RESEARCH ARTICLE: SOAP with self-reflection to improve student confidence regarding clinical reasoning competencies in community pharmacy practice



Clinical reasoning, Community pharmacy, Confidence, Reflection, SOAP note


Objectives: Self-reflection has been shown to foster clinical reasoning competencies (CRC). Thus, the SOAP+, which incorporated self-reflection into the SOAP note, has been implemented in community pharmacy clerkship. The aims of this study was to explore the opinion of pharmacy students regarding 1) the confidence in CRC in community pharmacy practice following the SOAP+ writing and 2) the benefits of reflection in SOAP+ writing.

Methods: This was a mixed method study, including a questionnaire survey and focus group discussions of 6th year pharmacy students. The self-rating confidence score before SOAP writing, after SOAP writing, and after reflection writing to complete the SOAP+ were compared using repeated measure ANOVA. The data from the focus group discussions was analyzed using thematic analysis. 

Results: Thirty-seven students completed the questionnaire (68.52% response rate). The scores after reflection writing are the highest score with statistically significant difference for every CRC. The perceived benefits of reflection include promoting of self-directed learning, CRC improvement, and improvement of assessment validity.  

Conclusions: The student confidence regarding CRC in community pharmacy practice were improved through SOAP+ writing, which promotes self-reflection and learning from student experiences.


Al-Quteimat, O.M., & Amer, A.M. (2016). Evidence-based pharmaceutical care: the next chapter in pharmacy practice. Saudi Pharmaceutical Journal, 24(4), 447-451.

Chaffey, L., de Leeuw, E.J., & Finnigan, G. (2012). Facilitating students' reflective practice in a medical course: literature review. Education for Health, 25(3), 198-203.

Croft, H., Gilligan, C., Rasiah, R., Levett-Jones, T., & Schneider, J. (2018). Thinking in pharmacy practice: a study of community pharmacists’ clinical reasoning in medication supply using the think-aloud Method. Pharmacy, 6(1), 1.

Fernandez, S.C., Chelliah, K.K., & Halim, L. (2015). A peek into oneself: reflective writing amongst undergraduate medical imaging students. Reflective Practice, 16(1), 109-122.

Fry, M., & MacGregor, C. (2014). Confidence and impact on clinical decision-making and behaviour in the emergency department. Australasian Emergency Nursing Journal, 17(3), 91-97.

Maudsley, G., & Strivens, J. (2000). Promoting professional knowledge, experiential learning and critical thinking for medical students. Medical Education, 34(7), 535-544.

Hecimovich, M.D., & Volet, S.E. (2009). Importance of building confidence in patient communication and clinical skills among chiropractic students. Journal of Chiropractic Education, 23(2), 151-164.

Judge, T.A., Jackson, C.L., Shaw, J.C., Scott, B.A., & Rich, B.L. (2007). Self-efficacy and work-related performance: the integral role of individual differences. Journal of applied psychology, 92(1), 107.

King, M.C.A., & Bithell, M.C. (1998). Expertise in diagnostic reasoning: a comparative study. British Journal of Therapy and Rehabilitation, 5(2), 78-87.

Linn, A., Khaw, C., Kildea, H., & Tonkin, A. (2012). Clinical reasoning - a guide to improving teaching and practice. Australian Family Physician, 41(1-2), 18-20.

Lutz, G., Scheffer, C., Edelhaeuser, F., Tauschel, D., & Neumann, M. (2013). A reflective practice intervention for professional development, reduced stress and improved patient care--a qualitative developmental evaluation. Patient Education and Counseling, 92(3), 337-345.

Mann, K., Gordon, J., & MacLeod, A. (2007). Reflection and reflective practice in health professions education: a systematic review. Advances in Health Sciences Education, 14(4), 595.

Martins, J.C.A., Baptista, R.C.N., Coutinho, V.R.D., Mazzo, A., Rodrigues, M.A., & Mendes, I.A.C. (2014). Self-confidence for emergency intervention: adaptation and cultural validation of the self-confidence scale in nursing students. Revista Latino-Americana de Enfermagem, 22(4), 554-561.

Mazzo, A., Martins, J.C.A., Jorge, B.M., Batista, R.C.N., Almeida, R.G.d.S., Henriques, F.M.D., Coutinho, V.R.D., & Mendes, I.A.C. (2015). Validation of the self-confidence scale of nursing care in urinary retention. Revista Latino-Americana de Enfermagem, 23, 814-820.

McBrien, B. (2007). Learning from practice--reflections on a critical incident. Accident and Emergency Nursing, 15(3), 128-133.

Pearce, P.F., Ferguson, L.A., George, G.S., & Langford, C.A. (2016). The essential SOAP note in an EHR age. Nurse Practitioner, 41(2), 29-36.

Rencic, J. (2011). Twelve tips for teaching expertise in clinical reasoning. Medical Teacher, 33(11), 887-892.

Stajkovic, A.D., & Luthans, F. (1998). Self-efficacy and work-related performance: a meta-analysis. Psychological bulletin, 124(2), 240.

Tsingos, C., Bosnic-Anticevich, S., & Smith, L. (2014). Reflective practice and its implications for pharmacy education. American Journal of Pharmaceutical Education, 78(1), 18.


2021-04-06 — Updated on 2021-05-09


How to Cite

RESEARCH ARTICLE: SOAP with self-reflection to improve student confidence regarding clinical reasoning competencies in community pharmacy practice. (2021). Pharmacy Education, 21, p. 1–8. (Original work published April 6, 2021)



Research Article