科研之友
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摘要
Context: Providing opportunities to develop clinical decision-making skills, including clinical reasoning, is an important aspect of clinical education. The learner-centered technique of summarizing the history and findings, narrowing the differential, analyzing the differential, probing the instructor about uncertainties, plan management, and selecting an issue for self-directed study (SNAPPS) is used in medicine to express clinical reasoning. Objective: To investigate the effects of SNAPPS on the clinical reasoning, reflection, and 4 case presentation attributes (length, conciseness, case summary, and expression of clinical reasoning) in athletic training students. Design: Randomized controlled clinical trial. Setting: Three undergraduate programs accredited by the Commission on Accreditation of Athletic Training Education. Patients or Other Participants: We randomly assigned 38 athletic training students (17 men, 21 women; age 21.53 +/- 1.18 years, grade point average = 3.25 +/- 0.31) who had completed at least 1 year of clinical education and all orthopaedic evaluation coursework to the SNAPPS group or the usual and customary group using a stratification scheme. Intervention(s): The SNAPPS group completed four 45minute clinical reasoning and case presentation learning modules led by an investigator to learn the SNAPPS technique, whereas the usual and customary group received no formal instruction. Both groups audio recorded all injury evaluations performed over a 2-week period. Main Outcome Measures: Participants completed the Diagnostic Thinking Inventory and Reflection in Learning Scale twice. Case presentations were analyzed for 4 attributes: length, conciseness, case summary, and expression of clinical reasoning. Results: Case presentations were longer (t(18.806) = -5.862, P < .001) but were more concise (t(32) = 11.297, P < .001) for the SNAPPS group than for the usual and customary group. The SNAPPS group performed better on both the case summary subscale (t(32) = 2.857, P = .007) and the clinical reasoning subscale (t(25.773) = -14.162, P < .001) than the other group. We found a time effect for Diagnostic Thinking Inventory scores (F-1,F-34 = 6.230, P = .02) but observed no group effects (F-1,F-34 = 0.698, P = .41) or time-by-group interaction (F-1,F-34 = 1.050, P = .31). The Reflection in Learning Scale scores analysis revealed no group-by-time interaction (F-1,F-34 = 1.470, P = .23) and no group (F-1,F-34 = 3.751, P = .06) or time (F-1,F-34 = 0.835, P = .37) effects. Conclusions: The SNAPPS is an effective and feasible clinical education technique for case presentations. This learnercentered technique provides the opportunity for the expression of clinical reasoning skills.
- 出版日期2013-6
