wording and making it flow well for the next reader. Now, I am better at knowing the order to write my HPI to make it clear and coherent.
4. I feel comfortable doing the physical exam, however I feel that I still need more practice. I feel strongest in the musculoskeletal and neurological exams. On the other hand, I cannot be sure of my “expertise” in certain exams until I perform them on patients, pelvic exams specifically. Another area that I feel I need more practice in is cardiac auscultation, as I do not feel I would be able to confidently distinguish murmurs. I feel confident and comfortable doing the physical exam, however I would just like more practical experience, which I will be looking forward to on rotations.
5. I would like to improve on cardiac auscultation as mentioned before. Furthermore, I would like to improve on combining my skills in both history-taking and physical exams to come up with a plan and list of differential diagnoses. I feel currently many of my skills are segmented and I have not yet mastered the skill of merging them to fully understand the patient’s condition.

Scan Jun 13, 2020