Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Department of Clinical Medicine, University of Campinas, Campinas, Brazil.
Perspect Med Educ. 2020 Aug;9(4):245-250. doi: 10.1007/s40037-020-00588-y.
One-minute preceptor (OMP) and SNAPPS (a mnemonic for Summarize history and findings; Narrow the differential; Analyze the differential; Probe the preceptor about uncertainties; Plan management; and Select case-related issues for self-study) are educational techniques developed to promote learners' expression of clinical reasoning during the case presentation in the workplace. The aim of this present study was to compare the content of the case presentation between the SNAPPS and the OMP methods.
This was a randomized controlled trial comparing SNAPPS and OMP in 60 medical students at the beginning of their fifth year of medical school. After an introduction session, students presented and discussed two cases based on real patients and provided in written format. All case presentations were recorded and evaluated by two researchers. The assessed elements of the case presentations were divided into three subgroups related to expression of clinical reasoning, time and initiative to guide the presentation.
There were 30 participants in each group. There was no difference in the expression of clinical reasoning between OMP and SNAPPS groups (number of differential diagnoses, justification of most likely diagnosis and differential diagnosis, expression of comparing and contrasting hypotheses). However, students in the SNAPPS group expressed significantly more questions and uncertainties (p < 0.001), and more often took the initiative to present and justify the most likely diagnosis, differential diagnosis and management plan than students in the OMP group, both in simple and complex cases (all p values <0.001) without extending the length of the teaching session.
OMP and SNAPPS equally promote medical students' expression of clinical reasoning. The SNAPPS technique was more effective than the OMP technique in helping students to take on an active role during case presentation. We propose SNAPPS as an effective learning tool, engaging students and promoting the expression of their clinical reasoning as part of a case presentation.
一分钟导师（OMP）和 SNAPPS（一个用于总结病史和发现；缩小鉴别范围；分析鉴别范围；向导师询问不确定之处；计划管理；选择与病例相关的问题进行自学的助记符）是为了促进学习者在工作场所的病例呈现中表达临床推理而开发的教育技术。本研究的目的是比较 SNAPPS 和 OMP 方法在病例呈现中的内容。
这是一项随机对照试验，比较了医学五年级学生中的 60 名学生的 SNAPPS 和 OMP。在介绍会议后，学生根据真实患者呈现并讨论了两个案例，并以书面形式提供。所有病例呈现均由两名研究人员记录和评估。病例呈现的评估要素分为与表达临床推理、指导呈现的时间和主动性相关的三个亚组。
每组有 30 名参与者。在表达临床推理方面，OMP 和 SNAPPS 组之间没有差异（鉴别诊断的数量、最可能诊断和鉴别诊断的理由、比较和对比假设的表达）。然而，SNAPPS 组的学生表达了更多的问题和不确定性（p<0.001），并且比 OMP 组的学生更主动地呈现和证明最可能的诊断、鉴别诊断和管理计划，无论是在简单病例还是复杂病例中（所有 p 值均<0.001），而不会延长教学时间。
OMP 和 SNAPPS 同样促进医学生表达临床推理。与 OMP 技术相比，SNAPPS 技术在帮助学生在病例呈现中发挥积极作用方面更有效。我们建议将 SNAPPS 作为一种有效的学习工具，让学生参与并促进他们在病例呈现中表达临床推理。
