Scrubbing Our Assessments: Using SOAP as a Template for OB/GYN Resident Evaluation 1Kelley E. Whitehurst, MAEd • 1Alyson P. Riddick, C-TAGME • 2Heather Z. Sankey, MD • 1Keith H. Nelson, MD

 1Vidant Medical Center • Brody School of Medicine at East Carolina University • Greenville, North Carolina 2University of Massachusetts Medical School – Baystate • Springfield, MA

Our   aim   was   to   create   electronic   evalua1on   SOAP  (eSOAP)   Notes   for   use   by   the   OB/GYN   faculty   to  facilitate   evalua1on   comple1on   and   improve   the  quality   of   ac1onable   feedback   provided   to   the  program’s   residents   and   CCC,   as   well   as   increase  resident   sa1sfac1on   with   evalua1on   and   feedback  received  from  faculty.    

Objectives

Background

Data   from   the   2014-­‐2015   Accredita1on   Council   for  Graduate   Medical   Educa1on   (ACGME)   Survey   of  Obstetrics   and   Gynecology   (OB/GYN)   residents   at  Vidant   Medical   Center   (VMC)   indicated   resident  dissa1sfac1on   with   the   program’s   evalua1on  processes   and   the   performance   feedback   they  received.   Simultaneously,   the   program’s   Clinical  Competency   CommiSee   (CCC)   was   struggling   to  evaluate  resident  achievement  of  Milestones  due  to  a  lack  of  data  as  the  program’s  one  evalua1on  form  was  vague  and  viewed  by  faculty  as  onerous.    

The   VMC   Graduate   Medical   Educa1on   (GME)   Office  staff   and   the   OB/GYN   program   director   devised   an  improvement   plan   capitalizing   on   evalua1on   skills  faculty  already  possessed  by  employing  the  Subjec1ve-­‐Objec1ve-­‐Assessment-­‐Plan  (SOAP)  approach  to  pa1ent  assessment   within   resident   evalua1ons.   While   a  literature   review   uncovered   use   of   SOAP   elements  within  overall  program  evalua1on  and  a  connec1on  to  the   Reporter-­‐Interpreter-­‐Manager-­‐Educator   (RIME)  components,   there   was   liSle   indica1on   of   SOAP  element   use   as   the   template   for   resident   evalua1on  documents.

The   VMC   GME   staff   and   OB/GYN   program   director   developed   evalua1on  ques1ons   based   on   the   program’s   curriculum,   specialty   Milestones,   and  aSributes   corresponding   with   the   SOAP   elements.   These   ques1ons   were  then  systema1cally  organized  to  create  evalua1on  forms,  or  eSOAP  Notes,  for  each  rota1on  by  training  year.  

The   eSOAP   Note   began   with   subjec1ve   ques1ons   primarily   aimed   at  assessing  Milestone  progress  in  Prac1ce-­‐Based  Learning  and  Improvement,  Professionalism   and   Interpersonal   and   Communica1on   Skills.   Objec1ve  ques1ons   then   followed,   targe1ng   topics   in   Pa1ent   Care,   Medical  Knowledge,   and   System-­‐Based   Prac1ce.   A^er   addressing   these   ini1al  elements,   the   eSOAP   Note   transi1oned   to   an   assessment   of   resident  performance   in   regard   to   autonomy,   faculty   expecta1ons   and   rota1on  objec1ves.  The  eSOAP  Note  concluded  with  an  improvement  plan  in  which  faculty  recommend  an  area  the  resident  should  focus  on  prior  to  the  next  rota1on  or  independent  prac1ce.  

Methods

Twenty-­‐seven  unique  eSOAP  Notes  were  developed,  which  the  program   began   u1lizing   for   resident   evalua1on   in   July   2016.  Fi^y  eSOAP  Notes  were  completed  by   faculty   in   the  first   two  blocks   of   the   2016-­‐2017   academic   year,   with   90%   of   those  including  specific,  ac1onable  feedback  to  the  resident.    

By   involving   residents   in   the   eSOAP   Note   development  process,   the   2015-­‐2016   ACGME   OB/GYN   resident   survey  results   regarding   use   of   evalua1ons   to   improve   the   program  increased   from   26%   to   81%,   while   resident   sa1sfac1on   with  feedback  a^er  assignments  increased  from  21%  to  67%.    

Results

eSOAP   Notes,   which   u1lize   the   SOAP   pa1ent   assessment  approach   faculty   clearly   understand,   are   one   approach  programs  may   employ   when   seeking   to   op1mize   the   clinical  learning   environment   by   providing   ac1onable   feedback.   To  ensure   resident   and   faculty   sa1sfac1on   with   a   program’s  evalua1on   system,   both   must   be   included   in   evalua1on  development  and  improvement.    

Significance

Residents  and  faculty  were  provided  dra^  eSOAP  Notes  with  educa1on  to  promote   a   shared   mental   evalua1on   model.   The   finalized   eSOAP   Notes  were  then  entered  into  the  ins1tu1on’s  residency  management  system  and  mapped  to  the  ACGME  Milestones  for  CCC  u1liza1on.