SNAPPS as a Method of Case Presentation for Inpatient Setting: A Randomized Controlled Trial

Case presentation is a time-honored tradition in clinical medicine. During conventional case presentations, students’ reasoning skills remain mostly unknown. This study focuses on the feasibility of SNAPPS, to facilitate clinical reasoning skills in postgraduate students of surgery.

In this randomized controlled trial, postgraduates were divided in two groups, SNAPPS (n=12) and control (n=12). They presented total 60 cases (30 each) in both the groups. The presentations were observed for Presentation time, Clinical reasoning, Expressed uncertainties and clarifications, Patient management plan and Identification of case-related topics and resources.

The three variables showed statistically significant difference between two groups in Number of basic clinical attributes covered, Number of diagnoses kept in differential diagnosis and Number of justified diagnosis kept in the differential diagnosis (P value 0.0001). The four responses namely, concisely history taking, Performing all steps of general examination, Relevant Systemic examination findings and in accordance with history and identification of sufficient case-based learning issues for self study, showed significant difference between the two groups. As per tutors feedback, 25 (83.33%) in cases and 10 (33.33%) in control group concisely covered all aspects of history taking.

SNAPPS can be used effectively as a method of case presentation for postgraduate students in indoor settings. It is effective to facilitate the expression of clinical reasoning and diagnostic thinking as it involves case analysis and identification of practice points during case presentation. It also enables to dedicate uniform and more time for case discussion which gives it an advantage over conventional method where the time dedicated is less and varied.