Using the SNAPPS model to develop student physical therapist decision-making skills during new patient encounters in the outpatient clinic: a pilot study

Main Article Content

Patti J. Berg-Poppe
Matt Dewald
Becca Jordre
Joy R. Karges-Brown
Adam Ladwig

Abstract

Rationale: The SNAPPS (summarize, narrow, analyze, probe, plan, select) model is a six-step teaching tool that facilitates decision-making in clinic environments. The tool promotes active communication between students and clinical instructors (CIs) and positions the student as lead in the learning scenario. The current study employed the SNAPPS model for use with student physical therapists. The purpose of the study was to gauge changes in perceptions of verbal ability, decision-making, and confidence levels following new patient evaluations where the SNAPPS model was utilized.


Methods: Participating student and CI partners received training to learn the SNAPPS model with fidelity. Log worksheets guided students through the SNAPPS steps. After new patient encounters, student and CI partners rated student verbal skills, decision-making, and confidence levels using mirrored statements. Representative early, middle, and late week ratings were compared for change.


Results: Six of forty-eight (12.5%) eligible students participated. Student and CI assessments were not significantly different, indicating reliable student self-assessment. Improvements were noted in students’ (1) skill in providing a verbal rationale, (2) ability to generate thoughtful and relevant learning prompts, (3) confidence in diagnosing pathology and impairment, and (4) confidence in selecting an appropriate intervention.


Clinical relevance: The SNAPPS model is a clinical education tool that shows promise toward improving thought process verbalization and confidence levels for the student seeing new patients in an outpatient setting. This active learning experience can promote accountability for learning and enhance student verbal and analytical skills.

References


  1. Cutrer WB, Sullivan WM, Fleming AE. Educational strategies for improving clinical reasoning. Curr Probl Pediatr Adolesc Health Care (2013) 43(9): 248–57. doi: 10.1016/j.cppeds.2013.07.005
  2. Levin M, Cennimo D, Chen S, et al. Teaching clinical reasoning to medical students: a case-based illness script worksheet approach. MedEdPORTAL (2016) 12: 10445. doi: 10.15766/mep_2374-8265.10445
  3. Choi S, Oh S, Lee DH, et al. Effects of reflection and immediate feedback to improve clinical reasoning of medical students in the assessment of dermatologic conditions: a randomised controlled trial. BMC Med Educ (2020) 20: 146. doi: 10.1186/s12909-020-02063-y
  4. Croskerry P, Nimmo G. Better clinical decision-making and reducing diagnostic error. J R Coll Physicians Edinb (2011) 41(2): 155–62. doi: 10.4997/JRCPE.2011.208
  5. Ferdinand NK, Kray J. Does language help regularity learning? The influence of verbalizations on implicit sequential regularity learning and the emergence of explicit knowledge in children, younger and older adults. Dev Psychol (2017) 53(3): 597–610. doi: 10.1037/dev0000262
  6. Gagné RM, Smith EC, Jr. A study of the effects of verbalization on problem-solving. J Exp Psychol (1962) 63(1): 12–18. doi: 10.1037/h0048703
  7. Berardi-Coletta B, Buyer LS, Dominowski RL, et al. Metacognition and problem-solving: a process-oriented approach J Exp Psychol (1995) 21(1): 205–23. doi: 10.1037/0278-7393.21.1.205
  8. Oh RC. The Socratic Method in medicine – the labor of delivering medical truths. Fam Med (2005) 37(8): 537–9.
  9. Wolpaw TM, Wolpaw DR, Papp KK. SNAPPS: a learner-centered model for outpatient education. Acad Med (2003) 78: 893–8. doi: 10.1097/00001888-200309000-00010
  10. Connor DF, Pearson GS. Feasibility and implementation of SNAPPS in an outpatient child psychiatry clinic. Acad Psychiatry (2017) 41: 299–300. doi 10.1007/s40596-016-0635-7
  11. Banning M. A review of clinical decision-making: models and current research. J Clin Nurs (2008) 17: 187–95.
  12. Shin HS. Reasoning processes in clinical reasoning: from the perspective of cognitive psychology. Korean J Med Educ (2019) 31(4): 299–308. doi: 10.3946/kjme.2019.140
  13. Roach K, Gandy J, Deusinger SS, et al. The development and testing of APTA clinical performance instruments. Phys Ther (2002) 82(4): 329–53. doi: 10.1093/ptj/82.4.329
  14. Jain V, Rao S, Jinadani M. Effectiveness of SNAPPS for improving clinical reasoning in postgraduates: randomized controlled trial. BMC Med Educ (2019) 19(1): 224. doi: 10.1186/s12909-019-1670-3
  15. Kapoor A, Kapoor A, Kalraiya A, et al. Use of SNAPPS model for pediatric outpatient education. Indian Pediatr (2017) 54(4): 288–90. doi: 10.1007/s13312-017-1090-6
  16. Sawanyawisuth K, Schwartz A, Wolpaw T, et al. Expressing clinical reasoning and uncertainties during a Thai internal medicine ambulatory care rotation: does the SNAPPS technique generalize? Med Teach (2015) 37(4): 379–84. doi: 10.3109/0142159X.2014.947942
  17. Anderson LW, Krathwohl DR, Airasian PW, et al. A taxonomy for learning, teaching, and assessing: a revision of bloom’s taxonomy of educational objectives. New York: Addison Wesley Longman, Inc; 2001.

Article Details

Keywords:
Clinical Education, learning outcomes, communication skills, decision-making, patient management, teaching and learning
Section
Original Research Articles
How to Cite
Berg-Poppe, P. J. ., Dewald, M., Jordre, B., Karges-Brown, J. R., & Ladwig, A. (2022). Using the SNAPPS model to develop student physical therapist decision-making skills during new patient encounters in the outpatient clinic: a pilot study. The Journal of Clinical Education in Physical Therapy, 4. https://doi.org/10.52214/jcept.v4.8093