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医学生在获取临床推理技能过程中的一分钟带教法、SNAPPS法及传统教学法

One-Minute Preceptor, SNAPPS, and Traditional Teaching in the Acquisition of Clinical Reasoning Skills by Medical Students.

作者信息

Grunewald Sabrine Teixeira Ferraz, Lucchetti Alessandra Lamas Granero, Grunewald Thiago, Vale Aline Halfeld Fernandes, Silva Luiz Fernando Cal, da Silva Feliciano Caroline, Castelo Bárbara Bizzo, da Silva Ezequiel Oscarina, Lucchetti Giancarlo

机构信息

School of Medicine, Universidade Federal de Juiz de Fora, Av. Eugênio do Nascimento s/nº Bairro: Dom Bosco, Juiz de Fora, MG CEP.: 36038-330 Brazil.

University Hospital, Universidade Federal de Juiz de Fora, Av Eugenio do Nascimento s/n - Dom Bosco, Juiz de Fora, 36038-330 Brazil.

出版信息

Med Sci Educ. 2024 Nov 28;35(2):823-835. doi: 10.1007/s40670-024-02241-3. eCollection 2025 Apr.

Abstract

BACKGROUND

Despite growing evidence on teaching tools to improve clinical reasoning (CR), there is still uncertainty about which tool is more appropriate and leads to better outcomes.

OBJECTIVES

To evaluate the effectiveness of one-min preceptor (OMP) and SNAPPS (summarize relevant findings, narrow the differential, analyze, probe the preceptor, plan management, select issues for self-study) models compared to traditional teaching in CR skills acquisition by medical students.

METHODS

A randomized controlled trial where students were enrolled into three arms: OMP, SNAPPS, and traditional teaching (control arm). They were evaluated before and after their pediatrics clerkship rotation, both in a simulated environment and with real patients, on several CR-related outcomes and the quality of clinical case presentations.

RESULTS

A total of 256 students were randomized (86 control, 83 OMP, 87 SNAPPS), with no significant baseline differences. After the clerkship rotation, both intervention arms performed significantly better than the control arm. SNAPPS produced better results than OMP in the simulated environment for discussion time, case presentation quality score, student performance score, and the number of differential diagnoses presented and justified. In real medical settings, SNAPPS was superior to OMP for case presentation quality score. OMP was better evaluated than SNAPPS regarding satisfaction with the use of the tool, and both tools were superior to traditional teaching.

CONCLUSIONS

Clinical reasoning is an important outcome for medical training, and the use of CR tools can improve student performance. While SNAPPS had better results in CR-related outcomes and clinical case presentation, OMP received higher satisfaction scores.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-024-02241-3.

摘要

背景

尽管有越来越多关于改善临床推理(CR)教学工具的证据,但对于哪种工具更合适以及能带来更好的结果仍存在不确定性。

目的

评估与传统教学相比,一分钟带教(OMP)和SNAPPS(总结相关发现、缩小鉴别诊断范围、分析、向带教老师提问、制定管理计划、选择自学问题)模式在医学生获取CR技能方面的有效性。

方法

一项随机对照试验,学生被分为三组:OMP组、SNAPPS组和传统教学组(对照组)。在儿科实习轮转前后,通过模拟环境和真实患者,对他们在多个与CR相关的结果以及临床病例汇报质量方面进行评估。

结果

总共256名学生被随机分组(86名对照组、83名OMP组、87名SNAPPS组),基线无显著差异。实习轮转后,两个干预组的表现均显著优于对照组。在模拟环境中,SNAPPS在讨论时间、病例汇报质量评分、学生表现评分以及提出并论证的鉴别诊断数量方面比OMP产生了更好的结果。在实际医疗环境中,SNAPPS在病例汇报质量评分方面优于OMP。在对工具使用的满意度方面,OMP比SNAPPS得到更好的评价,并且两种工具都优于传统教学。

结论

临床推理是医学培训的一个重要成果,使用CR工具可以提高学生的表现。虽然SNAPPS在与CR相关的结果和临床病例汇报方面有更好的结果,但OMP获得了更高的满意度评分。

补充信息

在线版本包含可在10.1007/s40670-024-02241-3获取的补充材料。

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