Faculty-or senior resident-led SNAPPS for postgraduate teaching in pediatricsA Dabas, D Mishra, Swarnim, R Saxena
Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
Keywords: Case based learning, medical education, training, work-place-based assessment
There is an increasingly felt need to improve clinical exposure, case-based learning, and decision making during postgraduate training. Newer methods of teaching like One-Minute Preceptor and SNAPPS which stands for summarize-narrow differentials- analyze-probe- plan- and select can be used for an effective focused educational opportunity within a shorter stipulated time., Although, earlier experience with the use of the SNAPPS technique is documented,,, there is no published experience with the use of this technique by senior residents.
Therefore, we assessed the satisfaction and experiences of postgraduate students with faculty and senior resident-led SNAPPS sessions.
The study was conducted in the inpatient and outpatient clinics in the Department of Pediatrics of a large public hospital attached to a medical college between July to October 2021. The study was an educational intervention and was commenced after permission from the institutional ethics committee.
Five faculty who were interested and volunteered to participate in this exercise were selected. Senior residents are registrars who are employed after completion of post-graduation to assist in clinical and academic work. Ten senior residents who were available in the department were invited to participate in the study, out of whom five senior residents were finally available for the study. The faculty and senior residents were chosen irrespective of whether they had completed any training in medical education.
Five faculty members and five residents were trained in conducting SNAPPS by the investigators, using an interactive online session, and were given a handout on SNAPPS. A separate session was conducted for faculty and senior residents. A briefing for postgraduate students about the use of this tool was conducted in an online mode using video demonstration. Students were allotted a patient with a systemic disease that required hospitalization or detailed workup by the respective facilitator for the SNAPPS session. SNAPPS session was held within 24-48 hours of the case allotment.
Two separate feedback questionnaires (online) were developed to record the feedback of students and preceptors (faculty/senior residents) after the conduct of the session. The content of the questionnaire was validated by one faculty who was not involved with the study. These were completed by the preceptor after two-three sessions and by postgraduate students at the end of completion of their respective SNAPPS sessions. The responses to closed-ended questions were in the form of yes/no or on a 5-point (1-5) Likert scale.
Quantitative data were entered in a Microsoft Excel sheet. The scores on the 5-point Likert scale were summarized as the median and interquartile range (IQR) and compared between faculty and senior resident group using the non-parametric Mann Whitney test. The responses to open ended questions were identified for any similar themes between the two preceptor groups.
A total of 30 postgraduate students were invited to participate in the study, 28 attended the sensitization, and 24 were consecutively enrolled - 12 in each faculty and senior resident group, respectively. [Table 1] enlists the satisfaction scores of postgraduate students on the Likert scale in the faculty and senior resident group. Most postgraduate students wanted more frequent (52.9% opined for once a week) SNAPPS sessions unlike preceptors (50% opined for once a month), P = 0.097. Students remarked this technique helped them assimilate knowledge and generate self-directed learning (SDL) opportunities that were less emphasized routinely. This was opined as a structured format that covered all components of a case discussion even when conducted by a senior resident.
The preceptors opined that SNAPPS changed their own attitude towards postgraduate training with an overall median (IQR) satisfaction score of 4.5. They remarked that students were less confident for SDL among the six steps of SNAPPS, but could express their respective concerns related to higher-order cognitive domain after the session was completed. All five senior residents opined that SNAPPS changed their attitude toward conducting a teaching exercise and improved their own attitude towards postgraduate training.
The major problems which the postgraduate students faced were time management of the case presentation and effectively summarizing and completing the analysis of the case. Few (n = 4) also reported initial anxiety with SNAPPS and wanted more detailed sensitization.
The present study reported satisfactory experiences of postgraduate students in Pediatrics using a new teaching-learning tool SNAPPS administered by senior residents and faculty. Similar results have been shown with other teaching-learning methods like mini-clinical evaluation exercise (mini-CEX), and objective structured clinical examination (OSCE) with senior residents in the role of teachers.
Teaching is perceived as an essential skill for residents during residency by the attending doctors with the advantage of developing a student/resident peer-teacher support system for self-development of skills and an overall rich learning experience. The new interactive teaching tools like SNAPPS, support a learner to construct newer concepts by assimilating and self-reflection making it a learner-driven approach (constructivism theory). The use of newer and innovative methods of teaching requires more active involvement by the facilitators where senior residents can be involved to train undergraduate and postgraduate students. The senior residents themselves reported high satisfaction after using SNAPPS and gathered self-learning and self-development opportunities which reiterate the advantage of using structured teaching tools.
The limitation of this study was the limited number of postgraduate residents enrolled, due to the administrative delays in postgraduate admissions. The sensitization meetings for SNAPPS were conducted online due to the pandemic restrictions. The present study could not evaluate the acceptability of this tool beyond the volunteers who participated in the study. Higher Kirkpatrick evaluation levels like learning and behavior could not be tested as the proforma only collected satisfaction scores that recorded short-term responses only.
The major advantage of this study was the successful implementation of a new tool in teaching clinical skills to postgraduate students and demonstrating good acceptability and effectiveness of the tool in hands of senior residents (educational innovation). This study also suggests the need to train senior residents with newer skills in medical education for the capacity building of institutions.
We express our sincere regards for late Dr Devender Kumar, Head, MEU, MAMC who was instrumental in the conduct of the study. We also thank our faculty member, Dr Mukta Mantan and senior residents Dr Archana, Dr Rimjhim, Dr Aparajita, Dr Sruti and Dr Kunal for the implementation of the study. Dr Rajrshi and Dr Biswajit were the student volunteers of their respective batches who deserve special thanks. We also thank the Faculty and batch mates of the Advanced Course in Medical Education (ACME) group who have guided and supported us throughout this learning endeavor.
Institutional Ethics Committee, Maulana Azad Medical College, number F.1/IEC/MAMC/(80/08/2020/no 311) dated 14 Jan 2021.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.