SOAP‐V: Introducing a method to empower medical students to be change agents in bending the cost curve

Abstract

Medical students must learn how to practice high‐value, cost‐conscious care. By modifying the traditional SOAP (Subjective‐Objective‐Assessment‐Plan) presentation to include a discussion of value (SOAP‐V), we developed a cognitive forcing function designed to promote discussion of high‐value, cost‐conscious care during patient delivery. The SOAP‐V model prompts the student to consider (1) the evidence that supports a test or treatment, (2) the patient's preferences and values, and (3) the financial cost of a test or treatment compared to alternatives. Students report their findings to their teams during patient care rounds. This tool has been successfully used at 3 medical schools. Preliminary results find that students who have been trained in SOAP‐V feel more empowered to address the economic healthcare crisis, are more comfortable in initiating discussions about value, and are more likely to consider potential costs to the healthcare system. Journal of Hospital Medicine 2016;11:217–220. © 2015 Society of Hospital Medicine

Pediatric Training Faculty and Resident Perceptions on Teaching High-Value, Cost-Conscious Care: A Multi-Institutional Study

“…22 A recent study on the effect of a value-added presentation format for medical students showed this concept can apply to medical students and improve their comfort in considering value in decisionmaking. 23 However, the presence of a formal curriculum in the absence of faculty role modeling is likely insufficient for training, as demonstrated by the fact that Institution 1 had a formal HVCCC curriculum but residents were still dissatisfied. The ideal curriculum desired by residents also strongly prioritized informal discussion on rounds, which further supports that the presence of a formal curriculum alone is not sufficient.…”

Countering cognitive biases in minimising low value care

“…When formulating diagnostic impressions and management plans, conscious consideration should be given to adding a value statement detailing the perceived benefits, harms and costs of what is being planned. 31 Focused attention on the consequences of decisions may reframe any negative connotations of not doing certain things to a positive stance of configuring care to bestow the highest value for that patient. Any potential for omission regret felt by the clinician may be reframed as offsetting patient regret from their consenting to a management plan that results in undesired outcomes.…”

Incorporating High Value Care into Undergraduate Medical Education

“…Some schools have begun training students to write SOAP-V notes on their patients, where the "V" stands for "value." [15] In these notes, the student comments on the effectiveness of the plan as it pertains to cost of the plan, effectiveness of the plan, and also possible better viable alternatives (suggested by the literature or otherwise). In this way, the student is more an active participant in review of the patient care the team delivers.…”