The Obstetrics and Gynecology Portfolio Note: An integrated learning experience Vrunda Bhavsar Desai MD, Janice Crabtree MS, Jessica Illuzzi MD, MS Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT Objective Pharmacology Cost Effectiveness Socioeconomic and Cultural Considerations Psychosocial Barriers Clinical Resource Availability Ethical Considerations Health Policy and Public Health Global Health Social Barriers Preventive Care Quality of Life Provide an assignment for clerkship students that promotes reflection upon the socioeconomic, psychosocial, public health and cost-effectiveness of care, as well as a forum for group analysis of their individual findings. Introduction Full understanding of the many complex factors that affect patient care, including social and cultural components, cost and access to care, as well as public and global health care concerns, is often difficult for clerkship students during their interactions with patients. To encourage students’ exploration of the full extent of their patients’ experiences of health and illness, including various barriers to care, we enhanced the existing clerkship portfolio note assignment. The new assignment leads students to heightened awareness of the challenges faced by patients when engaging with the medical system. Sharing their reflections on this writing assignment with their peers at the end of the clerkship provides students with further opportunities for enhanced recognition of factors affecting patients experiences. Materials and Methods Results Medical students rotating through the Obstetrics and Gynecology Clerkship are given this assignment at the start of the 6-week rotation and are guided through selection of the appropriate patient for the note. In addition to the standard patient information typically included in a chart note, students are required to compose additional paragraphs illustrating the their “deeper considerations” of the many external factors that affect a patient’s interactions with the healthcare system. In the final week of the clerkship faculty-moderated group time is provided for peer discussion of their findings and the implications for future practice. Students have been sharing their portfolio note findings as a group during the final group meeting of the clerkship with the clerkship directors. This exercise fosters self-reflection and peer-reflection on the varied elements of patient care. Sharing their findings with fellow students allows them further opportunities to broaden their understanding of the factors influencing patients’ experiences navigating the health care system. Students have remarked that the exercise made them aware of a variety of limitations faced by patients including access to care; long wait times for appointments; difficulties with transportation to visits; challenges for obtaining child care; the extent to which social & cultural backgrounds influence patients’ perception of their care and impact their decision making, as well as quality of life. Students were often surprised by the unexpected ethical dilemmas that arose so frequently during their clinical experiences. Conclusion Opportunities for self-reflection, peer discussion, and faculty feedback offered by this exercise broaden clerkship students’ understanding of patients’ experiences and the wide range of societal issues they face within the health care system. Acknowledgement We would like to thank the Yale School of Medicine Class of 2016