Effectiveness of SNAPPS in Family Medicine Residency Program
NCT Number: NCT06484010
Status: COMPLETED
Study Type: INTERVENTIONAL
Phases: NA
Conditions: Medical Education
Interventions: OTHER: SNAPPS Model of case presentation
Sponsor: Hawler Medical University
Collaborators: Arab Board of Health Specializations, Iraq
Sex: ALL
Age: CHILD, ADULT, OLDER_ADULT
Enrollment: 36
Study Design: Allocation: RANDOMIZED|Intervention Model: PARALLEL|Masking: DOUBLE (PARTICIPANT, OUTCOMES_ASSESSOR)|Primary Purpose: OTHER
Start Date: 2023-03-15
Completion Date: 2023-08-30
Locations: Hawler Medical University/ College of Medicine, Erbil, 44001, Iraq

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.

Primary Outcome Measures: Total presentation length (Time in Minutes), The total case presentation time was measured in minutes. The comparison was made between the 2 groups' presentations depending on the mean of the total presentation time in each group., 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.|Duration of summary (Time in Minutes), The duration of summary time was measured in minutes. The comparison was made between the 2 groups' presentations depending on the mean duration of summary in each group., 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.|Number of basic clinical attributes covered, The number of basic clinical attributes covered during each presentation was recorded and the comparison made between the two groups on the mean number of basic clinical attributed covered in each group., 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.|Number of diagnoses kept (Dx) in differential diagnosis (DDx), The comparison made between the two groups on the mean number of diagnoses kept (Dx) in differential diagnosis (DDx) in each group., 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.|Number of basic attributes in support of Diagnoses (Dx) in the differential diagnosis (DDx), The comparison made between the two groups on the mean number of basic attributes in support of Dx in the DDx in each group., 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.|Number of justified diagnoses (Dx) in the differential diagnosis (DDx), The comparison made between the two groups on the mean number of justified diagnoses (Dx) in the differential diagnosis (DDx) in each group., 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.|Number of distinct comparisons made between two diseases, The comparison made between the two groups on the mean number of distinct comparisons made between two diseases in each group., 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.|Does the student seek clarification and information by asking questions and acknowledging their uncertainties?, The answer was Yes or No. The comparison made between the two groups depending on the percentage of those who got (Yes) or (No) in each group., 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.|Number of uncertainties expressed and obtained clarifications, The comparison made depending on the mean number of uncertainties expressed and obtained clarifications in each group., 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.|Did the student discuss patient management plan?, The answer was Yes or No. The comparison made between the two groups depending on the percentage of those who got (Yes) or (No) in each group., 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.|Did the student Discuss case related topics and resources?, The answer was Yes or No. The comparison made between the two groups depending on the percentage of those who got (Yes) or (No) in each group., 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 Outcome Measures: Residents' Feedback on each presentation, Measures the residents' agreement on Likert Scale-based questionnaire (a scale used to represent people's attitudes, opinion or perception to a topic) regarding their experience in each case presentation, the format of the scale was composed of 5 level Likert items (5 indicating strongly agree whereas 1 indicating strongly disagree)

1. Strongly disagree (minimum)
2. Disagree
3. Neither agree nor disagree (neutral)
4. Agree
5. Strongly agree (maximum)

The Feedback of the residents in both groups was compared to each other depending on the mean of their scores., 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.|Preceptors' Feedback on each presentation, Measures the preceptors' agreement on Likert Scale-based questionnaire (a scale used to represent people's attitudes, opinion or perception to a topic) regarding their experience in each case presentation, the format of the scale was composed of 5 level Likert items (5 indicating strongly agree whereas 1 indicating strongly disagree)

1. Strongly disagree (minimum)
2. Disagree
3. Neither agree nor disagree (neutral)
4. Agree
5. Strongly agree (maximum)

The Feedback of the preceptors in both groups was compared to each other depending on the mean of their scores., 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 Outcome Measures: Diagnostic Thinking Inventory (DTI) scores, The Diagnostic Thinking Inventory (DTI) is a self-report instrument that has been validated to assess clinical reasoning.

This inventory contains 41 items concerning the diagnostic thinking. Each item contains a stem, two accompanying statements and a rating scale. The scale refers to a continuum between the two statements.

The score of each student is calculated by the summation of the rating scale score (from 1 to 6).

The DTI questionnaire was given to the students in both groups following the final case presentation and the scores were calculated according to the DTI categories of thinking flexibility and the structure of memory.

The randomized groups of Family Medicine residents were compared on the mean of the scores they obtained after their presentations., 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.