Department of Sports Medicine, West Chester University, PA 19383, USA.
J Athl Train. 2013 May-Jun;48(3):362-71. doi: 10.4085/1062-6050-48.2.17. Epub 2013 Feb 20.
Providing opportunities to develop clinical decision-making skills, including clinical reasoning, is an important aspect of clinical education. The learner-centered technique of summarizing the history and findings, narrowing the differential, analyzing the differential, probing the instructor about uncertainties, plan management, and selecting an issue for self-directed study (SNAPPS) is used in medicine to express clinical reasoning.
To investigate the effects of SNAPPS on the clinical reasoning, reflection, and 4 case presentation attributes (length, conciseness, case summary, and expression of clinical reasoning) in athletic training students.
Randomized controlled clinical trial.
Three undergraduate programs accredited by the Commission on Accreditation of Athletic Training Education.
We randomly assigned 38 athletic training students (17 men, 21 women; age = 21.53 ± 1.18 years, grade point average = 3.25 ± 0.31) who had completed at least 1 year of clinical education and all orthopaedic evaluation coursework to the SNAPPS group or the usual and customary group using a stratification scheme.
INTERVENTION(S): The SNAPPS group completed four 45-minute clinical reasoning and case presentation learning modules led by an investigator to learn the SNAPPS technique, whereas the usual and customary group received no formal instruction. Both groups audio recorded all injury evaluations performed over a 2-week period.
Participants completed the Diagnostic Thinking Inventory and Reflection in Learning Scale twice. Case presentations were analyzed for 4 attributes: length, conciseness, case summary, and expression of clinical reasoning.
Case presentations were longer (t18.806 = -5.862, P < .001) but were more concise (t32 = 11.297, P < .001) for the SNAPPS group than for the usual and customary group. The SNAPPS group performed better on both the case summary subscale (t32 = 2.857, P = .007) and the clinical reasoning subscale (t25.773 = -14.162, P < .001) than the other group. We found a time effect for Diagnostic Thinking Inventory scores (F1,34 = 6.230, P = .02) but observed no group effects (F1,34 = 0.698, P = .41) or time-by-group interaction (F1,34 = 1.050, P = .31). The Reflection in Learning Scale scores analysis revealed no group-by-time interaction (F1,34 = 1.470, P = .23) and no group (F1,34 = 3.751, P = .06) or time (F1,34 = 0.835, P = .37) effects.
The SNAPPS is an effective and feasible clinical education technique for case presentations. This learner-centered technique provides the opportunity for the expression of clinical reasoning skills.
提供发展临床决策技能的机会，包括临床推理，是临床教育的一个重要方面。以学习者为中心的总结病史和发现、缩小鉴别范围、分析鉴别范围、向教师询问不确定因素、管理计划和选择一个自我指导学习的问题的技术（SNAPPS）在医学中用于表达临床推理。
调查 SNAPPS 对运动训练学生临床推理、反思和 4 个病例报告属性（长度、简洁性、病例总结和临床推理表达）的影响。
随机对照临床试验。
三个由运动训练教育认证委员会认证的本科课程。
我们随机分配了 38 名运动训练学生（17 名男性，21 名女性；年龄=21.53±1.18 岁，平均绩点=3.25±0.31），他们已经完成了至少 1 年的临床教育和所有的骨科评估课程，采用分层方案将他们随机分配到 SNAPPS 组或常规和习惯组。
SNAPPS 组完成了四个 45 分钟的临床推理和病例报告学习模块，由一名研究员进行指导，以学习 SNAPPS 技术，而常规和习惯组没有接受任何正式指导。两组都在两周的时间内记录了所有的损伤评估。
参与者两次完成诊断思维量表和学习反思量表。病例报告分析了 4 个属性：长度、简洁性、病例总结和临床推理表达。
SNAPPS 组的病例报告更长（t18.806=-5.862，P<0.001）但更简洁（t32=11.297，P<0.001），比常规和习惯组。SNAPPS 组在病例总结子量表（t32=2.857，P=0.007）和临床推理子量表（t25.773=-14.162，P<0.001）上的表现都优于其他组。我们发现诊断思维量表评分存在时间效应（F1,34=6.230，P=0.02），但没有发现组效应（F1,34=0.698，P=0.41）或时间-组交互效应（F1,34=1.050，P=0.31）。学习反思量表评分分析显示，组间无交互作用（F1,34=1.470，P=0.23），组间无差异（F1,34=3.751，P=0.06）或时间差异（F1,34=0.835，P=0.37）。
SNAPPS 是一种有效的、可行的临床教育病例报告技术。这种以学习者为中心的技术提供了表达临床推理技能的机会。
