Uso de ferramentas para aferição do raciocínio clínico no ensino de estudantes de medicina em um cenário hospitalar: estudo randomizado controlado

Abstract

Introduction: Clinical reasoning is essential for interactions with patients and professional colleagues. It involves the synthesis of clinical and investigative data to generate and prioritize a differential diagnosis and recommend safe and accurate treatment plans. Clinical reasoning education involves the use of several approaches, such as the One-Minute Preceptor (OMP) model and SNAPPS (Summarize relevant patient history and findings; Narrow the differential; Analyze the differential; Probe the preceptor about uncertainties; Plan the management; Select case-related issues for self-study). These approaches aim to facilitate students’ learning and optimize their clinical case presentations. The available research on these approaches is mostly quasi-experimental and limited to the outpatient setting, and few studies have compared OMP and SNAPPS. Objectives: To evaluate the effectiveness of OMP and SNAPPS in teaching clinical reasoning competence to undergraduate medical students in a hospital setting as compared to a control group (i.e., traditional teaching). Method: A randomized controlled educational intervention study on the impact of OMP and SNAPPS educational approaches in developing clinical reasoning competence in undergraduate medical students at the Federal University of Juiz de Fora (UFJF) was conducted from July 2018 to December 2019. Students were assessed through preand post-tests in a simulated environment and in the real-world environment, using the Learning Reflection Scale and the Diagnostic Reasoning Inventory. Results: A total of 256 students were included in the study, with 86 in the control group, 83 in the OMP group, and 87 in the SNAPPS group. In the pre-test, all three groups were similar in relation to the variables evaluated. In the post-test, the OMP and SNAPPS groups performed significantly better than the control group for all outcomes studied in the simulated environment and the real world. Furthermore, SNAPPS showed superior results than the OMP groups for discussion time, case presentation quality score, student performance score, and the number of differential diagnoses presented and justified. Students and preceptors perceived OMP to be slightly better rated than SNAPPS, while both scored better than the control. Conclusions: Teaching clinical reasoning is an important part of medical training, and using approaches that help structure this process can facilitate student performance. The results indicate that the use of OMP and SNAPPS approaches is promising for teaching clinical reasoning competence, especially in a hospital teaching setting for undergraduate students; therefore, such approaches should be recommended and incorporated into medical curricula.