Assessment of SOAP note evaluation tools in colleges and schools of pharmacy

Impact of removing group SOAP note writing from a problem-based learning course series on documentation performance during experiential rotations

BACKGROUND AND PURPOSE

Documentation is a key component of pharmacy education, and SOAP (subjective, objective, assessment, plan) notes are a common framework. Learners must receive feedback, but the amount needed to achieve desired outcomes on experiential rotations is unknown. This study assessed the impact of discontinuing group-written SOAP notes in a four-course problem-based learning (PBL) series on note scores in experiential rotations.

EDUCATIONAL ACTIVITY AND SETTING

Three cohorts across five graduating classes were compared; group-written SOAP notes in four, two, and no PBL semesters. Note writing scores on inpatient medicine and ambulatory care introductory and advanced pharmacy practice experiences (IPPEs and APPEs) were compared using logistic analysis. The odds ratio (OR) of writing a "high performance" note was determined compared to the reference of zero semesters of PBL note writing.

FINDINGS

Additional PBL SOAP note writing did not impact inpatient medicine IPPE scores; however, four semesters of note writing significantly lowered internal medicine APPE note writing scores (OR = 0.51, 95% CI = 0.31-0.84, P = .008). In contrast, two and four semesters of SOAP note writing improved ambulatory care IPPE note writing (OR = 2.33, 95% CI = 1.17-4.65, P = .02 and OR = 2.48, 95% CI = 1.47-4.16, P < .001, respectively) but there was no difference in ambulatory care APPE note scores.

SUMMARY

Removing opportunities for group-written SOAP notes in a PBL course series minimally impacted students' performance on APPEs. Institutions may consider if current SOAP note feedback is effective in preparing learners for APPEs.

Advanced pharmacy practice of a doctor of pharmacy student at an allied surgical ward in a hospital in Africa

Introduction

The pharmacy profession is undergoing transformational change in Ghana. The role of pharmacists has become more patient-focused with increased accountability and responsibility.

Aim

This study is aimed at reporting the experiential learning on the clinical interventions made and documented at the Allied Surgical Wards of Korle-Bu Teaching Hospital (KBTH).This involves a review of patient's medical records during the Advanced Pharmacy Practice Experience (APPE) learning. One case each from Eye, Ear, Nose, Throat, (ENT) and Dental units' subspecialty were reviewed from October 7, 2019 to November 15, 2019 b y a Pharm D student.

Conclusion

The student was able to make prompt clinical interventions that contributed to patient care in clinical wards assigned during her clinical clerkship.

Shifting from SOAP Notes to Consult Notes for Clinical Documentation by Pharmacy Students

Objective. Clinical documentation is an important element of patient care that pharmacy students traditionally learn through subjective-objective-assessment-plan (SOAP) notes. In clinical practice, pharmacists often document more succinctly, both in length and time, using formats such as consult notes. The objective of this study was to assess consult note assignments for third-year pharmacy (P3) students.Methods. Consult note assignments were implemented in a P3 skills laboratory course by converting SOAP notes to consult notes. The series began with an introduction and a practice consult note. Four graded notes were then completed throughout the semester, whereby the time allotted for writing decreased throughout the semester. To assess the series, grades and estimated time to completion were collected for each graded note. A survey given before and after the course assessed student self-confidence in overall documentation, specific elements of consult notes, and concerns related to writing. Friedman tests were used to compare grades and times. Wilcoxon signed rank tests were used to compare self-assessments.Results. The median grades on the four consult notes were 92%, 88%, 80%, and 90%. Median times for completing each note were 75 minutes, 120 minutes, 60 minutes, and 60 minutes. Students' self-confidence in writing consult notes significantly increased, as did five of the six individual elements.Conclusion. The consult note assignments allowed students to practice documenting patient care in a succinct format with consideration for time efficiency. Further work should evaluate best pedagogies for teaching documentation skills and assess the impact on performance during advanced pharmacy practice experiences.

