Subjective, Objective, Assessment, Plan Research Articles

A novel model of ambulatory teaching of residents in general practice in China: a cross-sectional study

BackgroundThis study aims to determine the satisfaction and future training needs of general practice residents participating in a novel model of ambulatory teaching aligned with the specifications for standardized residency training in outpatient management issued by the Chinese Medical Doctor Association (CMDA).MethodsA cross-sectional survey of the satisfaction and training needs was conducted among general practice residents at West China Hospital, Sichuan University. Patient characteristics and preceptors’ feedback on the residents’ performance were also analyzed.ResultsThe study involved 109 residents (30.28% men) and 161 patients (34.78% men; age: 52.63 ± 15.87 years). Residents reported an overall satisfaction score of 4.28 ± 0.62 with the ambulatory teaching program. Notably, residents scored lower in the Subjective-Objective-Assessment-Plan (SOAP) evaluation when encountering patients with the greater the number of medical problems (P < 0.001). Residents encountering patients with a shorter duration of illness (< 3 months) achieved higher scores than those with longer illness durations (≥ 3 months, P = 0.044). Residency general practitioners (GPs) were most challenged by applying appropriate and effective patient referrals (43/109; 39.45%). GPs expressed a strong desire to learn how to make decisions when facing challenging patient situations (4.51 ± 0.63).ConclusionThis study suggests selecting patients with multiple comorbidities for ambulatory teaching and enhancing training on practical problem-solving abilities for GPs. The findings provide insights for the development of future ambulatory teaching programs.

Intelligent Clinical Documentation: Harnessing Generative AI for Patient-Centric Clinical Note Generation

Comprehensive clinical documentation is crucial for effective healthcare delivery, yet it poses a significant burden on healthcare professionals, leading to burnout, increased medical errors, and compromised patient safety. This paper explores the potential of generative AI (Artificial Intelligence) to streamline the clinical documentation process, specifically focusing on generating SOAP (Subjective, Objective, Assessment, Plan) and BIRP (Behavior, Intervention, Response, Plan) notes. We present a case study demonstrating the application of natural language processing (NLP) and automatic speech recognition (ASR) technologies to transcribe patient-clinician interactions, coupled with advanced prompting techniques to generate draft clinical notes using large language models (LLMs). The study highlights the benefits of this approach, including time savings, improved documentation quality, and enhanced patient-centered care. Additionally, we discuss ethical considerations, such as maintaining patient confidentiality and addressing model biases, underscoring the need for responsible deployment of generative AI in healthcare settings. The findings suggest that generative AI has the potential to revolutionize clinical documentation practices, alleviating administrative burdens and enabling healthcare professionals to focus more on direct patient care.

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

Background and purposeDocumentation 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 settingThree 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. FindingsAdditional 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. SummaryRemoving 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.

The SOAP Feedback Training Program.

Accessible and efficient opportunities for health professional faculty to hone feedback skills are limited. In addition, feedback models to apply to the objective structured clinical examination (OSCE) setting are lacking. Annually, paediatric interns from Children's National Hospital and Walter Reed National Military Medical Center participate in an OSCE, which includes faculty observation and immediate feedback to trainees. In 2018, we incorporated the subjective, objective, assessment, plan (SOAP) Feedback Training Program during 20 min of the pre-OSCE faculty orientation. The SOAP Feedback Training Program introduced the SOAP feedback model (subjective, objective, assessment, plan), facilitated practice in pairs and distributed a cognitive aid referencing the model. We evaluated the quality of faculty feedback exchanges during the 2018 OSCE via retrospective video review using the Direct Observation of Clinical Skills Feedback Scale (DOCS-FBS). We compared the results to the 2015 initial evaluation and used focus groups to understand how and why faculty feedback changed. Comparison of the initial evaluation to the post-SOAP Feedback Training Program intervention data using a Wilcoxon signed rank test showed statistically significant improvement in six of eight feedback items on the DOCS-FBS. Causal coding of focus group transcripts revealed that the SOAP Feedback Training Program evoked affective responses, reinforced prior practice in feedback delivery, improved feedback organisation and increased feedback delivery preparation. The SOAP Feedback Training Program is an effective intervention to teach the SOAP feedback model and improve faculty feedback quality in an OSCE setting. It is efficient and low resource, facilitating its potential use in settings beyond the OSCE.

