Open Questions, Closed Questions, and What I Did Not Ask: Reflecting on My First Graduate Health History With a Digital Standardized Patient
Student Name
Master of Science in Nursing Program, Aspen University
N518: Advanced Physical Assessment
Instructor Name
Month Day, Year
Open Questions, Closed Questions, and What I Did Not Ask: Reflecting on My First Graduate Health History With a Digital Standardized Patient
After 14 years as a medical-surgical nurse, I assumed a health history would be the easiest part of advanced physical assessment. The ShadowHealth health history exercise showed me the difference between the nursing admission interview I know well and the comprehensive history an advanced practice nurse needs. This essay reflects on what went well, where I fell short, and how I will change my approach, drawing on the Calgary-Cambridge model of the medical interview and research on learning through virtual patients.
What Went Well
My strengths were rapport and organization. I introduced myself, explained the purpose of the interview, and began with an open question about why the patient had come in. I moved through the history in a logical order: the reason for the visit and its story, then past illnesses and operations, medicines and allergies, the family's health, her life and habits, and finally a head-to-toe symptom review. When the patient mentioned a symptom, I explored it with the attributes I use every day at the bedside: when it began, where it is, how long it lasts, its quality, what eases or aggravates it, and its intensity. My empathy statements, such as acknowledging her frustration with a long wait, were recognized in the debrief, and my documentation was complete and well organized.
Where I Fell Short
My weaknesses were in how I asked and what I skipped. I relied too heavily on closed questions. When I asked, "Do you have any trouble breathing?" the patient said no, but a later open question, "Tell me about your usual activity," revealed that she avoids stairs because she gets winded. Kurtz et al. (2003) describe how the Calgary-Cambridge guides separate the content of the interview, what information is gathered, from the process, how it is gathered, and argue that process skills such as open-to-closed questioning determine whether the content is accurate and complete. My content checklist was sound, but my process let information slip through.
I also rushed the social history. I asked about tobacco and alcohol but not about housing, food security, intimate partner safety, or how she pays for her medications, all of which affect the care plan as much as her diagnoses. Andermann (2016) argues that clinicians should ask about social challenges routinely and sensitively, help patients access benefits and services, and advocate for change, because these conditions shape health outcomes at least as much as clinical care. A comprehensive history that stops at tobacco and alcohol leaves out the part of the patient's life most likely to determine whether the plan works. And I did not summarize at the end to confirm that I had understood her correctly, which would have given her a chance to correct me or add something important. I gathered answers to my questions, but I did not always find out what the patient needed me to know.
What the Simulation Taught Me About Learning
The virtual patient made my habits visible in a way that clinical practice rarely does. At work, no one scores whether I asked an open question first or whether I summarized. The debrief did, and reviewing my transcript line by line showed patterns I would not have noticed otherwise. Kleinheksel (2014) found that virtual patient simulations can prompt students to reflect critically on their own performance, especially when they examine what they missed rather than only what they did correctly. That was my experience: the most useful part of the exercise was reading my transcript and seeing the question I did not ask.
Changes I Will Make
I will make three changes. First, I will begin each section of the history with an open question and move to closed questions only to clarify, following the open-to-closed cone the Calgary-Cambridge guides describe (Kurtz et al., 2003). Second, I will use a structured social history that includes social determinants, safety, and the patient's own goals. Third, I will close every history with a summary and ask, "Is there anything else you think I should know?" These changes should make my histories more accurate and my patients more likely to feel heard.
References
Andermann, A. (2016). Taking action on the social determinants of health in clinical practice: A framework for health professionals. Canadian Medical Association Journal, 188(17-18), E474-E483. https://doi.org/10.1503/cmaj.160177
Kleinheksel, A. J. (2014). Transformative learning through virtual patient simulations: Predicting critical student reflections. Clinical Simulation in Nursing, 10(6), e301-e308. https://doi.org/10.1016/j.ecns.2014.02.001
Kurtz, S., Silverman, J., Benson, J., & Draper, J. (2003). Marrying content and process in clinical method teaching: Enhancing the Calgary-Cambridge guides. Academic Medicine, 78(8), 802-809. https://doi.org/10.1097/00001888-200308000-00011
How this N 518 Module 1 example is structured
N518 Module 1 typically pairs the ShadowHealth health history assessment with a reflection essay on the experience, using at least two scholarly sources beyond the textbook; the module discussion asks for a comprehensive risk assessment of a friend or family member. Your ShadowHealth exam is your own work and is not sampled. Aspen revises courses, so follow your classroom's prompt. This example names strengths and gaps precisely, interprets them with a model of the clinical interview and ends with concrete changes.
N518 Module 1 questions, answered
What does N518 Module 1 usually ask for?
Completing the ShadowHealth health history assessment and writing a reflection essay on the experience, with at least two scholarly sources beyond the textbook. The module discussion asks for a comprehensive risk assessment of a friend or family member without identifiers.
What is the Calgary-Cambridge model?
A widely used framework for the clinical interview that separates its content, the information gathered, from its process, the skills used to gather it, such as moving from open to closed questions, listening and summarizing.
What should a health history reflection include?
Specific strengths and weaknesses with examples from your transcript, an explanation of why the weaknesses matter supported by sources, what you learned about your own learning and concrete changes you will make.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.