Community pharmacy-based SOAP notes documentation

There is still scarce and sparse evidence regarding documentation of the subjective, objective, assessment and plan (SOAP) note in community pharmacies despite its long implementation history in clinical and academia settings. Hence, we aimed to document and maintain SOAP notes for individual patients visiting community pharmacies for their health problems. We conducted a community-based cross-sectional study at 2 community pharmacies in Nepal from July to December 2019. We recruited 400 patients from all age groups suffering from any health problem using simple random sampling. Patients' subjective complaints were retrieved from their respective prescriptions and verified by interviewing them. Data were collected on the standard format of the SOAP notes and all data related to patients' subjective and objective evaluations, and assessments and plans were descriptively analyzed with R programming 4.0.3. Drug interaction profile was checked with the Medscape Drug Interaction Checker. A total of 87 (21.8%) patients aged 42 to 51 years participated in the research, out of whom 235 (58.8%) were female, 208 (52%) illiterate, 359 (89.8%) were facing mild polypharmacy, and 40 (9.9%) were suffering from joint, leg, ankle, and knee pain. There were 41 minor (11.4%), 130 major (32.7%), and 3 severe (0.9%) drug interaction cases (i.e., medication-related problems), with 11 (2.8%) occurring between amlodipine and metformin, which required close monitoring. There were 226 (56.5%) cases with follow-up planned for the patients when necessary. This novel approach in documenting SOAP notes at community pharmacies during dispensing would be an extended form of the same being applied in clinical settings. Hence, this would open a new arena for the community pharmacists to expand their professionalism beyond the clinical and academia by documenting patients' complex disease and medication profiles in their documentation.

Experiential Education in Pharmacy Curriculum: The Lebanese International University Model

Experiential education is an essential component of pharmacy education in order to allow intern students to experience real conditions and training opportunities in different inpatient and outpatient settings. This paper provides a description of the pharmacy practice experiences (PPEs) in the Lebanese International University (LIU) 5-year bachelor of pharmacy (BPharm) and postgraduate doctor of pharmacy (PharmD) programs; focuses on the opportunities and challenges encountered; and presents a model for experiential education in Lebanon. Learning outcomes and thus students’ acquisition of predefined competencies are evaluated in actual practice settings through assessment tools. Our experiential education program aligns with the accreditation/certification criteria set by the Accreditation Council for Pharmacy Education (ACPE) and equips future pharmacists with the knowledge and skills to become major components in the healthcare team.

[Rubric Assessment for Pharmacotherapy in Spiral Curriculum: Development and Usefulness Evaluation]

A requirement, which students must satisfy, for a diploma at the Showa University School of Pharmacy is the ability to "plan, practice, and assess pharmacotherapy". To continuously assess the ability of students to meet this requirement and to provide patients with proper pharmacotherapy during student clinical rotations, we formulated the "Rubric assessment for pharmacotherapy" and evaluated its usefulness in tutorial learning classes. Clinical pharmacy faculty members created the rubric based on the Subjective, Objective, Assessment, and Plan (SOAP) note guidelines of the university. Third- (2016) and fourth-year students (2017) were required to self-assess their SOAP notes to analyze six clinical cases using the rubric. The rubric consists of three domains: (1) Evaluation of patient condition, (2) Proposal of pharmacotherapy, and (3) Plan for an assessment of pharmacotherapy. The rubric comprises 31 subdomains and is evaluated according to four levels of performance. In this study, 978 rubric sheets that were used by students to evaluate their own SOAP notes were analyzed. We found that the students were able to continuously self-assess their performance using the rubric while continuously improving their achievement level (p<0.05). The results of this study suggest that rubric assessments may be used as a tool for supporting students to plan, practice, and assess pharmacotherapy.

Pharmaceutical Care in Sports

Pharmaceutical care in sports is a new field of work to clinical pharmacists, focused on promoting pharmacotherapeutic follow up and clinical services to athletes, physical activity practitioners and enthusiasts of any sports modality. A broad range of pharmaceuticals, dietary supplements and herbal drugs have been used historically as performance promoters, doping or ergogenic aids. In this context, the role of pharmacists in prevent adverse events, drug interactions or any drug related problems, as doping issues, was described. Its actions can be important to contribute with a multi professional clinical health team, leading athletes to use these resources in a rational way, promoting and optimizing the therapeutic when its necessary.

Inter-rater Reliability of a Clinical Documentation Rubric Within Pharmacotherapy Problem-Based Learning Courses

Objective. To evaluate a clinical documentation rubric for pharmacotherapy problem-based learning (PBL) courses using inter-rater reliability (IRR) among different evaluators. Methods. A rubric was adapted for use in grading student pharmacists' clinical documentation in pharmacotherapy PBL courses. Multiple faculty evaluators used the rubric to assess student pharmacists' clinical documentation. The mean rubric score given by the evaluators and the standard deviation were calculated. Intra-class correlation coefficients (ICC) were calculated to determine the inter-rater reliability (IRR) of the rubric. Results. Three hundred seventeen clinical documentation submissions were scored twice by multiple evaluators using the rubric. The mean initial evaluation score was 9.1 (SD=0.9) and the mean second evaluation score was 9.1 (SD=0.9), with no significant difference found between the two. The overall ICC was 0.7 across multiple graders, indicating good IRR. Conclusion. The clinical documentation rubric demonstrated overall good IRR between multiple evaluators when used in pharmacotherapy PBL courses. The rubric will undergo additional evaluation and continuous quality improvement to ensure that student pharmacists are provided with the formative feedback they need.