0341 Acupuncture and Its Effects on Various Patterns of Insomnia

Abstract Introduction Acupuncture has been shown to treat Insomnia. Insomnia is classified as difficulty falling asleep and staying asleep, waking up throughout the night, and waking up early, which is associated with decreased daytime function, mental health, and cardiometabolic health. The purpose of our study is to describe a series of 12 cases seen in an Acupuncture Clinic in Tampa for symptoms of Insomnia. Methods We used intakes from eight females, seven Caucasians, one African American, and four Caucasian males aged 30-65 and assessed information through Acupuncture systems. Patients were seen for Insomnia along with other treatable symptoms between January 2019 and October 2022. Information on Gynecological, Orthopedic, Genito-Urinary, Psycho-Emotional, Gastrointestinal, Respiratory, Ear/Nose/Throat, Neurological, Endocrine, and Allergic/Immunologic were collected. Follow-up intake information and Subjective, Objective, Assessment Plan (SOAP) notes were conducted during each visit through the electronic medical system. Differential diagnosis, as well as ICD codes, are housed within the system. The Acupuncture method utilized was Traditional Chinese Medicine (TCM) and not dry needling, which does not include a differential diagnosis and is typically used for Orthopedic conditions. Results We retrieved data from twelve patients, eight women and four men receiving Acupuncture treatment in private practice. The mean age of the sample was 46.91 [30-65] years. Of the 12 patients, 10 of them fully recovered after treatment. Among those who fully recovered, treatments ranged as low as two up to 14, with three patients receiving six treatments and one receiving 14. One patient discontinued treatment after six treatments with a slight change to differential insomnia pattern. One patient received fourteen treatments with only partial remission to differential insomnia pattern. Conclusion Acupuncture may be an effective modality in treating Insomnia, regardless of the pattern. Further studies are necessary to determine the mechanism of action. Support (if any) R01HL152453, R01MD007716, and R01HL142066

Comparing oral case presentation formats on internal medicine inpatient rounds: a survey study

BackgroundOral case presentations – structured verbal reports of clinical cases – are fundamental to patient care and learner education. Despite their continued importance in a modernized medical landscape, their structure has remained largely unchanged since the 1960s, based on the traditional Subjective, Objective, Assessment, Plan (SOAP) format developed for medical records. We developed a problem-based alternative known as Events, Assessment, Plan (EAP) to understand the perceived efficacy of EAP compared to SOAP among learners.MethodsWe surveyed (Qualtrics, via email) all third- and fourth-year medical students and internal medicine residents at a large, academic, tertiary care hospital and associated Veterans Affairs medical center. The primary outcome was trainee preference in oral case presentation format. The secondary outcome was comparing EAP and SOAP on 10 functionality domains assessed via a 5-point Likert scale. We used descriptive statistics (proportion and mean) to describe the results.ResultsThe response rate was 21% (118/563). Of the 59 respondents with exposure to both the EAP and SOAP formats, 69% (n = 41) preferred the EAP format as compared to 19% (n = 11) who preferred SOAP (p < 0.001). EAP outperformed SOAP in 8 out of 10 of the domains assessed, including advancing patient care, learning from patients, and time efficiency.ConclusionsOur findings suggest that trainees prefer the EAP format over SOAP and that EAP may facilitate clearer and more efficient communication on rounds, which in turn may enhance patient care and learner education. A broader, multi-center study of the EAP oral case presentation will help to better understand preferences, outcomes, and barriers to implementation.

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.

Designing and Implementing a Novel Virtual Rounds Curriculum for Medical Students' Internal Medicine Clerkship During the COVID-19 Pandemic.

