Teaching Models for Outpatient Clinic (Traditional Model, One-Minute Preceptor (OMP), SNAPPS)

1. Teaching Models for
Outpatient Clinic
JIBRAN MOHSIN (MHPE Student)
Advanced Level Course on Teaching & Learning 2 (February 13-17, 2023)
Master of Health Professions Education
Department for Educational Development
The Aga Khan University

2. Outline
• Learning Objectives
• Scenario
• Individual teaching models (components and videos)
• Overview (comparison and contrast) of teaching models
• Conclusion
• Critique
• Application to own practice
• External Readings

3. Learning Objectives
At the end of this presentation, participants should be able
• To enumerate different teaching models specific for outpatient's clinic, along with
components of individual models.
• To compare and contrast different teaching models specific for outpatient's clinic.
• To apply appropriate model in their parent settings.

4. Scenario
• A 34-year-old woman with a 3-day history of acute cough and fever.
• On physical examination, she has notably a temperature of 100.4oF and crackles in
the right lower lobe on lung examination.
_____________________________________
How do you decide what and how to teach medical student in busy clinic?

5. Teaching/Pedagogic Models/Strategies
• Traditional (Preceptor / Patient-centered) Model
• OMP (One-Minute Preceptor) Model
• SNAPPS Model

6. Traditional Model

7. Five Micro Skills (Neher et al 1990s) ( Royal College of Physicians)
Get a commitment Get a commitment from the learner about what he or she thinks is going
on with the case
Probe for supporting
evidence
Probe for underlying reasoning to explore the learner’s understanding
Teach a general principle Teaching general rules pertaining to the case
Reinforce what was done
well
Provide positive feedback about what the learner did correctly
Correct learner’s error and make recommendations for improvement
One Minute Preceptor (OMP)

8. One Minute Preceptor

9. SNAPPS
Summarize` Summarize briefly the history and findings
Narrow Narrow the differential to 2 or 3 relevant possibilities
Analyze Analyze the differential by comparing and contrasting the possibilities
Probe Probe the preceptor by asking questions about uncertainties, difficulties or
alternative approaches ***
Plan Plan management for the patient’s medical issues
Select Select a case-related issue for slef-directed learning***
*** Unique bits of SNAPPS (Learner initiated actions  Reversal of typical interaction)

10. SNAPPS

11. Traditional Model OMP SNAPPS
Patient- centered vs
Learner - centered
Patient centered Learner-centered Learner-centered
Locus of control of
teaching interaction
(Preceptor vs Learner)
Preceptor > Learner Preceptor = Learner Preceptor < Learner
(step 4 and 6)
Feedback Rare (mini lecture)
Must be inferred by learner from
dictated decisions by preceptor
Yes (encounter specific) Yes (encounter
specific)
Purpose Efficient extraction of information for
clinical decisions by preceptor (act as
expert consultant)
Enhance teaching encounter via
five micro skills
Focusing the teaching
specifically on leaner's
needs.
Training Preceptor No Yes (additional cognitive
capacity)
Yes (Change of role
from expert to
facilitator)
Learner
No No Yes (Forced to take
lead)

12. Traditional Model OMP SNAPPS
Effective
Clinical
teaching
tool
Knowledge and
reasoning of
learner
Remain unclear – no guidance for
teaching process
Assessed
Learner initiated
Leaner directed
Learner control
Teaching /
instruction geared
to learner level
No (Often general) Yes
Applicability of
knowledge
Not translatable to future cases Disease – specific / higher-
order thinking
Indication • Efficient and appropriate in
instances with little time and patient
needs are paramount
For learners who need
preceptor guidance and
facilitation during interaction
Advanced Leaners
(Inappropriate for
1. novice leaner,
2. unreliable history,
3. unorganized oral
presentation)

13. Conclusion
• OMP and SNAPPS
• Cognitive (learner) Perspective
• Requires active engagement of leaner in clinical reasoning
• Activate leaner’s prior knowledge and apply it to case in hand (bridge in)
• Learners’ pattern recognition and illness scripts are better developed and retained
• Push learners to margins of their capabilities to address uncertainties found.
• Teaching (Preceptor) Perspective
• Requires effective preceptor – communicate knowledge to learner in an understandable
and powerful way after diagnosing leaner.
• Focus of teaching on few key pints in each case  Memorable teaching (not
overwhelmed)

14. Critique
• Strength
• Comprehensive and Concise
• Explained with similar real time scenario for all 3 models
• Easy language (no difficult terminology used)
• Weakness
• Lack of tabulation of comparison and contrast of different models
• Few typing mistakes

15. Application to own Practice
• I am using OMP and SNAPPS in my surgical clinic (after I learned it in
introductory short course) depending on the level of learner.
• These models help me to engage my learners in patient care and clinical critical
thinking without compromising the optimal patient care.

16. External Readings
OMP: Systemic Review (Gatewood & De Gagne, 2019)
The OMP model is supported by literature for its effectiveness as a teaching model
and preference by students and preceptors. It has been shown to increase teaching
techniques including feedback and assessment of students’ clinical reasoning.
Gatewood, E., & De Gagne, J. C. (2019). The one-minute preceptor model: A systematic review. Journal of the American Association of Nurse Practitioners, 31(1), 46-57.

17. External Readings
• SNAPPS as T-L Method in outpatient setting has shown positive impact on clinical reasoning
skills of surgery residents. (Apturkar, 2014)
• The ‘commitment part’ and ‘probing the preceptor’ encouraging them to self directed learning.
(Apturkar, 2014)
• SNAPPS a learner centered technique for case presentations facilitated the expression of clinical
diagnostic reasoning and case-based uncertainties in the inpatient setting without extending the
unusual length of the student case presentations. (Jain, 2019)
• It also paved way for enhanced self-directed learning. (Jain, 2019)
Apturkar, D. K., Jorwekar, G. J., Baviskar, P. K., Shaikh, M. H., & Sadawarte, N. A. (2014). Impact of SNAPPS on clinical reasoning skills of surgery residents in outpatient setting. Int J Biomed Adv
Res, 5(9), 418-21.
Jain, V., Rao, S., & Jinadani, M. (2019). Effectiveness of SNAPPS for improving clinical reasoning in postgraduates: randomized controlled trial. BMC medical education, 19, 1-8.

18. THANK YOU