SNAPPS: On-Shift Learning with Dr. Jess Mason

Overview

"I think we need better on-shift teaching." This is a common quote from residents and med students alike in the emergency department. EMRA*Cast host Chris Reilly, MD, MS, talks with EM:RAP queen and Deputy Director Jessica Mason, MD, about different ways residents can take learning into their own hands and get the most out of their on-shift education. It’s as easy as a SNAPPS (punny if you listen).

TAKE-HOME POINTS

• The responsibility of education is a shared responsibility; you must learn to be a good learner.
  • "When you are on-shift, think of learning like an investment account. You have to actually invest if you're going to gain anything of value. It's on you."
• You will pick up as many tips from poor educators as from those who inspire you. Remember that as you examine your own role in teaching others on-shift.
• Patient safety/quality care trumps your role as an educator – and it's important to set that expectation for your learners.
• Attention, learners! Use the SNAPPS technique:
  • Summarize the history and findings
  • Narrow the differential
  • Analyze the differential by comparing/contrasting
  • Probe the preceptor re: difficulties, questions, etc.
  • Plan management for current and potential issues
  • Select a case-related issue for self-directed learning
• Recognize the various types of attendings and how to relate to them on the learner/educator level:
  • The Teacher: Be vulnerable and seek feedback.
  • The Quiet One: Probe using specific questions.
  • The No-Autonomy One: Seek to understand this attending's perspective while building trust; probe to reveal the medical decision-making process and learn from it.
  • The Absent One: Understand that they're likely looking over your shoulder even when they're silent. Ask for help when you need it so they can engage.
  • The Harsh One: As long as it's not abuse, keep it in perspective. You will remember their teaching points – and you'll get the best stories. (See also: "what not to do" examples.)
• Give your attending an assignment at the beginning of the shift. Make it specific so they know exactly what feedback you're seeking.

Resources

1. Wolpaw TM, Wolpaw DR. Papp KK. SNAPPS: a learner-centered model for outpatient education. Acad Med. 2003;78(9):893-898. https://pubmed.ncbi.nlm.nih.gov/14507619/
2. Chinai SA, Guth T, Lovell E, Epter M. Taking advantage of the teachable moment: A review of learner-centered clinical teaching models. West J Emerg Med. 2018;19(1):28-34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5785198/
3. Guth TA. EMRA Resident as an Educator: A Guidebook Written by Residents, for Residents. EMRA. 2013. https://www.emra.org/siteassets/emra/publications/books/emra-2013residentaseducator-interactive.pdf
4. Sudario G. PV Card: One-Minute Preceptor – NERDS Mnemonic. Academic Life in Emergency Medicine. 2015. https://www.aliem.com/pv-card-one-minute-preceptor-nerds-mnemonic/
5. Konda SR, Davidovitch RI, Egol KA. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. J Orthop Trauma. 2013;27(9):498-504. https://pubmed.ncbi.nlm.nih.gov/23287770/#:~:text=Conclusion%3A%20CT%20scan%20performs%20better,in%20the%20appropriate%20clinical%20setting.