SNAPPS-Plus: An Educational Prescription to Facilitate Formulating and Answering Clinical Questions

SNAPPS is a six-step, learner-centered technique for student case presentations. We evaluated the addition of a PICO-formatted educational prescription (Patient-Intervention-Comparison-Outcome) to the final SNAPPS’ Select step. We hypothesized that this would foster high quality questions and answers. Students were instructed to use educational prescriptions as a complement to their SNAPPS case presentations at the bedside. The educational prescriptions were collected and coded for four outcomes: topic of student’s uncertainty, PICO conformity score (8-point scale), presence of an answer, and quality of the answer (directness, presence of evidence, and preferred management). A total of 191 education prescriptions were coded, of which 190 (99%) included a question and 176 (93%=176/190) included an answer. Therapy questions constituted 59% (112/190) of the questions generated by the students while providing care for their patients; 19% (37/190) were related to making a diagnosis. Three fifths of the questions (61%=116/190) were scored either 7 or 8 on the 8-point PICO conformity scale. The quality of the answers varied, with 37% (71/190) meeting all three criteria for high quality. There was a positive correlation between the PICO conformity score and the quality of the answers (Spearman Rank-Order Correlation Coefficient =0.726; p<.001). This technique was easily integrated into the inpatient clerkship structure and guaranteed that virtually every case presentation had a well-formulated question and an answer. SNAPPS-Plus could promote lifelong learning skills by teaching students to ask clear questions regarding their self-identified areas of uncertainty, which in turn can lead to quality answers.