Background: Oral case presentations are an integral part of patient care and medical education on internal medicine rounds. Presentations provide opportunities for learners to synthesize and integrate pertinent information and to formulate assessments and plans, while simultaneously enabling supervising physicians to identify gaps in learner knowledge or clinical reasoning. Despite ubiquitous modernizations in medicine, the oral case presentation has largely been static, based on the traditional Subjective-Objective-Assessment- Plan (SOAP) format. In this study, we sought to understand learner perceptions of, and preference between SOAP, and a novel format in which subjective and objective patient data are incorporated within the prioritized assessment and plan (Events-Assessment- Plan [EAP]).
Methods: We created a survey (Qualtrics, Provo, UT) to evaluate the extent of learner exposure to the SOAP and EAP formats, exposure duration, learner satisfaction with each of these formats, and overall preference between the two formats (for those who had experience with both). Questions evaluating satisfaction with each format spanned several domains, including: adequacy of the format for discussing the patient’s subjective experience; the extent to which the format encouraged distillation and integration of information; the extent to which the format focused on the assessment and plan; the format’s ability to help learners learn from their own patients and those of their peers; the overall impact on care provided; time efficiency; and ease of use. The survey was distributed to all third- and fourth-year medical students and internal medicine residents via email. Descriptive statistics were used to describe the results N (%) and mean. For comparative analysis between SOAP and EAP, Wilcoxon Signed Rank Test was used to evaluate differences. Comparison data reported include those associated with learners who reported use of both formats. All statistical analyses were done using SAS V9.4 (SAS Institute, Cary, NC). P < 0.05 was considered statistically significant.
Results: Overall response rate was 14% amongst medical students and 46% amongst residents. A total of 98% (n=116) and 52% (n=59) of respondents reported experience with SOAP and EAP formats, respectively. Among medical students (n=62), 60% (n=37) reported experience with SOAP only while 39% (n=24) had experience with both formats. Among residents (n=56), 36% (n=20) and 63% (n=35) had experience with SOAP only and both formats, respectively.In comparing the two formats across ten domains, EAP outperformed SOAP in its ability to allow for: conveying of thought processes, distilling pertinent information, encouraging data integration, focusing on assessment and plan, learning from patients and peers, and advancing patient care. Additionally, the EAP format was considered to be more time efficient (Table 1). Differences were most marked in the following areas: distillation of pertinent information, integration of information to develop an assessment and plan, a focus on the assessment and plan, and time-efficiency. After removing 7 learners who answered “no preference or other,” 79% (n=41) of learners preferred the EAP format compared to 21% (n=11) who preferred SOAP (p< 0.001).
Conclusions: The EAP presentation format outperformed SOAP in nearly every domain queried and was the preferred format for learners. Adoption of the EAP format should be considered by academic medical centers as a way to modernize internal medicine rounds.
