Effectiveness of SNAPPS in Family Medicine Residency Program

NCT06484010 | Completed

• 1 other identifier: SNAPPS Iraq
• Study Type: interventional
• Target: 36
• Locations: 1 country
• Sites: 1

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.

Conditions

Medical Education

Keywords

Medical education, SNAPPS, Clinical reasoning, Iraq

Outcome Measures

Primary Outcomes (11)

• 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 Outcomes (2)

• Residents' Feedback on each presentation

  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

  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 (1)

• Diagnostic Thinking Inventory (DTI) scores

  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.

Study Arms (2)

SNAPPS Group

ACTIVE COMPARATOR

The intervention was the implementation of the SNAPPS model as a method of case presentation in out-patient settings.

Other: SNAPPS Model of case presentation

Control Group

NO INTERVENTION

In the control group, as both learners and preceptors are familiar with the traditional method of case presentation, no special training was required.

Interventions

SNAPPS Model of case presentation OTHER

The intervention was the implementation of the SNAPPS model as a method of case presentation in out-patient settings. All preceptors and residents in the SNAPPS group were sensitized and trained one week before the beginning of case presentations and data collection by a training session that was carried out by the authors at Brayati Primary Health Center training hall for a duration of more than two hours, the session included a preview of the traditional method, introduction to the SNAPPS method, role play and doubts clarification. The training materials included a presentation explaining the SNAPPS method in details with examples, instructional videos, and handouts highlighting the six steps of the SNAPPS method. Before the beginning of the presentation by 72 hours, there was a double check by the principal investigator with all participants regarding the method and all doubts were clarified.

SNAPPS Group

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• 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).

You may not qualify if:

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

Sponsors & Collaborators

• Hawler Medical University: lead
• Arab Board of Health Specializations, Iraq: collaborator

Study Sites (1)

Hawler Medical University/ College of Medicine

Erbil, 44001, Iraq

Location

Study Officials

• Ghaith S Shindala, M.B.Ch.B

  Ninevah Health Directorate/ Ministry of Health - Iraq

  PRINCIPAL INVESTIGATOR

• Nazdar E Alkhateeb, PhD.Med.Educ

  College of Medicine/ Hawler Medical University - Iraq

  STUDY DIRECTOR

• Ali S Dauod, JBFM

  College of Medicine/ Hawler Medical University - Iraq

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: Both the students (participants) and the preceptors (Outcome Assessors) in each group were unaware of the other group participants, Outcome Assessors, and the method used for case presentations. We ensured that by asking the participants in both groups not to discuss any information regarding the study with anyone.
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Dr

Model Details: 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.

Study Record Dates

• First Submitted: June 25, 2024
• First Posted: July 3, 2024
• Study Start: March 15, 2023
• Primary Completion: August 30, 2023
• Study Completion: August 30, 2023
• Last Updated: July 3, 2024

Record last verified: 2024-06

Locations

IR (1)