The study of comparative impact of an integrated model (GSR: Grandstand, Supervising and Report-back) versus SNAPPS of outpatient education on developing students’ clinical competencies in Infectious clerkship

Document Type : Original Article

Authors

1 Department of Education and Psychology, Faculty of Education and Psychology, University of Brigand, Birjand, Iran

2 Hepatitis Research Center, Department of Infectious Diseases, Birjand University of Medical Sciences, Birjand, Iran

3 Hepatitis Research Center, Department of Internal Medicine, Birjand University of Medical Sciences, Birjand, IRAN

10.22038/fmej.2023.74902.1562

Abstract

Background: This study aimed to compare the effectiveness of  SNAPPS and an integrated model of outpatient education in developing clinical competencies of clerkship students concerning infectious diseases.
Method: This study has a quasi-experimental design (pretest, posttest, control group). The experimental and control groups were selected without random placement. The experimental group was trained using the integrated model, whereas the controls were trained with the SNAPPS model. After the data were collected, the test results were analyzed  in the three areas of Knowledg, clinical reasoning, and skills using the Wilcoxon test, Mann-Whitney U test, and paired t-test.
Results: The mean within-group score changes were significant in both groups concerning clinical reasoning, skills, and cognition. The cognition mean scores in the integrated and SNAPPS models were 18.94 and 18.06, respectively, with a significant difference between the two models (P=0.029). However, there were no significant differences between the groups concerning the mean scores of clinical reasoning (p=0.425) and skills (p=0.092).
Conclusion: The integrated model outperformed SNAPPS in increasing the knowledge, clinical reasoning,and skills of clerkship students.

Keywords

Main Subjects


  1. Brauer S, Kettunen J, Levy A, Merenmies J, Kulmala P. The educational paradigm shift—a phenomenographic study of medical teachers’ experiences of practices. BMC Med Educ. 2023;23(1):29.
  2. Zhu N, Zhang Z, Xie J, Ou Y, Tan J, Gao H. The relationship between the sources of confidence in overcoming COVID-19 and the improvement of medical students' professional identity: mediation by medical students' attention to COVID-19. BMC Med Educ. 2023;23(1):27.
  3. Kumar P, Parthasarathy R. Walking out of the hospital: the continued rise of ambulatory care and how to take advantage of it. McKinsey Co Healthc Syst Serv. 2020.
  4. Coyle A, Helenius I, Cruz CM, Lyons EA, May N, Andrilli J, et al. A decade of teaching and learning in internal medicine ambulatory education: a scoping review. Journal of graduate medical education. 2019;11(2):132-42.
  5. Wolpaw TM, Wolpaw DR, Papp KK. SNAPPS: a learner-centered model for outpatient education. Acad Med. 2003;78(9):893-8.
  6. Wolpaw T, Côté L, Papp KK, Bordage G. Student uncertainties drive teaching during case presentations: more so with SNAPPS. Acad Med. 2012;87(9):1210-7.
  7. Kapoor A, Kapoor A, Kalraiya A, Longia S. Use of SNAPPS model for pediatric outpatient education. Indian pediatrics. 2017;54:288-90.
  8. Dent JA. AMEE Guide No 26: clinical teaching in ambulatory care settings: making the most of learning opportunities with outpatients. Med teach. 2005;27(4):302-15.
  9. Ramazanzade K, Ebrahimzade A. Comparison of the Effect of Two Clinical Education Methods SNAPPS and conventional method on the medical students' clinical reasoning skills. Journal of Birjand University of Medical Sciences. 2018;25:46-52. Persian.
  10. Sabzghabaei F, Salajeghe M, Arabshahi SKS. Evaluating ambulatory care training in Firoozgar hospital based on Iranian national standards of undergraduate medical education. Medical Journal of the Islamic Republic of Iran. 2017;31:99. Persian.
  11. Pascoe JM, Nixon J, Lang VJ. Maximizing teaching on the wards: review and application of the One‐Minute Preceptor and SNAPPS models. Journal of hospital medicine. 2015;10(2):125-30.
  12. Sawanyawisuth K, Schwartz A, Wolpaw T, Bordage G. Expressing clinical reasoning and uncertainties during a Thai internal medicine ambulatory care rotation: does the SNAPPS technique generalize? Med teach. 2015;37(4):379-84.
  13. Schimbeno V, Bosle C, Stegmeier-Petroianu A, Etminan N, Hoffmann K. Competence-based teaching and learning in the outpatient clinic: development of a clinical elective in ambulatory medicine. GMS Journal for Medical Education. 2019;36(4).
  14. Beigzadeh A, Yamani N, Bahaadinbeigy K, Adibi P. Challenges and problems of clinical medical education in Iran: a systematic review of the literature. Strides in Development of Medical Education. 2019;16(1). Persian.
  15. Goad M, Huntley-Dale S, Whichello R. The use of audiovisual aids for patient education in the interventional radiology ambulatory setting: a literature review. Journal of Radiology Nursing. 2018;37(3):198-201.
  16. Franco RLO, Machado JLM, Grinbaum RS, Porfírio GJM. Barriers to outpatient education for medical students: a narrative review. International journal of medical education. 2019;10:180.
  17. Wolpow T, Papp K, Bordage G. Using SNAPPS to facilitate the expression of clinical reasoning and uncertainties: a randomized clinical trial. Acad Med. 2009;84:517-24.
  18. Jain V, Rao S, Jinadani M. Effectiveness of SNAPPS for improving clinical reasoning in postgraduates: randomized controlled trial. BMC med educ. 2019;19:1-8.
  19. Seki M, Otaki J, Breugelmans R, Komoda T, Nagata-Kobayashi S, Akaishi Y, et al. How do case presentation teaching methods affect learning outcomes?-SNAPPS and the One-Minute preceptor. BMC med educ. 2016;16(1):1-7.
  20. C Chinai SA, Guth T, Lovell E, Epter M. Taking advantage of the teachable moment: a review of learner-centered clinical teaching models. Western Journal of Emergency Medicine. 2018;19(1):28.
  21. Warm EJ, Schauer DP, Diers T, Mathis BR, Neirouz Y, Boex JR, et al. The ambulatory long-block: an accreditation council for graduate medical education (ACGME) educational innovations project (EIP). Journal of general internal medicine. 2008;23:921-6.
  22. Khazaei Z, Ramezanzadeh K, Moodi M, Moradi M. Quality of clinical education in Birjand Medical School from the students perspective. Future med educ j. 2012;2(1):22-6.
  23. Ebrahimzadeh A. Student-centered ambulatory education based on SNAPPS model. Research in Medical Education. 2016;8(3):17-23. Persian.