1
|
Flores-Cohaila JA, Vizcarra-Jiménez SF, Bermúdez-Peláez MF, Vascones-Román FF, Rivarola-Hidalgo M, Taype-Rondan A. Effects of SNAPPS in clinical reasoning teaching: a systematic review with meta-analysis of randomized controlled trials. Diagnosis (Berl) 2024; 11:220-230. [PMID: 38446132 DOI: 10.1515/dx-2023-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Clinical reasoning is crucial in medical practice, yet its teaching faces challenges due to varied clinical experiences, limited time, and absence from competency frameworks. Despite efforts, effective teaching methodologies remain elusive. Strategies like the One Minute Preceptor (OMP) and SNAPPS are proposed as solutions, particularly in workplace settings. SNAPPS, introduced in 2003, offers a structured approach but lacks comprehensive evidence of its effectiveness. Methodological shortcomings hinder discerning its specific effects. Therefore, a systematic review is proposed to evaluate SNAPPS' impact on clinical reasoning teaching. CONTENT We searched PubMed, EMBASE, and CINAHL for randomized controlled trials (RCTs) comparing SNAPPS against other methods. Data selection and extraction were performed in duplicate. Bias and certainty of evidence were evaluated using Cochrane RoB-2 and GRADE approach. SUMMARY We identified five RCTs performed on medical students and residents. Two compared SNAPPS with an active control such as One Minute Preceptor or training with feedback. None reported the effects of SNAPPS in workplace settings (Kirkpatrick Level 3) or patients (Kirkpatrick Level 4). Low to moderate certainty of evidence suggests that SNAPPS increases the total presentation length by increasing discussion length. Low to moderate certainty of evidence may increase the number of differential diagnoses and the expression of uncertainties. Low certainty of evidence suggests that SNAPPS may increase the odds of trainees initiating a management plan and seeking clarification. OUTLOOK Evidence from this systematic review suggests that SNAPPS has some advantages in terms of clinical reasoning, self-directed learning outcomes, and cost-effectiveness. Furthermore, it appears more beneficial when used by residents than medical students. However, future research should explore outcomes outside SNAPPS-related outcomes, such as workplace or patient-related outcomes.
Collapse
Affiliation(s)
| | - Sonia F Vizcarra-Jiménez
- Escuela de Medicina Humana, Facultad de Ciencias de la Salud, 120782 Universidad Privada de Tacna , Tacna, Peru
| | | | | | - Marco Rivarola-Hidalgo
- Centro de Estudios e Investigación en Educación Médica y Bioética, 120782 Universidad Privada de Tacna , Tacna, Peru
| | - Alvaro Taype-Rondan
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, 33225 Universidad San Ignacio de Loyola , Lima, Peru
| |
Collapse
|
2
|
Kassianos AP, Plackett R, Kambouri MA, Sheringham J. Educators' perspectives of adopting virtual patient online learning tools to teach clinical reasoning in medical schools: a qualitative study. BMC MEDICAL EDUCATION 2023; 23:424. [PMID: 37291557 DOI: 10.1186/s12909-023-04422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Learning tools using virtual patients can be used to teach clinical reasoning (CR) skills and overcome limitations of using face-to-face methods. However, the adoption of new tools is often challenging. The aim of this study was to explore UK medical educators' perspectives of what influences the adoption of virtual patient learning tools to teach CR. METHODS A qualitative research study using semi-structured telephone interviews with medical educators in the UK with control over teaching materials of CR was conducted. The Consolidated Framework for Implementation Research (CFIR), commonly used in healthcare services implementation research was adapted to inform the analysis. Thematic analysis was used to analyse the data. RESULTS Thirteen medical educators participated in the study. Three themes were identified from the data that influenced adoption: the wider context (outer setting); perceptions about the innovation; and the medical school (inner context). Participants' recognition of situations as opportunities or barriers related to their prior experiences of implementing online learning tools. For example, participants with experience of teaching using online tools viewed limited face-to-face placements as opportunities to introduce innovations using virtual patients. Beliefs that virtual patients may not mirror real-life consultations and perceptions of a lack of evidence for them could be barriers to adoption. Adoption was also influenced by the implementation climate of the setting, including positioning of CR in curricula; relationships between faculty, particularly where faculty were dispersed. CONCLUSIONS By adapting an implementation framework for health services, we were able to identify features of educators, teaching processes and medical schools that may determine the adoption of teaching innovations using virtual patients. These include access to face-to-face teaching opportunities, positioning of clinical reasoning in the curriculum, relationship between educators and institutions and decision-making processes. Framing virtual patient learning tools as additional rather than as a replacement for face-to-face teaching could reduce resistance. Our adapted framework from healthcare implementation science may be useful in future studies of implementation in medical education.
