Every new patient requires a complete H&P. (Two new patients/week = minimum 16). You may submit as many as you like in the portfolio for feedback. The final requirement for the portfolio is to select your 4 best write-ups which will be part of your final clerkship evaluation and grade. (Archive those you do not consider your 4 best.)
The Clerkship Directors determine competency. The evaluation checklist is a guide for some of the key things we look for.
Your portfolio coach is primarily responsible for giving feedback on the write-ups. If you want your attending to give you feedback on your write-ups, as k them how they would like to do this. If for some reason your attending has a problem with the way you are taught to do a write-up, please refer him/her to the Clerkship Directors so that you do not get penalized (or find your self writing two versions, which is not acceptable).
The format used for H&P’s is the traditional one taught in ICM, Bates, and most US medical schools. Detailed instructions are in the links below and in the menu.Submitting H&Ps to the portfolio does not create additional work but should give you more consistently constructive feedback. It is expected that you will need to do some reading to formulate your differential, assessment, and plan.
Timeline for an H&P:
- Record the history, physical exam, and labs immediately after obtaining them. (Tip: if you find your forgot something, go back and do it, and incorporate it into the H&P. No one will know you forgot.)
- Read about your leading diagnosis and other aspects of the presentation you need to learn about that day/evening
- Write your assessment and plan before rounds the next day
- Submit to the portfolio for feedback (particularly early in clerkship)
- Apply feedback to the next H&P
You are not allowed to edit and resubmit a write-up that has already received feedback. This is not a good use of your time and we are more interested in seeing if you can apply the feedback in a new setting. You are welcome to submit write-ups that include the track changes feedback some portfolio coaches use.
Perfection is not the goal. Missing minor details, minor organization problems, grammar issues will not affect your grade. Missing major aspects of data collection (e.g. incomplete physical exam), a difficult to follow narrative in the HPI, and/or giving an unclear working diagnosis and/or clinical rationale are problems that could affect your grade.
In addition to formal instructions, we have provided multiple examples of write-ups below to help you understand the expectations.