IntroductionDuring the COVID-19 pandemic, third-year medical students were temporarily unable to participate in onsite clinical activities. We identified the curricular components of an internal medicine (IM) clerkship that would be compromised if students learned solely from online didactics, case studies, and simulations (i.e., prerounding, oral presentations, diagnostic reasoning, and medical management discussions). Using these guiding principles, we created a virtual rounds (VR) curriculum to provide IM clerkship students with clinical exposure during a virtual learning period.MethodsHeld three times a week for 2 weeks, VR consisted of three curricular components. First, clerkship students prerounded on an assigned hospitalized patient by remotely accessing the electronic health record and calling into hospital rounds. Second, each student prepared an oral presentation on their assigned patient. Third, using videoconferencing, students delivered these oral presentations to telemedicine VR small groups consisting of three to four students and three tele-instructors. Tele-instructors then provided feedback on oral presentations and taught clinical concepts. We assessed the effectiveness of VR by anonymously surveying students and tele-instructors.ResultsTwenty-nine students and 34 volunteer tele-instructors participated in VR over four blocks. A majority of students felt VR improved their prerounding abilities (86%), oral presentation abilities (93%), and clinical reasoning skills (62%). All students found small group to be useful.DiscussionVR allowed students to practice rounding skills in a supportive team-based setting. The lessons learned from its implementation could facilitate education during future pandemics and could also supplement in-person clerkship education.

STUDENT ACHIEVEMENT IN A PHARMACOTHERAPY PRACTICE COURSE: A CASE STUDY AT AN INDONESIAN PHARMACY SCHOOL

Background: Indonesian pharmacy schools are expected to meet required clinical pharmacy components and the proportion of practical courses according to nationally established standards. This is essential to produce competent Indonesian pharmacists. The implementation of Pharmacotherapy of Gastrointestinal, Respiratory Tract Diseases, and Special Conditions Practice was one of the measures taken to meet this requirement. This case study aims to explore obstacles in Pharmacotherapy of Gastrointestinal, Respiratory Tract Diseases, and Special Conditions Practice.Case discussion: Pharmacotherapy of Gastrointestinal, Respiratory Tract Diseases, and Special Conditions (FAF 314) Practice was conducted using group case study with SOAP (subjective, objective, assessment, plan) worksheet. During the sixth week of practice, a modified OSCE was conducted to assess the learning process. The skills that were assessed included problem identification, problem-solving, drug information service, effective communication, as well as attitude and professionalism. However, the students’ average score in this assessment was about 1-2 of maximum score 3, and the required passing score was 2. Conclusion: The sub-optimal students’ achievement in the mid-term assessment of Pharmacotherapy of Gastrointestinal, Respiratory Tract Diseases, and Special Conditions Practice may be due to the students’ obstacles in understanding the information from literature and showing effective communication skills and professional attitude in drug information provision. To address these issues, further measures such as constructive alignment analysis of this practice, revising practice activities design and allocating adequate time to practice effective communication skills and professional attitude in drug information provision. Keywords: constructive alignment, communication, pharmacotherapy practice, OSCE, SOAP

Man vs. machine: Predicting hospital bed demand from an emergency department

BackgroundThe recent literature reports promising results from using intelligent systems to support decision making in healthcare operations. Using these systems may lead to improved diagnostic and treatment protocols and to predict hospital bed demand. Predicting hospital bed demand in emergency department (ED) attendances could help resource allocation and reduce pressure on busy hospitals. However, there is still limited knowledge on whether intelligent systems can operate as fully autonomous, user-independent systems.ObjectiveCompare the performance of a computer-based algorithm and humans in predicting hospital bed demand (admissions and discharges) based on the initial SOAP (Subjective, Objective, Assessment, Plan) records of the ED.MethodsThis was a retrospective cohort study that compared the performance of humans and machines in predicting hospital bed demand from an ED. It considered electronic medical records (EMR) of 9030 patients (230 used as a testing set, and hence evaluated both by humans and by an algorithm, and 8800 used as a training set exclusively by the algorithm) who visited the ED of a tertiary care and teaching public hospital located in Porto Alegre, Brazil between January and December 2014. The machine role was played by Support Vector Machine Classifier and the human prediction was performed by four ED physicians. Predictions were compared in terms of sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUROC).ResultsAll graders achieved similar accuracies. The accuracy by AUROC for the testing set was 0.82 [95% confidence interval (CI) of 0.77–0.87], 0.80 (95% CI: 0.75–0.85), 0.76 (95% CI: 0.71–0.81) for novice physicians, machine, experienced physicians, respectively. Processing time per test EMR was 0.00812±0.0009 seconds. In contrast, novice physicians took on average 156.80 seconds per test EMR, while experienced physicians took on average 56.40 seconds per test EMR.ConclusionsOur data indicated that the system could predict patient admission or discharge states with 80% accuracy, which was similar the performance of novice and experienced physicians. These results suggested that the algorithm could operate as an autonomous and independent system to complete this task.

