Update in Medical Education
Reena Karani, MD
1
, Shobhina G. Chheda, MD, MPH
2
, Kathel Dunn, PhD
3
, Kenneth Locke, MD
4
,
and Carol K. Bates, MD
5
1
Brookdale Department of Geriatrics and Palliative Medicine, Samuel M. Bronfman Department of Medicine, Department of Medical
Education, Mount Sinai School of Medicine, New York, NY, USA;
2
Department of Medicine, Section of General Internal Medicine, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA;
3
National Library of Medicine, Bethesda, MD, USA;
4
Department of
Medicine, Division of General Medicine, University of Toronto, Toronto, ON, Canada;
5
Division of General Medicine and Primary Care, Beth
Israel Deaconess Medical Center, Boston, MA, USA.
KEY WORDS: advances; innovations; general internal medicine;
manuscripts; education.
J Gen Intern Med 26(1):83–7
DOI: 10.1007/s11606-010-1502-y
© Society of General Internal Medicine 2010
INTRODUCTION
This article summarizes 12 manuscripts that represent
advances within medical education in 2009 from a general
internal medicine perspective.
METHODS
Our search was limited to articles published between January 1,
2009 and December 31, 2009. We reviewed the Table of Contents
in 12 publications: Academic Medicine, Annals of Internal
Medicine, British Medical Journal, Journal of the American
Medical Association, Journal of the American Geriatrics Society,
Journal of Continuing Education in the Health Professions,
Journal of General Internal Medicine, Lancet, Medical Educa-
tion, Medical Teacher, New England Journal of Medicine, and
Teaching and Learning in Medicine. Our previous literature
review consistently found that these journals contained articles
most relevant to academic generalists and most likely to impact
their teaching practice. We also performed a PubMed search,
limited to English language articles published in 2009, using the
search strategy of medical education, learners, outcomes and
evaluation. More than 7,000 citations were examined. We
reached consensus on our final articles based on the questions
“Is this relevant to academic general internists?” and “Will this
article change the practice of teaching and learning?”
RESULTS
The 12 articles fall into four themes: (1) teaching, (2) simulation,
(3) assessment and (4) professionalism.
TEACHING
Wolpaw T, Papp KK, Bordages G. Using SNAPPS to facilitate
the expression of clinical reasoning and uncertainties: A
randomized comparison group trial.
1
This study determined whether third year medical students
(MS), trained to use a learner-centered technique called
SNAPPS for case presentations, expressed clinical reasoning
and raised learning issues more than students not trained in
this technique. The six-step technique required the learner to
summarize findings, narrow the differential, analyze the
differential, probe the preceptor about uncertainties, plan
management and select case-related issues for self-study.
One hundred and eight of 162 eligible students were divided
into three groups based on random assignment of their pre-
ceptors during the family medicine rotation. SNAPPS students
(N=39) received hands-on training about the technique on the
first day of the four-week rotation and learning was reinforced
twice in the subsequent two weeks. Preceptors also received
training about the technique by an author. Comparison students
(N=32) received training sessions focused on obtaining preceptor
feedback. Preceptors for this group received training on the
importance of feedback. Usual-and-customary students (N=37)
received no special training and their preceptors received a phone
call asking if they had any questions. Outcomes included ten
presentation elements in six categories related to clinical reason-
ing and case-based uncertainties. The last week of the clerkship,
students audio-taped all cases presented to faculty. Sixty four of
76 presentations were audible and coded by two authors. Mean
number of audiotaped cases was 3.31 (SD 2.1) with no by-group
differences. SNAPPS students’ case presentations took 1-minute
longer than comparison group students (p = 0.05). SNAPPS
students outperformed all other students across the six outcome
categories and were the only ones who identified the need for
additional case-related readings.
These results may not be generalizable as the study was
conducted in a single outpatient setting. Selection bias and
contamination also remain concerns. However SNAPPS, with its
Received May 31, 2010
Revised August 16, 2010
Accepted August 18, 2010
Published online September 18, 2010
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