SNAPPS-Plus：一种教育处方，帮助学生制定和回答临床问题。

SNAPPS-Plus: an educational prescription for students to facilitate formulating and answering clinical questions.

机构信息

Dr. Nixon is vice chair for education, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. Dr. Wolpaw is vice dean for education, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. Dr. Schwartz is professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois. Dr. Duffy is assistant professor, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. Mr. Menk is research fellow, Biostatistical Design and Analysis Center, University of Minnesota Medical School, Minneapolis, Minnesota. Dr. Bordage is professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois.

出版信息

Acad Med. 2014 Aug;89(8):1174-9. doi: 10.1097/ACM.0000000000000362.

DOI:10.1097/ACM.0000000000000362

PMID:24918759

Abstract

PURPOSE

To analyze the content and quality of PICO-formatted questions (Patient-Intervention-Comparison-Outcome), and subsequent answers, from students' educational prescriptions added to the final SNAPPS Select step (SNAPPS-Plus).

METHOD

Internal medicine clerkship students at the University of Minnesota Medical Center were instructed to use educational prescriptions to complement their bedside SNAPPS case presentations from 2006 to 2010. Educational prescriptions were collected from all eligible students and coded for topic of uncertainty, PICO conformity score, presence of answer, and quality of answer. Spearman rank-order correlation coefficient was used to compare ordinal variables, Kruskal-Wallis test to compare distribution of PICO scores between groups, and McNemar exact test to test for association between higher PICO scores and presence of an answer.

RESULTS

A total of 191 education prescriptions were coded from 191 eligible students, of which 190 (99%) included a question and 176 (93%, 176/190) an answer. Therapy questions constituted 59% (112/190) of the student-generated questions; 19% (37/190) were related to making a diagnosis. Three-fifths of the questions (61%, 116/190) were scored either 7 or 8 on the 8-point PICO conformity scale. The quality of answers varied, with 37% (71/190) meeting all criteria for high quality. There was a positive correlation between the PICO conformity score and the quality of the answers (Spearman rank-order correlation coefficient = 0.726; P < .001).

CONCLUSIONS

The SNAPPS-Plus technique was easily integrated into the inpatient clerkship structure and guaranteed that virtually every case presentation following this model had a well-formulated question and answer.

摘要

目的

分析学生添加到最终 SNAPPS Select 步骤（SNAPPS-Plus）中的教育处方中的 PICO 格式问题（患者-干预-比较-结果）及其后续答案。

方法

明尼苏达大学医学中心的内科实习学生被指示使用教育处方来补充他们 2006 年至 2010 年在床边进行的 SNAPPS 病例介绍。从所有符合条件的学生中收集教育处方，并对不确定性主题、PICO 一致性评分、答案存在情况和答案质量进行编码。使用 Spearman 秩相关系数比较有序变量，使用 Kruskal-Wallis 检验比较组间 PICO 评分分布，使用 McNemar 精确检验检验较高 PICO 评分与答案存在之间的关联。

结果

从 191 名符合条件的学生中编码了 191 份教育处方，其中 190 份（99%）包含问题，176 份（93%，176/190）包含答案。治疗问题构成学生生成问题的 59%（112/190）；19%（37/190）与做出诊断有关。五分之三的问题（61%，116/190）在 8 分 PICO 一致性量表上的评分均为 7 或 8 分。答案的质量参差不齐，其中 37%（71/190）符合高质量的所有标准。PICO 一致性评分与答案质量之间存在正相关（Spearman 秩相关系数=0.726；P<0.001）。