Improved learning experience with modified case studies courses in a pharmacy curriculum

Background and purposeMany pharmacy programs have dedicated case studies (CS) courses; however, universal standards on how to implement CS courses do not exist. Understanding the process of changing CS courses at an institution may help others to recognize and overcome potential barriers. This study describes the implementation process of changes that occurred in CS courses and evaluates the impact of the changes on students' learning experiences. Educational activity and settingFaculty members involved in CS courses made changes that focused on small group discussions, increasing faculty availability, decreasing student-to-faculty ratio, providing immediate and detailed feedback, and facilitating active learning. After the implementation of the new CS course design, two surveys were administered to evaluate the impact of the new design, one to a single cohort of pharmacy students and one to faculty involved in the CS courses. FindingsSeventy-two students completed the survey (80% response rate). The majority of students preferred the following aspects of the new CS course design: more objective SOAP (subjective, objective, assessment, plan) note rubric with detailed descriptions on point allocation, small group discussion within a classroom, and faculty-facilitated case review in group discussion. Having the same, readily available instructors reviewing a case in each class was also an important factor in their learning experience. The faculty survey resulted in similar findings but with concerns of increased workload and teaching an unfamiliar topic. SummaryOverall, the new CS course design provided a better learning experience for pharmacy students compared to the previous CS course design.

Characterization of clinical knowledge and problem-solving assessments employed in postgraduate year 1 pharmacy residency interviews.

Attainment of postgraduate year 1 (PGY1) residency positions has become increasingly competitive. Inclusion of clinical knowledge and problem-solving assessments in onsite interviews has increased in recent years. Characterization of these assessments is necessary for applicants to best prepare for interviews and for mentors to provide guidance. An online survey was emailed to program directors of PGY1 pharmacy residency programs accredited by the American Society of Health-System Pharmacists (ASHP). Data were analyzed using descriptive statistics. Chi-square and Fisher's exact tests were used to compare categorical data. The Mann-Whitney U test was used to analyze nonparametric continuous data. Of the 221 respondents, most identified their programs as based at community (48%) or academic (39%) medical centers. Ninety percent of programs reported inclusion of clinical knowledge and problem-solving assessments in the onsite interview process. The most common assessments included asking clinical questions (70%), development of a SOAP (subjective, objective, assessment, plan) note or care plan (42%), and formal presentations that applicants prepared prior to arrival (39%). Most programs (71%) reported incorporating multiple assessments, with 2 assessments included most commonly (43%). Clinical assessment performance accounted for 10% to 25% of the overall interview score in approximately half of programs. During onsite PGY1 residency interviews, applicants must be prepared to participate in at least 1 clinical knowledge and problem-solving assessment, including answering clinical questions, developing a SOAP note or care plan, and/or delivering a presentation. Applicants should expect that these assessments will account for a substantial portion of the interview evaluation.

Take Pause in Quiet Moments: Engaging in Reflection to Guide Instruction

AbstractWith the pressures put on teachers today to meet standards, cover a dense curriculum, and be involved in numerous meetings, taking the time to reflect on instruction may be pushed aside. The authors examined the importance of reflection and its impact on teaching and learning. Reflection allows teachers to evaluate subjective and objective criteria that help them respond and make modifications to lessons. Many teachers engage in reflection intuitively. The authors describe how one teacher fully engages in the reflective process through the use of the reflective SOAP (subjective, objective, assessment, plan) strategy. In an era of accountability, SOAP notes help document instruction and student learning, thus benefiting educators and students. The SOAP notes model can be applied to any content area across all grade bands. One must consider the question of how teachers can fully engage in reflection to improve instruction and meet the learning needs of their students.

