The goal of this Randomized Controlled Trial is to assess how well SNAPPS (Summarize history and findings; Narrow differentials; Analyze differentials; Probe preceptor about uncertainties; Plan management; Select case-related issues for self-study) facilitates clinical reasoning and enhances time management in an outpatient setting as a learner-centered method of case presentation when compared to the conventional method among family medicine board residents and tutors, the main objectives of the study are: * To assess the implementation of a new technique of teaching and case presentation in family medicine residency program. * To understand the perception of postgraduates and tutors about this new method of case presentation. The researchers compared the outcomes of case presentations between two groups (the SNAPPS group and the control group) using dependable variables that has been used in previous researches to assess the SNAPPS versus the traditional method of case presentation. Participants in the SNAPPS group were introduced to the SNAPPS method by a training session, while the control group needed no intervention. Each student had to prepare and present two cases to the assigned tutor during their routine training days. Data were collected by the tutors during each case presentation and the participants answered survey questions regarding their opinion of the case presentation.
Clinical teaching's primary objectives include evaluating students' clinical reasoning abilities, advancing, and enhancing their development, as well as giving them clinical practice and feedback potential. Whilst trying to assist postgraduate residents in improving their clinical reasoning, medical educators experience a variety of difficulties like uncooperative patients, record requirements, increasing tasks, time restraints, and productivity objectives that conflict with teaching time. Students rarely convey their clinical reasoning or case-based doubts during traditional case presentations to preceptors, according to studies of such presentations. Instead, they tend to emphasize mostly on factual data However, the chance to consider one's own method of clinical thinking is seen as one of the most valuable components of the educational experience by both students and preceptors. Irby and Wilkerson have recently argued that there is a need for the development of time-effective teaching techniques in the clinical setting that give insights into the students' clinical reasoning strategies and doubts while also enabling the preceptor to stay completely involved in the priority areas of patient care. Yonke and Foley questioned whether successful educational methods in the hospital setting would translate well to the office as medical education stepped from the inpatient to the outpatient setting. Two models for enhancing clinical thinking ability-one-minute preceptor (OMP) and SNAPPS (Summarize history and findings; Narrow differentials; Analyze differentials; Probe preceptor about uncertainties; Plan management; Select case-related issues for self-study), have been well studied in the outpatient settings. Additionally, by using these teaching models, preceptors can give trainees a more specific education without losing more precious time. In the SNAPPS paradigm, the student presents a case to the preceptor by giving an informative summary of the pertinent information, which is followed by five steps that advocate for the expression of thinking and reasoning aloud. These actions are inspired in part by the rating scales for cognitive activity created by Connell et al. The SNAPPS paradigm relies on a learner-teacher continuum which in the end, should be led by the learner, but may initially require coaching from the preceptor to assist the learner become comfortable and proficient with the processes. It is now both the trainer's and trainee's responsibility to ensure the prosperity of the learning process rather than just one of them. To improve medical education in Family Medicine and other fields as well, we must comprehend and keep up with contemporary methodologies as they evolve in education. The Aim of the study is to assess how well SNAPPS facilitates clinical reasoning and enhances time management in an outpatient setting when compared to conventional method of case presentation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
DOUBLE
Enrollment
36
The intervention was the implementation of the SNAPPS model as a method of case presentation in out-patient settings. All preceptors and residents in the SNAPPS group were sensitized and trained one week before the beginning of case presentations and data collection by a training session that was carried out by the authors at Brayati Primary Health Center training hall for a duration of more than two hours, the session included a preview of the traditional method, introduction to the SNAPPS method, role play and doubts clarification. The training materials included a presentation explaining the SNAPPS method in details with examples, instructional videos, and handouts highlighting the six steps of the SNAPPS method. Before the beginning of the presentation by 72 hours, there was a double check by the principal investigator with all participants regarding the method and all doubts were clarified.
Hawler Medical University/ College of Medicine
Erbil, Iraq
Total presentation length (Time in Minutes)
The total case presentation time was measured in minutes. The comparison was made between the 2 groups' presentations depending on the mean of the total presentation time in each group.
Time frame: Data (Time) was recorded by the preceptors during each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Duration of summary (Time in Minutes)
The duration of summary time was measured in minutes. The comparison was made between the 2 groups' presentations depending on the mean duration of summary in each group.
Time frame: Data (Time) was recorded by the preceptors during each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Number of basic clinical attributes covered
The number of basic clinical attributes covered during each presentation was recorded and the comparison made between the two groups on the mean number of basic clinical attributed covered in each group.
Time frame: Data were recorded by the preceptors during each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Number of diagnoses kept (Dx) in differential diagnosis (DDx)
The comparison made between the two groups on the mean number of diagnoses kept (Dx) in differential diagnosis (DDx) in each group.
Time frame: Data were recorded by the preceptors during each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Number of basic attributes in support of Diagnoses (Dx) in the differential diagnosis (DDx)
The comparison made between the two groups on the mean number of basic attributes in support of Dx in the DDx in each group.
Time frame: Data were recorded by the preceptors during each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Number of justified diagnoses (Dx) in the differential diagnosis (DDx)
The comparison made between the two groups on the mean number of justified diagnoses (Dx) in the differential diagnosis (DDx) in each group.
Time frame: Data were recorded by the preceptors during each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Number of distinct comparisons made between two diseases
The comparison made between the two groups on the mean number of distinct comparisons made between two diseases in each group.
Time frame: Data were recorded by the preceptors during each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Does the student seek clarification and information by asking questions and acknowledging their uncertainties?
The answer was Yes or No. The comparison made between the two groups depending on the percentage of those who got (Yes) or (No) in each group.
Time frame: Data were recorded by the preceptors during each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Number of uncertainties expressed and obtained clarifications
The comparison made depending on the mean number of uncertainties expressed and obtained clarifications in each group.
Time frame: Data were recorded by the preceptors during each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Did the student discuss patient management plan?
The answer was Yes or No. The comparison made between the two groups depending on the percentage of those who got (Yes) or (No) in each group.
Time frame: Data were recorded by the preceptors during each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Did the student Discuss case related topics and resources?
The answer was Yes or No. The comparison made between the two groups depending on the percentage of those who got (Yes) or (No) in each group.
Time frame: Data were recorded by the preceptors during each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Residents' Feedback on each presentation
Measures the residents' agreement on Likert Scale-based questionnaire (a scale used to represent people's attitudes, opinion or perception to a topic) regarding their experience in each case presentation, the format of the scale was composed of 5 level Likert items (5 indicating strongly agree whereas 1 indicating strongly disagree) 1. Strongly disagree (minimum) 2. Disagree 3. Neither agree nor disagree (neutral) 4. Agree 5. Strongly agree (maximum) The Feedback of the residents in both groups was compared to each other depending on the mean of their scores.
Time frame: Data were recorded by each resident after each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Preceptors' Feedback on each presentation
Measures the preceptors' agreement on Likert Scale-based questionnaire (a scale used to represent people's attitudes, opinion or perception to a topic) regarding their experience in each case presentation, the format of the scale was composed of 5 level Likert items (5 indicating strongly agree whereas 1 indicating strongly disagree) 1. Strongly disagree (minimum) 2. Disagree 3. Neither agree nor disagree (neutral) 4. Agree 5. Strongly agree (maximum) The Feedback of the preceptors in both groups was compared to each other depending on the mean of their scores.
Time frame: Data were recorded by the preceptors after each case presentation, then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
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