SNAPPS

SNAPPS

Department of Family Medicine
The University of Mississippi Medical Center

Jackson, Mississippi

What is SNAPPS?

SNAPPS is a six-step learner-centered process that is
specifically geared for advanced and highly motivated
learners who prefer greater autonomy.

What is SNAPPS?

SNAPPS is an initiative that addresses Faculty Task Force
recommendations and responses to resident/faculty surveys and
interviews regarding;

• needed improvements in teaching and learning
• feedback,
• resident assessment,
• clinic efficiency,
• patient safety, and
• quality improvement.

SNAPPS in a nutshell

The learner sees a patient, presents the case to the “teacher”, narrows
and analyzes the differential diagnosis, asks questions for clarity and
after discussing and developing a plan of care for the patient, identifies
areas for future learning.

What is the value of SNAPPS?

SNAPPS CAN:
add structure and consistency to the supervision process
allow the learning process to become more self-directed
encourage learners to reflect on the patient, the problem and
possible solutions
facilitate learners’ self assessment
promote higher level clinical reasoning skills
enhance feedforward experiences of improving future performance

Now, here’s the whole hog about SNAPPS!

Depending on the patient presentation, the faculty will be listening for the following…

SNAPPS: Summarize

Summarize the case

• Present pertinent facts.
• Example – this is a 37 year old male with a history of HTN, DM,

GERD and obesity who presents to the clinic with a complaint of
abdominal pain. The pain started 3 days ago and has been getting
worse. Doesn’t seem to be related to eating. Not able to identify
an event that brought this on… etc.

SNAPPS: Narrow the differential

Narrow the differential diagnosis.

• Offer no more than 3 possible diagnoses.
• Note: This is a deviation from our “Strive for 5”.
• Example – “My differential includes reflux, pancreatitis, or

constipation.”

SNAPPS: Analyze the differential

Analyze the differential diagnosis.

• Review the pros and cons for each diagnosis to demonstrate analytic
clinical skills.

• Example: “Reflux is possible, but this patient’s pain is actually in the lower
umbilical region. Pancreatitis is higher on my differential given his alcohol
history and recent binge, but he doesn’t have any worsening of his pain with
food, etc.”

SNAPPS: Probe the teacher

Probe the “teacher”

• The learner asks questions to clarify any issues that may be
considered difficult or confusing.

• The “teacher” actively listens to the learner’s presentation and
actively engages in dialogue after the learner probes for clarity,
identifies areas of uncertainty or asks a question.

• Learner: “Dr. X, is it possible for patients with pancreatitis not to have pain
with food?”

• Teacher: Avoid mini-lectures to stay on time!

SNAPPS: Plan development and management

Plan development and management: A good management plan
requires an integrated clinical approach from the learner.

• This is a good opportunity for the “teacher” to provide some specific
feedforward.

• Learner: “So my plan is to get a CT of the abdomen.”

• Teacher: “How would a CT help you?”

“Should we start with a lipase or ultrasound?”
“What are the risks of CT?, etc.”

Faculty can also use this as an opportunity to teach, participate in
collaborative problem-solving and to answer questions.

SNAPPS: Select an issue

Select an issue for self-directed learning.

• After reflecting on the case, the learner identifies gaps or
opportunities to expand his/her knowledge base.

• This final step requires the learner to develop a plan/educational
prescription that can improve later performance.

• Learner: “My learning point for today is CT vs US for evaluation of
pancreatitis. I know that it is not what my patient has, but I would like to learn
more about this. And I also want to read about, etc.”

• Learner: Develops a PICO question and finds the answer.

The following slides demonstrate how the Ambulatory
Presentation Process should flow.

As you demonstrate competency in these skills you will progress
from a supervision to consultation model.

SNAPPS: Acute Problem. No Chronic.

•Summarize •Wellness plan
•Narrow differential •Had already
•Analyze differential •Needs today
•Probe •Will return
•Plan management
•Select issue for self-directed
learning

SNAPPS: Acute Problem h/o top FM Dx

•Summarize • Chronic Disease Management
•Narrow differential •Had already
•Analyze differential •Needs today
•Probe •Will return
•Plan management
•Select issue for self-directed •Wellness plan
learning •Had already
•Needs today
•Will return

SNAPPS: Chronic Disease Visit

• Obtain complete interval history • Note side effects/effect of medication on
comorbidities, etc.
• Perform physical exam appropriate
for the disease • Identify comorbidities (Summary)
• Explain how comorbidities affect current
• Indicate whether condition
controlled/not controlled disease state (Plan)
• Develop a plan for secondary prevention
• Identify appropriate lab or imaging
related to disease state (Plan)

• Manage abnormal lab or imaging • Wellness plan
•Had already
• Prescribe appropriate medication or •Needs today
other intervention •Will return

• Change medication

With practice, it’s a SNAP!