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

机译：SNAPPS改善研究生临床推理的有效性：随机对照试验

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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. 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. 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. 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.
机译：由于工作量的增加，住院研究生教学面临的问题是冗长而无序的演讲，包括很多历史信息和时间限制。六步式肺炎SNAPPS以学习者为中心的模型通过浓缩事实的报告，同时鼓励临床推理来修改学习过程。计划进行这项研究的目的是评估SNAPPS与传统病例相比在住院环境中促进临床推理的有效性。我们还想了解研究生和教师对这种新的案例展示方法的看法。这项公开标签的随机对照试验是在MGIMS的18名医学系居民中进行的。 SNAPPS的老师和居民通过视频，角色扮演和讲义进行了为时2分钟的每次30分钟的演讲，从而对SNAPPS技术敏感。每组进行了27例病例报告（3人/住院病人）（总共54例病例报告）。每次演示后，将数据记录到经过验证的数据记录表中，并从老师以及居民那里获得有关他们的感知的反馈。 SNAPPS模型预示着感知器训练的变化，将错误的发展和学习者的发展配对为教育伴侣。在SNAPPS技术的指导下，学生简要总结了患者的发现（7 vs. 2.7 vs. 5.22 vs. 2.33，p？=？0.0057），同时保持了与传统病例报告相同的透彻度。 SNAPPS组的学生更清楚地了解他们的诊断假设，并比较并对比了他们的不同诊断（2.56比1.74，p值= 0.002）。与对照组相比，SNAPPS组的学生发起患者管理讨论的次数几乎增加了20％。我们得出的结论是，SNAPPS是一种以学习者为中心的案例演示技术，可以在住院病人背景下方便地表达临床诊断推理和基于案例的不确定性，而无需延长学生案例演示的异常长度。这也为增强自主学习铺平了道路。

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