For more discussion on the EAP format, check out this paper: pubmed.ncbi.nlm.nih.gov/37226142/ I know that the paper defines EAP as standing for "Events, Assessment, Plan", but respectfully, I think "Events, Assessment, Problem List" is more accurate.
When I was a resident, I hated mentioning points earlier in my presentation that was a kind of needless “spoiler” for my assessment and plan. I would be excited to discuss management but have to go through the song and dance of regurgitating the chart first before saying how I’m interpreting that into what I’m doing for the patient.
super interesting. I'm a second year resident and I think another point is that for some problems, people already do the EAP format because it would be so painful to keep it separate in the SOAP format. I think the biggest one is insulin dependent diabetes. We're going to present the highest POC, the total insulin given over the last day, try to interpret the top offenders for the highs, and suggest an modification all within the problem. To your point of medicine being more ready for this change, I feel like more and more teams led encouraged us to save the labs and relevant imaging for when we were discussing the problems (maybe 50% of the teams i was on)
I agree that inpatient diabetes management is one of the problems for which the EAP format is the most well suited, and after reading your comment, I do think our ward teams also tend to save the presentation of data related to glycemic control until the problem list - a nice observation of yours I hadn't previously considered. But for most other data and problems within presentations on our ward teams, the data gets presented twice: once under "objective", and once under the plan for the relevant problem within the problem list.
Dr. Strong, Thank you for these incredible videos. Would you mind making a separate video on how to articulate and make a plan thats clear, concise, and with examples of common Medical issues (chf, afib, copd). Thank you very much
I'm what they call a PGY 4 resident nowadays. Having done a registrar job in both surgery and medicine, I totally agree SOAP note is just a pain. Whenever I round by myself, I can easily write a 4 pages SOAP note for EVERY patient. It's probably just me with a relatively bold handwriting with a decent amount of info, but I must say there's way too much info that is duplicated and isn't necessarily for day-to-day round notes but SOAP.
EAP's disadvantage of requiring more cognitive load for housestaff and students - this is also a benefit. Doing this mentally for each patient also reduces redundancy within our limited working memory but importantly it trains clinical reasoning/thinking skills rather than allowing people to simply focus on the data rather than their assessment/plan. I also agree that I have found so much redundancy while writing progress notes and giving oral presentations via SOAP and always wondered why it's still used in this day of age. With increasing information and data overload thanks to advancements in EMRs, the SOAP format can make students and residents miss the forest for the trees as they dedicate much time on organizing data into the SOAP format. A lot of us have started doing EAP at least for oral presentations without knowing it - it's the main difference between a senior resident's presentation and an intern's. Also saves so much time. How can we start pushing for change for this format?
Based on presentation, the EAP format sounds great, however my main concern with it is how much time it'll take to use for documentation. Since you're manually inserting all the information into your note, it'll take a lot more time compared to the templated SOAP notes that EMRs use. As well, the EAP note still fails to address a lot of the shortcomings that the SOAP note has, including the ID line being relatively unhelpful and bloated, and that you're just moving the note bloat to the end of the note instead of in the middle.
I don't necessarily disagree with you here. For example, as you suggest, streamlining the ID line and reprioritizing/updating the problem list daily are separate issues from SOAP vs. EAP. Regarding documentation and efficiency: the lack of autopopulated data is certainly why EAP is largely advocated as a presentation format rather than a documentation format. One of my biggest gripes about SOAP though is the fact that the objective section of a typical SOAP note is worthless. 98% of the information there has either been copy and pasted from a prior day (i.e. the exam), or has been autopopulated (in which case the data is easier to see and contextualize over time via the vitals and results tabs in the EMR anyway). SOAP notes are an anachronism from the pre-EMR era in which it was actually necessary for doctors to manually search for the relevant information on the wards and put it all together in one location in the chart. But today, no one reads the objective sections of SOAP notes - there's no reason to. I almost think an SAP note would be an improvement over what we currently do. But bottom line, I think it's completely reasonable to use EAP for presentations only.
@@StrongMed I'm a PA who works a lot with Epic and I agree - the entire Objective section no one (including myself) glances at since it's just pulled from the results/vitals. I personally think the Subjective part of the note is still important since that's the basis of medicine - we're describing what the patient is feeling while the 'Events' part sounds more sterile and objective. But I will be trying the EAP method for presenting patients from now on.
@@StrongMed Yes, autopopulated information is almost always useless. Copy-forward information is even worse. It very frequently transitions from useless to outright harmful, with things like "will stop antibiotics today " carried forward for 9 days or other now totally incorrect things in the plan that confuse nurses/consultants/social workers/families who read the notes.
For more discussion on the EAP format, check out this paper: pubmed.ncbi.nlm.nih.gov/37226142/
I know that the paper defines EAP as standing for "Events, Assessment, Plan", but respectfully, I think "Events, Assessment, Problem List" is more accurate.
