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

Courtney L Bradley¹, Karlie Wieder², Shaina E Schwartz²

¹High Point University, Fred Wilson School of Pharmacy, High Point, North Carolina cbradley@highpoint.edu.

American Journal of Pharmaceutical Education

|December 3, 2021

Summary

Pharmacy students improved their clinical documentation skills by practicing succinct consult notes instead of traditional SOAP notes. This shift enhanced their confidence and efficiency in patient care documentation.

Keywords:

SOAP notes consult notes documentation pharmacy education pharmacy student

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Area of Science:

Pharmacy Education
Clinical Documentation

Background:

Traditional pharmacy education uses Subjective-Objective-Assessment-Plan (SOAP) notes for clinical documentation.
Practicing pharmacists often utilize more concise formats like consult notes for efficiency.

Purpose of the Study:

To evaluate the effectiveness of consult note assignments for third-year pharmacy (P3) students.
To assess student performance and confidence in succinct clinical documentation.

Main Methods:

Implemented consult note assignments in a P3 skills laboratory, converting SOAP notes to consult notes.
Students completed four graded consult notes with decreasing time allotments.
Collected grades and completion times; administered pre- and post-course surveys on documentation self-confidence.

Main Results:

Median grades for consult notes ranged from 80% to 92%.
Median completion times varied, with later notes taking 60 minutes.
Student self-confidence in writing consult notes and five specific elements significantly increased.

Conclusions:

Consult note assignments effectively trained pharmacy students in succinct, time-efficient patient care documentation.
Further research is needed on optimal teaching methods for documentation skills and their impact on clinical performance.