Use of modified SOAP notes and peer-led small-group discussion in a Medical Physiology course: addressing the hidden curriculum.

Peer leading of small-group discussion of cases; use of modified subjective, objective, assessment of physiology (SOAP) notes; and opportunities for self-assessment were introduced into a Medical Physiology course to increase students' awareness and practice of professional behaviors. These changes arose from faculty members' understanding of the hidden curriculum and their efforts to reveal it to take increased advantage of its educationally beneficial aspects. Faculty members and students observed that the requirement for students to submit SOAP notes before their discussions meant that they were well prepared to participate. Student satisfaction with the protocol was high, with >95% of the students agreeing that discussants were well prepared and that the overall performance of their discussion group was good. A comparison of students' performance on selected exam questions showed that peer leading was equally as effective as a previously used teacher-centered approach. Students agreed that their ability to analyze a clinical case had improved using this protocol, an effect that persisted at least one semester after the end of the course. These approaches were time and cost efficient from a faculty perspective while serving the needs of the students. The use of SOAP notes and peer-led discussion were effective forms of instruction, in which students succeeded in learning medical physiology and in practicing professional behaviors.