What differences do you note between the two H&Ps?
Coming from a background in both EMS and medical office scribe work, I’ve had experience with medical documentation. However, my experience was much more fundamental than the knowledge I had to develop to take a thorough H&P. While I found that the documentation skills I developed in my previous roles were transferable to the skills needed to write a strong HPI as a PA student, it took some time for me to understand how to integrate the other aspects of the H&P alongside my HPI in a complementary way. The biggest difference I see in my H&Ps is due to reducing redundant information throughout the document and including information only in the area it best belongs. To name one of many examples, I learned that since a general survey is found later in an H&P, it does not need to be included in an HPI. As a result, I think my most recent H&P is more succinct and logically written than my first.
In what ways has your history-taking improved? Are you eliciting all the important information?
I think I have most improved in my ability and understanding of which ROS symptoms are important to ask the patient in order to direct my developing differentials. Secondary to that, I think I have a better understanding of which pertinent positives and negatives are important to highlight in my HPI. I think both of these skills are secondary to my developing medical education. Also, although it can’t be seen on paper, I did notice increased comfort taking a patient’s past medical history between my first and last HPIs. It felt easier to recall which questions to ask after I had forgotten a few during my first patient encounter. Overall, I feel comfortable that I am eliciting nearly all important information, but I know that as my medical knowledge continues to expand, I know I will strengthen this skill further.
In what ways has writing an HPI improved? (hint: look at the rubric scores)
Although the difference between my rubric scores was small, I recall a big difference in my comfort writing my first and last HPIs. Over the course of PD, I learned how to approach HPI writing from the more critical lens of an advanced provider rather than that of an EMT. As an EMT, I was not expected to have a knowledge of what information may be pertinent for a differential diagnosis. As a PA student, that information is of utmost important. I felt much more comfortable with my selection of what was pertinent to include in the HPI in order to guide my initial differential. Overall, I have a better understanding of the true purpose of an HPI from the lens of an advanced practitioner expected to make a diagnosis rather than from the lens as an EMT or scribe who would not.
What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?
Similarly to my experience with documentation, I do have experience performing physical exams from my work as an EMT, but transferring those skills to succeed as a PA student required an expansion of what I previously knew. I believe my strengths to be that I know how to communicate and prepare the patient for the ways in which I will be assessing them, and I know how and when to ensure their comfort throughout the exam. I feel most confident with vital signs and lung auscultation since I frequently did them as an EMT. Also, although examining these body systems was new to me, I feel comfortable with the ears, nose, and throat exams as well, maybe from observing so many of them from my time working in an urgent care office. I feel weakest with the fundoscopic exam and cardiac auscultation because I need to practice identifying turbulent heart sounds.
Which of the specific areas will you target as needing particular focus in future patient visits when you start the clinical year?
I think my biggest weakest at this time is taking a patient’s past medical history. I’ve taken a lot of past medical histories, but they were not required to be as in depth as they are for a real H&P. Sometimes I find muscle memory taking over, and I resort to asking the patient more reductive PMHs that I am used to from the past. I think I need to focus on emphasizing to myself which areas of the PMH are new to me and practice ensuring that I integrate them into the series of questions that I am used to asking. I think this will come easily with time and practice. Similarly, I think I need to get better at memorizing all body systems that need to be included in ROS. I don’t think I have the ability to recall all of them in a systematic way, but I think that too will come with time and repetition.
