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

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.