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Effectiveness of SNAPPS for improving clinical reasoning in postgraduates: randomized controlled trial.
BMC Med Educ. 2019 Jun 21; 19(1):224.BM

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.

Authors+Show Affiliations

Department of Medicine, Mahatma Gandhi Institute of Medical sciences, Sewagram, Wardha, Maharashtra, 442102, India. drwish1079@gmail.com.Department of Surgery, Mahatma Gandhi Institute of Medical sciences, Sewagram, Wardha, Maharashtra, 442102, India.Department of Physiotherapy, Seth GS medical college and KEM hospital, Mumbai, India.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

31226996

Citation

Jain, Vishakha, et al. "Effectiveness of SNAPPS for Improving Clinical Reasoning in Postgraduates: Randomized Controlled Trial." BMC Medical Education, vol. 19, no. 1, 2019, p. 224.
Jain V, Rao S, Jinadani M. Effectiveness of SNAPPS for improving clinical reasoning in postgraduates: randomized controlled trial. BMC Med Educ. 2019;19(1):224.
Jain, V., Rao, S., & Jinadani, M. (2019). Effectiveness of SNAPPS for improving clinical reasoning in postgraduates: randomized controlled trial. BMC Medical Education, 19(1), 224. https://doi.org/10.1186/s12909-019-1670-3
Jain V, Rao S, Jinadani M. Effectiveness of SNAPPS for Improving Clinical Reasoning in Postgraduates: Randomized Controlled Trial. BMC Med Educ. 2019 Jun 21;19(1):224. PubMed PMID: 31226996.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of SNAPPS for improving clinical reasoning in postgraduates: randomized controlled trial. AU - Jain,Vishakha, AU - Rao,Siddharth, AU - Jinadani,Mariya, Y1 - 2019/06/21/ PY - 2018/05/23/received PY - 2019/06/12/accepted PY - 2019/6/23/entrez PY - 2019/6/23/pubmed PY - 2020/1/14/medline KW - Inpatient learning KW - Postgraduates KW - SNAPPS KW - Teaching KW - Traditional method SP - 224 EP - 224 JF - BMC medical education JO - BMC Med Educ VL - 19 IS - 1 N2 - 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. SN - 1472-6920 UR - https://www.unboundmedicine.com/medline/citation/31226996/Effectiveness_of_SNAPPS_for_improving_clinical_reasoning_in_postgraduates:_randomized_controlled_trial_ L2 - https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-019-1670-3 DB - PRIME DP - Unbound Medicine ER -