Effectiveness of SNAPPS for improving clinical reasoning in postgraduates: randomized controlled trial

Abstract

Background In-patient postgraduate teaching suffers with issues like long and unstructured presentations inclusive of a lot of historical information and time constraints due to increasing workload. A six-step pneumonic SNAPPS a learner-centered model modifies the learning encounter by condensing the reporting of facts while encouraging clinical reasoning. This study was planned with the aim to evaluate the effectiveness of SNAPPS as compared to traditional case presentation for facilitating clinical reasoning in inpatient setting. We also wanted to understand perceptions of postgraduates and teachers about this new method of case presentation. Methods This open labeled randomized controlled trial was carried amongst the 18 residents of department of Medicine, MGIMS. The teachers and residents in the SNAPPS were sensitized to SNAPPS technique by using videos, role plays and handouts over 2 sessions of 30 min each. Twenty-seven case presentations (3/resident) were carried out in each group (total 54 case presentations). Data was recorded into validated data recording sheet after each presentation and feedback was taken from the teacher as well as residents regarding their perception. Results The SNAPPS model heralds a change in the preceptor training, pairing faulty development and learner development as companions in education. Guided by the SNAPPS technique, students summarized patient findings concisely (7 vs. 2.7 vs. 5.22vs. 2.33, p = 0.0057) while maintaining the same degree of thoroughness as in traditional case presentations. The students in the SNAPPS group were clearer about their diagnostic hypothesis and compared and contrasted their different diagnosis well (2.56 vs. 1.74, p value =0.002). The students in the SNAPPS group initiated patient management discussion almost 20% more times as compared to the control group. Conclusion We conclude that SNAPPS a learner centered technique for case presentations facilitated the expression of clinical diagnostic reasoning and case based uncertainties in the inpatient setting without extending the unusual length of the student case presentations. It also paved way for enhanced self-directed learning.

Evaluation of a telemedicine-based training for final-year medical students including simulated patient consultations, documentation, and case presentation

“…Competence-based medical education is supposed to prepare medical students for clinical problem solving [ 1 ]. Focused history taking, knowledge-based clinical reasoning, and adequate case presentation represent important facets of competence which are crucial for good patient management [ 2 ], [ 3 ], [ 4 ]. To acquire these competences, communication trainings with simulated patients, seminars, and other training programs have been established in undergraduate medical education [ 5 ], [ 6 ], [ 7 ], [ 8 ].…”

Olgu Temelli Klinik Akıl Yürütme ve Karar Verme Modeli

“…SNAPP modelinin uygulandığı çalışmada öğrenciler, öğrenme eylemlerinde aktif olduklarını, sezgisel düşünmelerinin arttığını, öğrenmelerinin kolaylaştığını belirtmişlerdir. (10) Uzmanlık eğitiminde SNAPPS modeli ile geleneksel olgu sunumlarının karşılaştırıldığı randomize klinik çalışmada, modelin tanı hipotezleri oluşturma, ayırıcı tanı yapmada etkin olduğunu bildirmişlerdir (12).…”

Infusing the axioms of clinical reasoning while designing clinical anatomy case vignettes teaching for novice medical students: a randomised cross over study

“…Thus, the process would enable significant ‘transfer of learning’ while solving similar cases in the clinical environment [ 33 ]. Jain et al [ 34 ] conducted an open labelled randomized control experiment to test the effectiveness of a six step pneumonic centred clinical reasoning model (SNAPPS) in improving the clinical reasoning ability of postgraduates. They found that students in SNAPPS group were clearer in generating diagnostic hypothesis and because of this, they could compare and contrast the differential diagnosis in a better way compared to control group.…”