Perception of electronic peer review of SOAP notes among pharmacy students enrolling in their first pharmacotherapeutics course

INTRODUCTION

This study aimed to assess the perception of electronic peer review of subjective, objective, assessment, plan (SOAP) notes performed by pharmacy students during their first pharmacotherapeutic course experience.

METHODS

In this single-center, cross-sectional study, a questionnaire was administered to students who had undergone an electronic peer review process of a SOAP note. Four areas were assessed: baseline knowledge, development of therapeutic plans, attitudes and perceptions on peer assessment in enhancing SOAP note writing skills, and perceptions of factors that were/would have been helpful toward providing and/or receiving peer assessment.

RESULTS

One hundred students completed and returned the survey (response rate 61.3%). Most students (93%) reported no prior exposure to writing SOAP notes prior to their participation. SOAP note writing was a valuable component of the module, with most students (97%) recognizing that SOAP note writing skills are important for their future practice as pharmacists. Students also acknowledged that activities in the module improved their abilities to develop (93%) and communicate (80%) patient-specific therapeutic plans in the form of SOAP notes.

CONCLUSIONS

Students were comfortable receiving an assessment of a SOAP note from a classmate, and most students indicated that their classmates could provide an honest assessment of their SOAP notes. The electronic peer review process allowed students to receive feedback on their work, and this learning strategy could be further extended to the education of other functional skills that are essential in pharmacy practice.

Ambulatory care preceptors' perceptions on SOAP note writing in advanced pharmacy practice experiences (APPEs)

INTRODUCTION

Descriptions of SOAP note requirements and assessment methods used during advanced pharmacy practice experiences (APPEs) are limited in the literature. This study aimed to gather information from preceptors regarding SOAP note writing and assessment methods utilized during ambulatory care APPEs.

METHODS

A survey was developed and distributed to ambulatory care preceptors with data collected via Qualtrics and analyzed using descriptive statistics, Fisher's exact test to assess the significance for associations between dependent and independent variables, and the Gamma test to assess dependent variables in grading habits and feedback types.

RESULTS

The survey response rate was 62% with 75% of preceptors having students write SOAP notes during APPEs. A majority of preceptors (84%) do not formally grade SOAP notes with full-time faculty being more likely to grade and provide written feedback. Half of the preceptors perceived students as either prepared or very prepared to write SOAP notes but the majority felt that students struggle with the assessment portion of the note. There were significant differences between schools in the percentage of preceptors that formally grade SOAP notes, ranging from 2 to 45%.

CONCLUSIONS

Preceptors' perception of student preparedness to write SOAP notes on ambulatory APPEs was similar, despite assessment methods varying widely.

Development and Validation of a Rubric to Evaluate Diabetes SOAP Note Writing in APPE

Objective. To develop and establish validity for a grading rubric to evaluate diabetes subjective, objective, assessment, plan (SOAP) note writing on primary care (PC) advanced pharmacy practice experiences (APPEs), and to assess reliability and student perceptions of the rubric. Methods. Ten PC APPE faculty members collaborated to develop a rubric to provide formative and summative feedback on three written SOAP notes per APPE student over a 10-month period. Correlation analyses were conducted between rubric scores and three criterion variables to assess criterion-related validity: APPE grades, Pharmaceutical Care Ability Profile Scores, and Global Impression Scores. Inter-rater and intra-rater reliability testing were completed using Cohen's kappa and Intraclass Correlation Coefficients (ICC). Student perceptions were assessed through an anonymous student survey. Results. Fifty-one students and 167 SOAP notes were evaluated using the final rubric. The mean score significantly increased from the first to second SOAP note and from the first to third SOAP note. Statistically significant positive correlations were found between final rubric scores and criterion variables. The ICC for inter-rater reliability was fair (.59) for final rubric scores and excellent for intra-rater reliability (.98 to1.00). Students responded that the rubric improved their ability (84.9%) and confidence (92.4%) to write SOAP notes. Conclusion. The rubric may be used to make valid decisions about students' SOAP note writing ability and may increase their confidence in this area. The use of the rubric allows for greater reliability among multiple graders, supporting grading consistency.