During my mid-site evaluation, I presented a case about a young female patient who presented to the clinic for epigastric abdominal pain that began after eating fried chicken and tomato salad. The clinical presentation was most consistent with GERD, which was my #1 differential. My additional differentials included biliary colic secondary to cholelithiasis, peptic ulcer disease (PUD), and acute pancreatitis. However, I realized that I had not considered cardiac-related causes of epigastric pain. Although these conditions are less common in a young patient with no comorbidities, I was reminded that serious diagnoses such as aortic dissection, angina, or pericarditis can sometimes present with epigastric discomfort. This reinforced the importance of maintaining a broad differential and considering other body system involvement even if the presentation initially appears to point toward a single, more likely cause.

My evaluator provided helpful feedback regarding my case presentation, noting that I was mostly reading directly from my paper and was not maintaining much eye contact. She stressed the importance of thoroughly knowing each patient you interview so that you can discuss the case confidently without relying on reading straight from your paper. She wanted me to present it how I would present to my preceptors, which involved stating only pertinent information to the case. This made sense to me because the purpose of presenting H&Ps is to help us, as students, build confidence when presenting cases to our preceptors during rotations. In fast-paced clinical settings, such as the ED, there is often limited time to write down extensive notes before presenting a patient to the PA or attending, so being familiar with the case and able to communicate it clearly is essential.

For my final evaluation, I applied my evaluators feedback and presented a case about a 55 year old female with chronic headaches, with my #1 differential diagnosis as tension-type headache. The flow of the presentation was way more natural and comfortable, as I was able to focus on clearly communicating key aspects of the case, including history, relevant findings, differential diagnosis, and plan, without reading directly from my notes. My journal article was relevant to this case, as it examined the difference of headache burden between men and women, finding that women experience more frequent headaches compared to men, as well as have a greater burden of disease.