Impact of SNAPPS Clinical Supervision Method on Clinical Reasoning of Post-Graduation Medical Residents: A Mixed Methods Study in a Real Clinical Context

Abstract

Objectives: To assess the impact of the SNAPPS method on postgraduate residents’ clinical reasoning and the quality of oral case presentations compared to the traditional method. Design: A randomized mixed-methods study with a pragmatic approach. Setting: Four medical departments in University Hospital of Constantine, Algeria. Participants: Sixteen residents in real-world practice and eleven clinical supervisors. The SNAPPS group (residents/supervisors) received training and framework; controls had neither. Main outcomes mea sures: Bordage DTI score in both groups. Analysis oral case presentations in traditional method (24 cases) with an analysis grid based on clinical reasoning steps. We used the SNAPPS grid for SNAPPS group oral case presentations (24 cases). Participants’ perceptions and experiences were collected through focus groups, along with their feedback. Results: The SNAPPS model represents an advancement in supervisors by establishing a continuum between the development of clinical supervisors and learners, integrating them into a shared educational process. This study demonstrated a significant difference in global Bordage DTI score between the two groups. The significant improvement in DTI score was mainly in the “memory structure” subscale, while the “thinking flexibility” subscale did not show a statistically significant difference . Guided by the SNAPPS method, learners formulated a clear synthesis based on relevant data, systematically generated hypotheses, and effectively compared their diagnostic assumptions. They sought clarifications, expressed uncertainties, and identified self-directed learning objectives, whereas traditional presentations focused on case management. Both learners and supervisors expressed positive perceptions of the SNAPPS method. Conclusion: The learner-centered and interactive SNAPPS method, applied in case presentations across four medical disciplines, facilitated the expression of clinical reasoning and case-related uncertainties in the hospital setting by engaging learners in an analytical process. It promoted responsible self-directed learning. The SNAPPS method was well received by all participants, highlighting its relevance and validating its strategic implementation in our context.