Improving Medical Student Surgery Notes Through Near-Peer Targeted Education: A Qualitative Analysis

Abstract

Introduction

It is necessary for medical students (MSs) to develop proficiency in medical documentation before residency; however, there is limited education focused on this task. We conducted a qualitative analysis of surgical clerkship note evaluations to create an intervention to improve note writing skills and utilized post-intervention assessments to determine the effect on the quality of clerkship student notes.

Methods

An intervention consisting of an in-person senior MS led lecture during the surgery clerkship orientation focused on Subjective-Objective-Assessment-Plan (SOAP) notes was introduced to MS with limited prior note writing education. Examples of complete and accurate surgical SOAP notes were discussed in-person and shared online. Reports from note assessments were analyzed for four clerkship cycles (2 pre-intervention and 2 post-intervention). Descriptive statistics and Fisher's exact tests were performed to compare assessment responses pre-intervention and post-intervention. Thematic analysis was performed on open-ended responses focused on areas for improvement from the anonymized evaluations.

Results

One hundred seventy-one total note assessments were evaluated (85 pre-intervention and 86 post-intervention). Pre-intervention, MS struggled with note organization and lack of inclusion of patient-centered language within their documentation. Post-intervention, students struggled less frequently with flow and chronology of notes but had continued opportunities to improve in concise and organized presentation of information. Students improved in their ability to provide a one-liner, prioritize a differential diagnosis, and organize and structure their notes effectively. Feedback focused on advanced skills including plan specificity, discharge details and parameters, or advanced physical exam finding documentation.

Conclusions

MS improved their SOAP format note writing skills in response to a targeted near-peer led educational intervention. Remaining growth opportunities in note writing skills appear more connected to evolving clinical reasoning and surgery-specific knowledge which can evolve with ongoing exposure and further education.