I love all of your videos and I hope you continue to keep making them. You truly are a great teacher and I hope you get the appreciation you deserve.
When I was a resident, I hated mentioning points earlier in my presentation that was a kind of needless “spoiler” for my assessment and plan.
I would be excited to discuss management but have to go through the song and dance of regurgitating the chart first before saying how I’m interpreting that into what I’m doing for the patient.
super interesting. I'm a second year resident and I think another point is that for some problems, people already do the EAP format because it would be so painful to keep it separate in the SOAP format. I think the biggest one is insulin dependent diabetes. We're going to present the highest POC, the total insulin given over the last day, try to interpret the top offenders for the highs, and suggest an modification all within the problem. To your point of medicine being more ready for this change, I feel like more and more teams led encouraged us to save the labs and relevant imaging for when we were discussing the problems (maybe 50% of the teams i was on)
I agree that inpatient diabetes management is one of the problems for which the EAP format is the most well suited, and after reading your comment, I do think our ward teams also tend to save the presentation of data related to glycemic control until the problem list - a nice observation of yours I hadn't previously considered. But for most other data and problems within presentations on our ward teams, the data gets presented twice: once under "objective", and once under the plan for the relevant problem within the problem list.
What an interesting view, thank you for sharing it 👍👍 and thank you for an amazing channel.
Dr. Strong,
Thank you for these incredible videos. Would you mind making a separate video on how to articulate and make a plan thats clear, concise, and with examples of common Medical issues (chf, afib, copd).
Thank you very much
I'm what they call a PGY 4 resident nowadays. Having done a registrar job in both surgery and medicine, I totally agree SOAP note is just a pain. Whenever I round by myself, I can easily write a 4 pages SOAP note for EVERY patient. It's probably just me with a relatively bold handwriting with a decent amount of info, but I must say there's way too much info that is duplicated and isn't necessarily for day-to-day round notes but SOAP.
EAP's disadvantage of requiring more cognitive load for housestaff and students - this is also a benefit. Doing this mentally for each patient also reduces redundancy within our limited working memory but importantly it trains clinical reasoning/thinking skills rather than allowing people to simply focus on the data rather than their assessment/plan.
I also agree that I have found so much redundancy while writing progress notes and giving oral presentations via SOAP and always wondered why it's still used in this day of age. With increasing information and data overload thanks to advancements in EMRs, the SOAP format can make students and residents miss the forest for the trees as they dedicate much time on organizing data into the SOAP format. A lot of us have started doing EAP at least for oral presentations without knowing it - it's the main difference between a senior resident's presentation and an intern's. Also saves so much time. How can we start pushing for change for this format?
Master ❤
Thank you❤
Based on presentation, the EAP format sounds great, however my main concern with it is how much time it'll take to use for documentation. Since you're manually inserting all the information into your note, it'll take a lot more time compared to the templated SOAP notes that EMRs use. As well, the EAP note still fails to address a lot of the shortcomings that the SOAP note has, including the ID line being relatively unhelpful and bloated, and that you're just moving the note bloat to the end of the note instead of in the middle.
I don't necessarily disagree with you here. For example, as you suggest, streamlining the ID line and reprioritizing/updating the problem list daily are separate issues from SOAP vs. EAP.
Regarding documentation and efficiency: the lack of autopopulated data is certainly why EAP is largely advocated as a presentation format rather than a documentation format. One of my biggest gripes about SOAP though is the fact that the objective section of a typical SOAP note is worthless. 98% of the information there has either been copy and pasted from a prior day (i.e. the exam), or has been autopopulated (in which case the data is easier to see and contextualize over time via the vitals and results tabs in the EMR anyway). SOAP notes are an anachronism from the pre-EMR era in which it was actually necessary for doctors to manually search for the relevant information on the wards and put it all together in one location in the chart. But today, no one reads the objective sections of SOAP notes - there's no reason to. I almost think an SAP note would be an improvement over what we currently do.
But bottom line, I think it's completely reasonable to use EAP for presentations only.
@@StrongMed I'm a PA who works a lot with Epic and I agree - the entire Objective section no one (including myself) glances at since it's just pulled from the results/vitals. I personally think the Subjective part of the note is still important since that's the basis of medicine - we're describing what the patient is feeling while the 'Events' part sounds more sterile and objective. But I will be trying the EAP method for presenting patients from now on.
@@StrongMed Yes, autopopulated information is almost always useless. Copy-forward information is even worse. It very frequently transitions from useless to outright harmful, with things like "will stop antibiotics today " carried forward for 9 days or other now totally incorrect things in the plan that confuse nurses/consultants/social workers/families who read the notes.
Nice