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Year : 2018  |  Volume : 31  |  Issue : 1  |  Page : 59-60

SNAPPS facilitates clinical reasoning in outpatient settings

1 Department of Medicine, MGIMS, Sawangi, Wardha, Maharashtra, India
2 Department of Physiology, JNMC, Sawangi, Wardha, Maharashtra, India
3 Department of Surgery, JNMC, Sawangi, Wardha, Maharashtra, India

Date of Web Publication14-Aug-2018

Correspondence Address:
Vishakha Jain
Department of Medicine, MGIMS, Sevagram, Wardha, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1357-6283.239052

How to cite this article:
Jain V, Waghmare L, Shrivastav T, Mahakalkar C. SNAPPS facilitates clinical reasoning in outpatient settings. Educ Health 2018;31:59-60

How to cite this URL:
Jain V, Waghmare L, Shrivastav T, Mahakalkar C. SNAPPS facilitates clinical reasoning in outpatient settings. Educ Health [serial online] 2018 [cited 2022 Jan 23];31:59-60. Available from:

Dear Editor,

Medical students usually focus on factual information rather than diagnostic uncertainties and reasoning in their case presentations. Developing clinical reasoning in residents and medical students is a distinctive yet essential component and poses some challenges to medical educators.[1] SNAPPS is a learner-centered approach to case presentations that has been shown to facilitate the expression of clinical reasoning and uncertainties in the outpatient setting. It was developed based on the cognitive learning (Bordage) and reflective practice theory (Osterman and Kottkamp).[2] SNAPPS is a six-step technique (summarize history and findings, narrow the differential, analyze the differential, probe preceptor about uncertainties, plan management, select case-related issues for self-study) for case presentations in an outpatient setting.[3] The SNAPPS technique offers a model for outpatient settings education by engaging learners and increasing collaborative as well as self-directed learning. This model encourages redirection of presentation to increase clinical reasoning and expression and links learner initiation and preceptor facilitation in an active learning conversation. The implication of the use of the SNAPPS model is in the strong precedent of the reflective practice and where the learner assumes the central role.

We planned a study with the aim to understand the efficacy of SNAPPS as compared to a conventional case presentation for facilitating learning/clinical reasoning. This open-labeled randomized controlled trial was carried among the residents of the Department of Medicine, Mahatma Gandhi Institute of Medical Sciences. Ten residents were randomized into either the SNAPPS group or the control or conventional case presentation group. The SNAPPS group students and teachers were sensitized to the technique of SNAPPS.[3] The students in each group underwent three case encounters/head (total 15 case encounters in each group). The outcomes were recorded on a structured data-recording sheet during all case encounters.[4]

The presentation time was almost similar in both groups with the SNAPPS group having more time for discussion [Table 1]. The students in the SNAPPS group had more differential diagnoses and diagnostic hypotheses and justified their differential diagnosis better as compared to the control group. Almost all students in the SNAPPS group formulated uncertainties and probed their preceptors for clarifications as compared to a very small percentage of students in the control group. The students in the SNAPPS group identified issues for self-study and resources in almost all instances as compared to a smaller percentage in the control group.
Table 1: Outcome variables during the case presentations by conventional method and summarize history and findings, narrow the differential, analyze the differential, probe preceptor about uncertainties, plan management, select case-related issues for self-study

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The SNAPPS technique for case presentation in the outpatient setting enhances the expression of clinical reasoning without having much effect on the time for case presentations. It requires brief faculty development for being able to facilitate this technique and extensive student development for being able to use this technique. However, this technique provides explicit steps to the students and the responsibility of expressing their clinical reasoning, expressing uncertainties, and probing the preceptor. Finally, identifying issues for self-study falls on the shoulders of students as a default to be facilitated by trained mentors.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Pascoe JM, Nixon J, Lang VJ. Maximizing teaching on the wards: Review and application of the one-minute preceptor and SNAPPS models. J Hosp Med 2015;10:125-30.  Back to cited text no. 1
Wolpaw TM, Wolpaw DR, Papp KK. SNAPPS: A learner-centered model for outpatient education. Acad Med. 2003;78:893-8.  Back to cited text no. 2
Practical Doc. SNAPPS. How Can I Help My Resident Become More Self-Directed? Available from: [Last accessed on 2017 Oct 05].  Back to cited text no. 3
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;37:379-84.  Back to cited text no. 4


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