Effects of SNAPPS in clinical reasoning teaching: a systematic review with meta-analysis of randomized controlled trials.

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.

Score in the national EsSalud exam and its associated factors in Peruvian medical students: A perspective of the university reform / Puntaje en el examen nacional del EsSalud y sus factores asociados en estudiantes de medicina peruanos: Una perspectiva de la reforma universitaria

Objective: To describe the academic and institutional characteristics of students who took the National Medical Internship Exam (ENIM) of the Social Security Health System (EsSalud, abbreviature in Spanish) and explore their association with the score obtained. Materials and Methods: A cross-sectional study of a secondary database of medical students who took the ENIM of EsSalud in Peru on December 27, 2022. We evaluated the factors associated with the ENIM score using linear regression. Results: We evaluated 1228 medical students who took the ENIM. The median ENIM score was 12.2 (range 10.2 to 13.8), 35.9% of students passed the exam, and only 26.5% came from a University with a licensed medicine program. In the adjusted model, the ENIM score was higher in students who belonged to a university with a licensed medicine program (ß 0.5; 95% CI: 0.2 to 0.8) and those with a university-weighted average greater than or equal to 13. And the score was lower in students from the partnership (ß -1.2; -1.6 to -0.8) or associative (ß -2.0; -2.4 to -1.6) universities compared to students from national universities. Conclusion: Medical students from national universities, universities with licensed medicine programs, and a university weighted average of 13 or greater had a better performance in EsSalud's national medical internship exam.

Objetivo: Describir las características académicas e institucionales de estudiantes que rindieron el Examen Nacional de Internado Médico (ENIM) del Seguro Social de Salud (EsSalud) y explorar su asociación con el puntaje obtenido. Materiales y métodos: Estudio transversal analítico de una base de datos secundaria de estudiantes de medicina que rindieron el ENIM del EsSalud en Perú el 27 de diciembre del 2022. Evaluamos los factores asociados al puntaje del ENIM mediante regresión lineal. Resultados: Evaluamos a 1228 estudiantes de medicina que rindieron el ENIM. La mediana de puntaje en el ENIM fue de 12,2 (rango 10,2 a 13,8), el 35,9% de los estudiantes aprobó el examen y solo el 26,5% proviene de una Universidad que cuenta con el programa de medicina ya licenciado. En el modelo ajustado, el puntaje en el ENIM fue mayor en estudiantes que pertenecían a una universidad con el programa de medicina ya licenciado (ß 0,5; IC 95%: 0,2 a 0,8) y aquellos con un promedio ponderado universitario mayor o igual a 13. Y el puntaje fue menor en estudiantes de universidades societarias (ß -1,2; -1,6 a -0,8) o asociativa (ß -2,0; -2,4 a -1,6) con respecto a estudiantes de universidades nacionales. Conclusión: Los estudiantes de medicina provenientes de universidades nacionales, universidades con programa de medicina licenciados y promedio ponderado universitario mayor o igual a 13 tuvieron un mejor desempeño en el examen nacional de internado médico de EsSalud.

El desempeño académico previo como predictor del examen nacional de medicina: un estudio transversal en Perú / Past academic achievement as a predictor of the national exam of medicine: a cross-sectional study from Peru

Introducción: El examen nacional de medicina (ENAM) es un examen de licenciamiento para ejercer la profesión médica en Perú. Su objetivo es asegurar un perfil de calidad en el egresado peruano y brindar ventajas competitivas en la adjudicación del servicio rural y de la postulación a especialidades médicas. Todos estos aspectos ponen al ENAM como un hito en la carrera profesional. Nuestro objetivo fue determinar la correlación entre el promedio ponderado universitario y el ENAM en estudiantes de una universidad del Perú, así como identificar predictores de rendimiento para el examen.Materiales y métodos.Se realizó un estudio transversal y analítico.Resultados.De 46 estudiantes, sólo se incluyó a 45. La media de la puntuación obtenida fue de 12,4. Los factores con mayor correlación fueron el promedio ponderado universitario (r = 0,64) y el desempeño del examen de progreso tomado en la misma universidad (r = 0,64); en el análisis multivariado, un promedio ponderado universitario mayor de 13 tuvo una odds ratio de 0,62 para obtener una nota aprobatoria en el ENAM.Conclusiones.El desempeño académico durante el pregrado es el mayor predictor de un desempeño favorable en el ENAM. (AU)

