Using the Student Case Presentation to Enhance Diagnostic Reasoning

This article resumes the series by the Council on Medical Student Education in Pediatrics (COMSEP) examining the skills and strategies of great clinical teachers. So far we have reviewed what makes a clinical teacher great1 and the importance of orientation,2 observation,3 and feedback.4 In this article we discuss how best to use the time during or after a student case presentation to assess and strengthen student diagnostic reasoning skills. The development of good clinical reasoning skills is an essential component of medical school training and remains critical to clinical practice. Each of us has heard lengthy presentations from medical students on patients they have seen. The presentations tend to emphasize the facts of the case (the history and what others have done) but often do not include an assessment or any explanation of why the student has come to a particular conclusion. Using case presentations as a platform, we present 2 models for assessing diagnostic reasoning skills: one in which the student presents the case and drives the learning (SNAPPS)5 and one in which the preceptor directs the learning by asking 5 types of questions after listening to the case presentation (One-Minute Preceptor [OMP]).6 Both models are designed for use in a busy office setting with minimal time commitment by the preceptor. SNAPPS is a learner-driven model in which the student articulates both his or her diagnostic reasoning processes and uncertainties about the clinical case.7 SNAPPS stands for “summarize the history and physical findings,” “narrow down … Address correspondence to Susan L. Bannister, MD, Department of Pediatrics, Faculty of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, Canada T3B 6A8. E-mail: susan.bannister{at}albertahealthservices.ca