The SOTAP or SOAP practice framework

As mentioned in a previous post (here), interdisciplinarity has to ability to cross-pollinate our professional understanding. Whether that is of own first professional field, or of a profession we are moving into. We can learn from the practices of other professions. For example, there is a medical appointment/review framework known as 'SOAP notes' in the USA (Weed, 1970), known as "SOTAP" in New Zealand (Evans et al., 2022), and SOAP in the UK (Altowaijri, 2014). For the sake of convenience, let's call this the SOAP model.

In a framework which could be used partially alongside, and to partially replace the Calgary-Cambridge model, the SOAP model explores two different categories of information that we need to collect from the client. SOAP stands for subjective and objective data, assessment, and planning, specifically "where: S, subjective data describe what the patients complains of from [their] point of view; O, objective data describe what the physiotherapist or other therapists actually see, touch or feel by inspection, percussion, auscultation and palpation; A, assessment of the problem that is an analysis of the subjective and objective data; and P, plan of action, including the proposed interventions to solve the problem (Altowaijri, 2014, p. 96). What I assume to be New Zealand acronym of SOTAP from speaking to practitioners here adds "treatment" after the first two items, so it reads "Subjective, Objective, Treatment, Assessment and Plan" (Evans et al., 2022, p. 824). An open access example demonstrating session note writing using SOAP can be read in the appendices of the Jones and Shepperd article (2011). 

If we wanted to use the Calgary-Cambridge model as well as SOAP, as we begin the session and gather information, we can seek the SO data of SOAP. We then replace "examine; explain and plan": with AP; and close the session (Altowaijri, 2014, Kurtz et al., 2003). That gives us: begin; gather Subjective & Objective data; Assess; Plan; close.

The aim is that we use SOAP to form the structure of our session; to ensure we have covered the required range of treatments or outcomes; to organise the content of our note-taking within our client sessions; as a structure to guide our self-reflection; and as framework for our practice to be audited to. Using a framework has some benefits: it gives a structure to our notes which means that other - or subsequent - practitioners can find the information they seek. It allows less experienced practitioners a checklist to work to, or a checklist for difficult cases. It is a well-known system, and it tends to be quick to complete once we are used to it. It is organised, and has standard language (Altowaijri, 2014). In addition, there is flexibility within SOAP to incorporate other frameworks. For example, a practitioner could utilise different questioning techniques and other frameworks such as a GROW questioning framework in the Subjective section, or to use the Calgary-Cambridge framework as the overall structure, while ensuring that the content covered all the SOAP elements.

However, like everything, there are some negatives: It has been 'time consuming', particularly as professionals need "to read all sections thoroughly so as not to miss information" - and there are a lot of sections (Altowaijri, 2014, p. 267). It has been suggested that auditing SOAP is tricky (Altowaijri, 2014). Any records need to be accessible, so access must be a key consideration. Where there is shared access, it needs to be "clear [as to] which are each profession's notes" (p. 267). Not all professionals read the entire record, and not all record everything that they 'should' (Altowaijri, 2014). Some have said that the process is too structured; some that it is not structured enough... which sounds to me like there is not enough customisation inherent in the framework. That - in my opinion - is a coding issue, not a framework issue.

While we should not homogenise career development, suggesting that all practitioners should use the same framework would assist training, we could use tools like SOAP as a learning framework. We could use it as a checklist when we work with clients who are experiencing complex issues. We could also use it to remind us that combining qualitative and quantitative  assessment (i.e. subjective and objective assessments) may better assist our clients. We could use some type of drop down lists with plenty of customisability to prevent being too channelled in our responses.

Considering new tools in our practice is a superb way to work. It keeps us fresh.

Sam

References:

Altowaijri, A. (2014). A Comprehensive Study to Develop and Evaluate the Acquired Brain Injury Physiotherapy Documentation in an Inpatient Setting. [Doctoral thesis, Cardiff University]. https://orca.cardiff.ac.uk/id/eprint/64397/1/A%20Comprehensive%20Study%20to%20Develop%20and%20Evaluate%20the%20Acquired%20Brain%20Injury%20Physiotherapy%20Documentation%20in%20an%20Inpatient%20Setting-%20PhD%20Thesis%20-%20Abdulrahman%20Altowaijri.pdf

Evans, M., Sykes, C., Hocking, C., Siegert, R., & Garratt, N. (2022). Inter-rater agreement when linking stroke interventions to the extended international classification of functioning, disability and health core set for stroke. Disability and Rehabilitation, 44(25), 8022-8028. https://doi.org/10.1080/09638288.2021.2008525

Kurtz, S., Silverman, J., Benson, J., & Draper, J. (2003). Marrying content and process in clinical method teaching: enhancing the Calgary–Cambridge guides. Academic Medicine, 78(8), 802-809. https://doi.org/10.1097/00001888-200308000-00011

Jones, A., & Sheppard, L. (2011). Physiotherapy scenario development: a new approach. Focus on Health Professional Education: A Multi-disciplinary Journal, 13(2), 1-12. https://search.informit.org/doi/pdf/10.3316/informit.537761478906796

Weed, L. (1970). Medical records, medical education and patient care: the problem-oriented record as a basic tool. Case Western Reserve University Press.