Impact of Curricular Integration Between Patient Care Laboratory and Introductory Pharmacy Practice Experience on Documentation

Objective. To assess the impact of curricular changes made through vertical integration between Patient Care Laboratory and Introductory Pharmacy Practice Experience (IPPE) courses on documentation outcomes. Methods. Curricular changes to address student pharmacist documentation deficiencies were developed by laboratory and experiential faculty members. A documentation activity using subjective, objective, assessment, plan (SOAP) notes completed in one IPPE rotation block, pre-intervention, were graded and compared to SOAP notes from the same IPPE rotation block in the subsequent year, post-intervention, using a standard checklist. Chi square test (or Fisher exact test when appropriate) was used to evaluate the relationship between each question's score and different timepoints. Wilcoxon rank sum test was used to compare total scores between the two groups of students. Results. Significant improvement among student pharmacists' SOAP note scores were observed in the post-intervention cohort (n=52) compared to pre-intervention cohort (n=52) following curricular changes. Specific SOAP note components that revealed significant improvements between years were drug therapy problem identified, proposed drug therapy problem resolution, follow-up plan identified, overall impression, and addressing a pharmacist-specific intervention. Conclusion. Collaboration between laboratory and experiential education faculty members are integral to the identification of gaps in student pharmacists' application of simulated activities into actual experiences and in the achievement of educational outcomes. Curricular quality improvements can be implemented and assessed quickly through vertically integrated courses.

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

IntroductionThis 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. MethodsIn 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. ResultsOne 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. ConclusionsStudents 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.

Assessment of pharmacy students' patient care skills using case scenarios with a SOAP note grading rubric and standardized patient feedback

Background and purposeTo determine if the patient care and documentation skills of pharmacy students improve in the third professional (P3) year using a subjective, objective, assessment, plan (SOAP) note grading rubric and a standardized patient (SP) checklist rubric with SPs taking the role as evaluator during a sequential system of case scenarios. Educational activity and settingDuring a required skills laboratory course in the P3 year at the University of Mississippi School of Pharmacy, students were evaluated with a SOAP note grading rubric and an SP checklist rubric during three consecutive SP case scenarios (hypertension, diabetes, asthma). FindingsOverall, scores for the sequential case scenarios improved across all three scenarios through the use of SOAP notes (F = 96.89, p < 0.0001). For the SP evaluations, total score improved for the second and third case scenarios versus the first (F = 27.48, p < 0.0001). SummaryPatient care skills of P3 pharmacy students improved during a sequential system of case scenarios using a SOAP note grading rubric and an SP checklist rubric as objectively developed evaluation tools, with SPs taking the role as evaluator.

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.

SOAPing in Pharmacology: An innovative Tool to Foster Critical Thinking during Didactic Years in Pharmacy School

During the didactic years of pharmacy education, it is imperative to provide students with tools to enhance their critical thinking skills that involve adequate use of analysis, reflection, open mindedness, and evidence in solving a problem at hand. This kind of training is anticipated to equip the students with the skills to tackle constantly evolving advances in pharmacy, such as availability of new medications as well as changes in delivery of patient care. For decades, such training has been introduced early in the didactic years in Clinical Science courses especially while instructing students to analyze patient cases and write up SOAP (subjective, objective, assessment, plan) notes. Such training has indisputably helped students to transition to their experiential rotations. Our aim was to design and implement a similar critical thinking tool in Basic Science courses, such as pharmacology, thus enabling pharmacy students to broaden their application of critical thinking skills during their didactic training. Towards this end, we have developed an Observational Screening Student Project (OSSP) for the second‐year pharmacy students based on the results of a battery of preclinical tests (termed Hippocratic Screening) originally administered on rats by Malone and colleagues in 1983 to test ethnopharmaceuticals. These tests form a subset of safety pharmacological studies required by the FDA in order to evaluate the non‐clinical safety profiles of pharmaceuticals and their effects on physiological functions.In the OSSP, students are given a worksheet with data containing CNS, respiratory, and autonomic pharmacologic responses in a rat induced by an intraperitoneal injection of a drug covered in prior courses taken in pharmaceutical sciences. After analyzing the data, students are asked to determine the drug class that most likely produced the pharmacological profile depicted by the data in that worksheet. When analyzing the data to determine the drug class, students must consider the signs and symptoms that are present as well as those that are absent. The students are encouraged to use analysis, reflection, open mindedness, and evidence in solving their problem at hand, which gives them an opportunity to develop their critical thinking skills.Survey results of the class demonstrated that over 70% felt that they were able to effectively review and analyze the rat's symptoms after administration of a drug as presented in the worksheet (80% response rate). A similar percentage of students indicated that they were able to keep an open mind and describe the process involved in assessing the data on the worksheet. However, only about 52% of students thought that they were able to develop follow‐up questions based on the evidence provided in the worksheet. Developing follow‐up questions is a higher order critical thinking process, which normally comes with more experience and training. Overall, more than 50% of the respondents felt that OSSP was a valuable educational tool that would better prepare them to progress into their experiential courses. In conclusion, OSSP can be regarded as a pre‐clinical subjective, objective, assessment, and plan (SOAP) tool to improve critical thinking skills that will aid students in analyzing a patient as a whole, working them up, assessing drug therapies, making necessary adjustments, and seeking appropriate literature as evidence to support their findings.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Reasons for encounter and health problems managed by general practitioners in the rural areas of Beijing, China: A cross-sectional study.