Introduction: The national examination of medicine (ENAM) is a licensing exam taken in Peru to practice medicine. Its main goal is to ensure quality of care from medical doctors in Peru. It provides competitive advantages in the awarding of rural service and postulation to medical specialties depending on performance. All these aspects set the ENAM as a milestone in the professional career. Our objective was to determine the correlation between the weighted university average and the ENAM in students at a Peruvian university, as well as to identify predictors of performance for the exam.Materials and methods.An analytical, cross-sectional study was carried out.Results.Of the 46 students, only 45 were included, the mean score obtained was 12.4. The factors with the highest correlation were university weighted average (r = 0.64) and progress exam performance taken at the same university (r = 0.64); in the multivariate analysis a university weighted average above 13 had an odds ratio of 0.62 to obtain a passing grade in the ENAM.Conclusions.Academic performance during undergraduate is the strongest predictor of favorable performance on the ENAM. (AU)

Predictors of Death in Patients with Neonatal Sepsis in a Peruvian Hospital.

Reducing neonatal mortality is a global challenge. This study's objective was to determine the predictors of mortality in patients with neonatal sepsis. The study was a retrospective cohort study in a Peruvian hospital from January 2014 to April 2022. Neonates diagnosed with sepsis were included. To find predictors of mortality, we used Cox proportional regression models. We evaluated 288 neonates with sepsis; the median birth weight and hospitalization time were 3270 g and seven days, respectively. During follow-up, 18.4% did not survive, and the most common complications were jaundice (35.42%), respiratory distress syndrome (29.51%), and septic shock (12.5%). The most isolated bacteria were Klebsiella pneumoniae. The risk factors associated with higher mortality were prematurity (aHR = 13.92; 95% CI: 1.71−113.51), platelets <150,000 (aHR = 3.64; 1.22−10.88), creatinine greater than 1.10 (aHR = 3.03; 1.09−8.45), septic shock (aHR = 4.41; 2.23−8.74), and admission to IMV (aHR = 5.61; 1.86−16.88), On the other hand, breastfeeding was associated with a lower risk of death (aHR = 0.25; 0.13−0.48). In conclusion, we report a high incidence of death and identify clinical (prematurity, septic shock, admission to IMV) and laboratory characteristics (elevated creatinine and thrombocytopenia) associated with higher mortality in patients with neonatal sepsis. Breastfeeding was a factor associated with survival in these patients.

Sleep Disorders and Their Associated Factors during the COVID-19 Pandemic: Data from Peruvian Medical Students.

Background and objectives: Sleep disorders are a common public health problem among college students. The objective of this study was to evaluate sleep quality and its associated factors in medical students during the COVID-19 pandemic. Materials and Methods: Cross-sectional analytical study-we conducted a secondary analysis of the survey "Nomophobia in medical students in Peru" database between 2020 and 2021. Sleep disturbances were assessed using the Pittsburgh Sleep Quality Index (PSQI). To evaluate associated factors, crude and adjusted prevalence ratios (aPR) and their 95% confidence intervals (95% CI) were calculated. Results: We analyzed data from 3139 participants from 18 cities in Peru (61.1% were women, median age: 22 years). 43.4% had a quality of sleep that could require medical attention; the PSQI dimension with the highest score was daytime dysfunction. The poor sleep quality was associated with symptoms of anxiety (aPR: 1.48; 95% CI: 1.27-1.72), depression (aPR: 2.03; 1.72-2.39), or nomophobia (aPR: 1.28; 1.09-1.51). Conclusions: Sleep disorders were a common problem among Peruvian medical students and were associated with anxiety, depression, or nomophobia symptoms.

Fear of Death in Medical Students from a Peruvian University during the COVID-19 Pandemic.

Due to close contact with death, medical students may question their own and their patients' dying process, especially with the impact of the COVID-19 pandemic on the increase in deaths. This situation provokes fear and negative attitudes towards dealing with patients and their environment. This study aimed to assess the level of fear of death and associated factors in medical students at a Peruvian university. A cross-sectional analytical study was conducted during March 2021 in human medicine students from the first to the seventh year. A validated survey including the Collet-Lester fear-of-death scale was applied. Factors associated with the fear-of-death score were evaluated by calculating linear regression coefficients (ß). A total of 284 students were included. The median age was 22 years, and 58.1% were female. The mean Collet-Lester scale score was 2.79, and it was higher in the dimensions related to the death of others. Adjusted analysis showed that the score on this scale was lower in students aged 24-40 years compared to 17-21 years (ß: -0.25; 95% CI: -0.46 to -0.04) and those who had no religious beliefs (ß: -0.29; 95% CI: -0.53 to -0.04). In conclusion, fear of death was lower than reported in other investigations despite the COVID-19 situation, being much lower among older students and those without religious beliefs.