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Student uncertainties drive teaching during case presentations: more so with SNAPPS
Terry Wolpaw1, Luc Côté, Klara K Papp
1Case Western Reserve University School of Medicine, Cleveland, Ohio 44106-4924, USA. Terry.wolpaw@case.edu
Summary
Medical students using the six-step SNAPPS technique expressed more uncertainties, particularly in diagnostic reasoning, compared to customary presentations. Preceptors effectively aligned teaching with these student-driven learning opportunities.
Area of Science:
- Medical Education
- Clinical Reasoning
- Professional Development
Background:
- Medical student case presentations are crucial for learning.
- Identifying and addressing student uncertainties is key to effective teaching.
- The SNAPPS (Summarize history and findings; Narrow the differential; Analyze the differential; Probe preceptors about uncertainties; Plan management; Select case-related issues for self-study) technique offers a structured approach to case discussions.
Purpose of the Study:
- To compare the types of uncertainties expressed by medical students using the SNAPPS technique versus traditional case presentations.
- To analyze how preceptors respond to student-expressed uncertainties in both presentation formats.
Main Methods:
- Secondary analysis of a randomized study comparing SNAPPS users with a comparison group.
- Transcription and coding of audiotaped case presentations to family medicine preceptors.
- Analysis focused on student uncertainty types, preceptor response alignment, and response expansion.
Main Results:
- SNAPPS students expressed nearly twice as many uncertainties as the comparison group (P = .0001).
- SNAPPS users' uncertainties predominantly focused on diagnostic reasoning (55% vs. 24%, P = .004).
- Preceptors' teaching aligned with student uncertainties, with 36% of comments expanding on the topic.
Conclusions:
- Students can actively direct their learning by expressing uncertainties during case presentations.
- Preceptors are prepared to provide immediate, context-specific teaching in response to student questions.
- The SNAPPS technique facilitates student-driven, just-in-time learning opportunities.
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