ObjectiveThe purpose of this study was to describe the patients’ reasons for encounter (RFE) and health problems managed by general practitioners (GPs) in the rural areas of Beijing to provide evidences for health services planning and GPs training.MethodsThis study was conducted at 14 community health service centers (CHSCs) in 6 suburban districts of Beijing, using a multistage sampling method. A total of 100 GPs was selected from the study sites. A self-designed data collection form was developed on the basis of Subjective-Objective-Assessment-Plan (SOAP), including patient characteristics, RFEs, health problems, interventions, and consultation length. Each GP recorded and coded their 100 consecutive patients’ RFEs and health problems with the International Classification of Primary Care, 2nd version (ICPC-2). Descriptive statistics were employed to describe the distribution of RFE and health problems. Student t-test and analysis of variance were used to compare the differences of mean number of RFE or health problems per encounter by patient characteristics.ResultsA total of 10,000 patient encounters with 13,705 RFEs and 15,460 health problems were recorded. The RFEs and health problems were mainly distributed in respiratory, circulatory, musculoskeletal, endocrine, metabolic and nutritional, and digestive systems. Cough and hypertension were the most common RFE and health problem, respectively. With increased ages, the mean number of RFEs decreased and the mean number of health problems increased. Patients with Beijing medical insurance had less RFEs and more health problems than those in other cities (p<0.001). Patients who had visited the CHSC previously and signed contracts with the GP team had more health problems than those who had not (p<0.001).ConclusionsThese findings present a view of patients’ demands and work contents of GPs in Beijing rural areas and can provide reference for health services planning and GPs training.

Dynamic Electronic Health Record Note Prototype: Seeing More by Showing Less.

Cluttered documentation may contribute adversely to physician readers' cognitive load, inadvertently obscuring high-value information with less valuable information. We test the hypothesis that a novel, collapsible assessment, plan, subjective, objective (APSO) note design would be faster, more accurate, and more satisfying to use than a conventional electronic health record (EHR) subjective, objective, assessment, plan (SOAP) note for finding information needed for ambulatory chronic disease care. We iteratively developed physician clinic note prototypes with features designed to emphasize more important information and de-emphasize less clinically relevant information. Sixteen primary care physicians reviewed comparable clinic notes with the 4 note styles presented in random order to find key information in the notes during timed tasks. The 4 note styles were denoted A (traditional SOAP note), B (2-column APSO note), C (collapsible APSO note), and D (2-column collapsible APSO note). The 4 unique note styles were designed to have equal amounts of information in each section. We simulated their utility for clinical practice by imposing time limits and by interrupting 1 of the tasks with a typical clinical interruption. For each session, we recorded audio, computer-screen activity, eye tracking, and made field notes. We obtained usability ratings (System Usability Scale), new feature preference ratings, and performed semistructured post-task interviews with subsequent content analysis. We compared the effectiveness of the 4 note styles by measuring time on task, task success (accuracy), and effort as measured by NASA Task Load Index. Note styles C and D were significantly faster than A and B for the Review of Systems and Physical Examination tasks, as we expected. Notes B and C had the best success (finding requested data) scores. Users strongly endorsed all the new note features incorporated into the new note prototypes. Previously expressed concerns about temporarily hiding parts of the note (using the accordion display design pattern) were allayed. Usability ratings for note A were worst but comparably better for note styles B, C, and D. The new APSO note prototypes performed better than the traditional SOAP note format for speed, task success (accuracy), and usability for physician users acquiring information needed for a typical chronic disease visit in primary care. Moving Assessment and Plan to the top is 1 easily accomplished feature change. Innovative documentation displays of EHR data can safely improve information display without eliminating data from the record of the visit.