Collapse
Affiliation(s)
- A P Kassianos
- Department of Applied Health Research, University College London (UCL), 1-19 Torrington Place, London, WC1E 7HB, UK
| | - R Plackett
- Department of Applied Health Research, University College London (UCL), 1-19 Torrington Place, London, WC1E 7HB, UK
| | - M A Kambouri
- Institute of Education, University College London (UCL), London, UK
| | - J Sheringham
- Department of Applied Health Research, University College London (UCL), 1-19 Torrington Place, London, WC1E 7HB, UK.
| |
Collapse
|
3
|
Thoma B, Abbott C, Snell L. The future of the CanMEDS physician competency framework. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:1-3. [PMID: 36998483 PMCID: PMC10042786 DOI: 10.36834/cmej.77098] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Brent Thoma
- Emergency Medicine, University of Saskatchewan, Saskatchewan, Canada
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | - Cynthia Abbott
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | - Linda Snell
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- Medicine and Health Sciences Education, McGill University, Quebec, Canada
| |
Collapse
|
4
|
Thoma B, Karwowska A, Samson L, Labine N, Waters H, Giuliani M, Chan TM, Atkinson A, Constantin E, Hall AK, Gomez-Garibello C, Fowler N, Tourian L, Frank J, Anderson R, Snell L, Van Melle E. Emerging concepts in the CanMEDS physician competency framework. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:4-12. [PMID: 36998506 PMCID: PMC10042782 DOI: 10.36834/cmej.75591] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background The CanMEDS physician competency framework will be updated in 2025. The revision occurs during a time of disruption and transformation to society, healthcare, and medical education caused by the COVID-19 pandemic and growing acknowledgement of the impacts of colonialism, systemic discrimination, climate change, and emerging technologies on healthcare and training. To inform this revision, we sought to identify emerging concepts in the literature related to physician competencies. Methods Emerging concepts were defined as ideas discussed in the literature related to the roles and competencies of physicians that are absent or underrepresented in the 2015 CanMEDS framework. We conducted a literature scan, title and abstract review, and thematic analysis to identify emerging concepts. Metadata for all articles published in five medical education journals between October 1, 2018 and October 1, 2021 were extracted. Fifteen authors performed a title and abstract review to identify and label underrepresented concepts. Two authors thematically analyzed the results to identify emerging concepts. A member check was conducted. Results 1017 of 4973 (20.5%) of the included articles discussed an emerging concept. The thematic analysis identified ten themes: Equity, Diversity, Inclusion, and Social Justice; Anti-racism; Physician Humanism; Data-Informed Medicine; Complex Adaptive Systems; Clinical Learning Environment; Virtual Care; Clinical Reasoning; Adaptive Expertise; and Planetary Health. All themes were endorsed by the authorship team as emerging concepts. Conclusion This literature scan identified ten emerging concepts to inform the 2025 revision of the CanMEDS physician competency framework. Open publication of this work will promote greater transparency in the revision process and support an ongoing dialogue on physician competence. Writing groups have been recruited to elaborate on each of the emerging concepts and how they could be further incorporated into CanMEDS 2025.
Collapse
Affiliation(s)
- Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | - Anna Karwowska
- University of Ottawa, Ontario, Canada
- Association of Faculties of Medicine of Canada, Ontario, Canada
| | - Louise Samson
- Université de Montréal, Quebec, Canada
- Collège des médecins du Québec, Quebec, Canada
| | | | | | | | | | - Adelle Atkinson
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- University of Toronto, Ontario, Canada
| | | | - Andrew K Hall
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- University of Ottawa, Ontario, Canada
| | | | - Nancy Fowler
- McMaster University, Ontario, Canada
- College of Family Physicians of Canada, Ontario, Canada
| | | | | | - Rob Anderson
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- NOSM University, Ontario, Canada
| | - Linda Snell
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- McGill University, Quebec, Canada
| | - Elaine Van Melle
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
- Queen’s University, Ontario, Canada
| |
Collapse
|