During my mid-site evaluation, I presented a case about a postmenopausal female who reported intermittent pelvic pressure, described as a straining sensation, along with vaginal dryness for approximately one year. My history and physical exam findings were most consistent with vaginal wall prolapse with components of atrophic vaginitis. While my presentation appropriately focused on the patient’s chief complaint, I received feedback that I was missing key information associated with the patient’s past medical and surgical histories. Specifically, I mentioned that she was a type II diabetic, but failed to include her most recent A1C which is a key component in assessing disease control and should be addressed in any patient with diabetes. Additionally, I mentioned that she had a prior hysterectomy, but didn’t include the reason why. Given that her surgical history was relevant to the case, I was advised to provide a more thorough and detailed review of her history to better support my clinical assessment.

In addition, I separated my differential diagnoses too rigidly, suggesting that vaginal wall prolapse was more likely than atrophic vaginitis. I was reminded that these conditions are not completely separate and may coexist. This highlighted the importance of considering multiple diagnoses together and maintaining a more well-rounded differential list.

During my final site evaluation, I presented a case of a 29 year old female at 33 weeks gestation who presented with vaginal bleeding and intermittent lower abdominal pain. On exam, thick white discharge was noted in the vaginal vault. Findings were most consistent with vaginal candidiasis, however I also considered more serious OB causes, such as preterm labor and placental abruption, given the patient’s third trimester bleeding and abdominal pain. Compared to my mid-site evaluation, I felt more confident in my presentation. I incorporated a broader differential, prioritizing potential high-risk conditions, and presented my findings in a more organized manner. Moving forward, I plan to continue strengthening my ability to integrate relevant past medical history into my assessments and maintain a balanced approach to my differentials.