Clinical trial NCT06484010: Effectiveness of SNAPPS in Family Medicine Residency Program
Official title: Effectiveness of the Implementation of SNAPPS in Family Medicine Residency Program in Erbil: A Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Medical Education
Keywords: Medical education, SNAPPS, Clinical reasoning, Iraq
Lead sponsor: Hawler Medical University
Sponsor class: OTHER
Collaborators: name: Arab Board of Health Specializations, Iraq
First posted: 2024-07-03
Enrollment: 36
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Thirty Family Medicine board residents and six preceptors from the department of Community and Family Medicine/ College of Medicine/ Hawler Medical University, were chosen by the convenience method and randomly distributed into two groups; the intervention group with the SNAPPS technique (first-arm) and the control group with the traditional case presentation method (2nd-arm) using a simple random number table by Microsoft Excel program, All residents was asked to prepare and present two different cases (per resident) according to their preferences during their daily training at health centers with a total of 60 case presentations (30 presentations for each group).

data and feedback were gathered after each presentation using validated data recording sheets.
Primary purpose: OTHER

Brief summary: 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.

Detailed description: 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.

Eligibility criteria: Inclusion Criteria:

Residents:

* Postgraduate students.
* Pursuing the board degree in Family Medicine after completion of their M.B.Ch.B and internship.

  (16 residents from the Arabic Board of Health Specialties fellowship and 14 residents from Kurdistan Board of Medical Specialties).

Preceptors

* Tutors who worked at the department of Community and Family Medicine/ College of Medicine / Hawler Medical University.
* Frequently instructed undergraduate and postgraduate students in the family medicine teaching health facilities.

(two assistant professors and four lecturers).

Exclusion Criteria:

Family Medicine residents, who are not enrolled in the Board study (not a postgraduate student)

Primary outcomes:
measure: Total presentation length (Time in Minutes)
timeFrame: 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.
measure: Duration of summary (Time in Minutes)
timeFrame: 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.
measure: Number of basic clinical attributes covered
timeFrame: 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.
measure: Number of diagnoses kept (Dx) in differential diagnosis (DDx)
timeFrame: 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.
measure: Number of basic attributes in support of Diagnoses (Dx) in the differential diagnosis (DDx)
timeFrame: 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.
measure: Number of justified diagnoses (Dx) in the differential diagnosis (DDx)
timeFrame: 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.
measure: Number of distinct comparisons made between two diseases
timeFrame: 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.
measure: Does the student seek clarification and information by asking questions and acknowledging their uncertainties?
timeFrame: 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.
measure: Number of uncertainties expressed and obtained clarifications
timeFrame: 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.
measure: Did the student discuss patient management plan?
timeFrame: 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.
measure: Did the student Discuss case related topics and resources?
timeFrame: 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.
Secondary outcomes:
measure: Residents' Feedback on each presentation
timeFrame: 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.
measure: Preceptors' Feedback on each presentation
timeFrame: 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.
Other outcomes:
measure: Diagnostic Thinking Inventory (DTI) scores
timeFrame: Data were recorded by each resident after the 2nd case presentation (final presentation for each resident), then analyzed using the Statistical Package for Social Sciences (SPSS, version 26) 2 weeks after all the presentations were finished.
Locations:
city: Erbil
country: Iraq
facility: Hawler Medical University/ College of Medicine
Study officials:
affiliation: Ninevah Health Directorate/ Ministry of Health - Iraq
name: Ghaith S Shindala, M.B.Ch.B
role: PRINCIPAL_INVESTIGATOR
affiliation: College of Medicine/ Hawler Medical University - Iraq
name: Nazdar E Alkhateeb, PhD.Med.Educ
role: STUDY_DIRECTOR
affiliation: College of Medicine/ Hawler Medical University - Iraq
name: Ali S Dauod, JBFM
role: STUDY_DIRECTOR
References: