Effectiveness of a SNAPPS in psychiatric residents assessed using objective structured teaching encounters: a case-control study

ABSTRACT BACKGROUND: Residents play the role of teachers in almost one-quarter of their activities in residency programs. OBJECTIVE: To evaluate whether a 45-minute class using summarize, narrow, analyze, probe, plan, and select (SNAPPS) could improve psychiatry residents' case discussion skills in diverse practical learning settings. DESIGN AND SETTING: This case-control, randomized, blinded study was conducted in a psychiatry hospital at Fortaleza-Ceará. METHODS: Using "resident as teacher" (RaT), objective structured teaching encounters (OSTEs), and SNAPPS, we conducted a study with 26 psychiatry residents. We analyzed video footage of psychiatric cases in three settings: outpatient, nursing, and emergency. An intervention was held two months later with the residents, who were then assigned to two groups: group A (lecture on SNAPPS) and group B (lecture on a topics in psychiatry). Shortly after the lectures, they were video recorded while discussing the same cases. Three blinded examiners analyzed the videos using an instrument based on the Stanford Faculty Development Program (SFDP-26). RESULTS: We found high internal consistency among external examiners and an interaction effect, group effect, and moment effect (P < 0.05). The residents who received the SNAPPS lecture scored significantly higher than their counterparts who received a traditional case presentation. CONCLUSION: This study indicates the efficacy of SNAPPS over traditional case presentation in all three settings as assessed by OSTEs and supports its implementation to improve the teaching of clinical reasoning.

Effectiveness of a SNAPPS in psychiatric residents assessed using objective structured teaching encounters: a case-control study.

BACKGROUND: Residents play the role of teachers in almost one-quarter of their activities in residency programs. OBJECTIVE: To evaluate whether a 45-minute class using summarize, narrow, analyze, probe, plan, and select (SNAPPS) could improve psychiatry residents' case discussion skills in diverse practical learning settings. DESIGN AND SETTING: This case-control, randomized, blinded study was conducted in a psychiatry hospital at Fortaleza-Ceará. METHODS: Using "resident as teacher" (RaT), objective structured teaching encounters (OSTEs), and SNAPPS, we conducted a study with 26 psychiatry residents. We analyzed video footage of psychiatric cases in three settings: outpatient, nursing, and emergency. An intervention was held two months later with the residents, who were then assigned to two groups: group A (lecture on SNAPPS) and group B (lecture on a topics in psychiatry). Shortly after the lectures, they were video recorded while discussing the same cases. Three blinded examiners analyzed the videos using an instrument based on the Stanford Faculty Development Program (SFDP-26). RESULTS: We found high internal consistency among external examiners and an interaction effect, group effect, and moment effect (P < 0.05). The residents who received the SNAPPS lecture scored significantly higher than their counterparts who received a traditional case presentation. CONCLUSION: This study indicates the efficacy of SNAPPS over traditional case presentation in all three settings as assessed by OSTEs and supports its implementation to improve the teaching of clinical reasoning.

Estrutura do Programa em Treinamento de Docência na Residência: Residente como Professor / Structure of The Teaching Training Program in Residency: The Resident as a Teacher

RESUMO Introdução Na residência médica, os residentes exercem o duplo papel de professor e aprendiz. Treinamentos de como ensinar residentes a exercer a função de docência com qualidade estão sendo implementados em todo o mundo e são denominados programas de Residente como Professor (Resident as Teacher - RaT). De acordo com as Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina, pode-se aprender a estabelecer objetivos educacionais e matriz de competência, além de habilidades como comunicação, empatia, mediação de conflitos, entre outras. A implementação desses programas deve ser baseada na compreensão do contexto de cada residência médica na qual se deseja inseri-los, e os residentes também devem conhecer as potencialidades de cada cenário de atuação da sua especialidade para promover uma docência eficaz. Objetivo O objetivo do estudo foi o desenvolvimento de uma estrutura de programa de treinamento de docência (RaT) dividido em módulos e detalhado com suas respectivas referências bibliográficas. Metodologia Realizou-se uma revisão de literatura sobre ensino médico e testaram-se alguns métodos em cenário de prática durante uma dissertação de mestrado, utilizando a técnica SNAPPS, e durante uma tese de doutorado, utilizando a técnica OMP. Resultado Foi construído um programa de treinamento de docência nas residências médicas baseado nos resultados positivos encontrados na literatura sobre ensino médico. Propõe-se que cada módulo tenha a duração de um mês aproximadamente, com atividades de um turno por semana. O formato da discussão pode variar de acordo com cada especialidade e com o número de residentes de cada programa. Sugere-se a realização de flipped classroom (sala de aula invertida) com o envio do referencial bibliográfico de suporte sobre os temas aos residentes por e-mail uma semana antes da realização de cada módulo. Diversas atividades podem ser postas em prática em cada módulo para sedimentação do material estudado. Conclusão Após a estruturação de um roteiro a ser implementado pelos programas de residência médica no Brasil, espera-se que os residentes desempenhem com maior eficácia o papel que muitos já exercem na prática e que consequentemente o nível de aprendizagem dos alunos de graduação e internos melhore.

ABSTRACT Introduction In medical residency, residents play the dual role of teachers and learners. Training programs aiming at teaching residents how to become teachers are being implemented around the world and are referred to as 'Resident as teacher' (RaT) programs. According to the National Curricular Guidelines of the Medical Undergraduate Course, one can learn to establish educational goals and competence matrix, as well as skills such as communication, empathy, mediation of conflicts, among others. The implementation of these programs should be based on the understanding of the context of each medical residency where they are to be included and the residents should also know the potential of each scenario of their specialty to promote an effective teaching. Objective The objective of the study was the development of the structure of a Teaching Training Program (Resident as Teacher) divided into modules and detailed with their respective bibliographical references. Method a literature review was performed on medical education and some methods were tested in a practice scenario during a master's degree dissertation, using the SNAPPS technique, and during a doctoral thesis presentation using the OMP technique. Outcome A Teaching Training Program was built in medical residencies based on the positive results found in the medical education literature. It is proposed that each module has a duration of approximately one month, with activities lasting one shift per week. The format of the discussion may vary with each specialty and with the number of residents in each program. It is suggested that a flipped classroom situation be carried out, sending the bibliographic reference of support on the subjects to the residents by email one week before the completion of each module. Several activities can be implemented in each module to consolidate the studied material. Conclusion After structuring a script to be implemented by the residency programs in Brazil, residents are expected to more effectively play the role that many already exercise in practice and that the level of learning of undergraduate and internship students consequently improves.