Use of simulation in distance learning (DL) programs for nurse practitioners is growing as technology advances and lends itself to user-friendly platforms. A need exists for innovative approaches to education that incorporate technology to complement student learning needs.1 One way in which students can practice and refine case presentation skills is through role-play simulation. While the student enters the clinical environment equipped with the educational foundation needed for practice, a need exists for course work designed to actively prepare the student for basic expectations in the clinical setting. Course work that focuses on cultivating case presentation skills prepares the student for success in the clinical setting. Assignments designed for students to practice in controlled environments allow them to master skills and boost confidence.
SNAPPS
The faculty turned to using the SNAPPS strategy, which is a 6-step student-directed learning technique to facilitate case presentations.2 Use of this technique has been validated as an effective strategy to enhance the student's ability to demonstrate diagnostic reasoning and reduce ambivalence in the clinical setting.3 In the first step, the student summarizes the history and physical findings in a succinct manner followed by step 2 in which the student narrows the differentials to 2 or 3 appropriate diagnoses.4 The third step requires the student to analyze the differentials by contemplating the possibilities of each diagnosis.4 Next, step 4 requires the student to probe the preceptor by asking questions related to concerns or difficulties with the case.4 This requires the student to initiate the learning discussion and identify needs and knowledge gaps. In the fifth step, the student creates the plan of care for the patient.4 Finally, in the sixth and final step, the student identifies a case-related issue in which they choose to perform self-directed learning following the clinical encounter.4 This structured approach gives students a guide for case presentation to improve efficiency and demonstrate better understanding of the issues presented in the patient encounter.
A review of literature demonstrates positive student outcomes with implementation of SNAPPS. Studies indicated that students were able to effectively present patient information succinctly while maintaining the same level of detail as students who chose a more traditional approach to case presentation.2 A study by Jain et al2 indicated that students who used SNAPPS were able to consider 1.5 times more differential diagnoses and more clearly identify the patient's diagnosis. Additionally, students independently initiated conversation regarding the patient's plan of care 20% more often, providing the preceptor with an opportunity to understand the student's learning needs and provide immediate feedback.2 Using SNAPPS shifted the responsibility to the student to self-identify areas of learning deficiency, resulting in more independent thinking.5 Preceptors expressed relief from identifying learning opportunities for the student as the technique promoted self-directed learning and required the student to assess own learning deficiencies.4
Presenting the SNAPPS material and teaching the technique equip students with a valuable approach to case presentation. Granting students an opportunity to receive feedback from faculty on their performance is important to aid in refining their skills. Use of this process ensures students understand the case presentation method and can reproduce its use in the clinical environment.
Flipgrid
The video recording platform Flipgrid is an ideal vehicle for DL students to role play their understanding of the technique to faculty. Flipgrid is an intuitive online video recording platform that encourages social learning for all ages and educational levels. Use of Flipgrid is free of cost and can be embedded into any learning management system. Use of the video platform encourages greater engagement between students and faculty while creating a sense of community between learners. Faculty must first register for an educator account through the Flipgrid webpage. Once registered, educators can create a grid, which is the homepage for course content and discussions. Each course grid is given a Flip code, which must be provided to students to enable access and locate the grid associated with the course.
Teaching Strategy
To improve student case presentation skills, an assignment was designed combining the SNAPPS technique with use of the Flipgrid platform. The goal of the SNAPPS assignment was to help students learn to efficiently compose a case presentation for the preceptor while simultaneously building confidence for the clinical setting. Students were supplied a copy of an article on SNAPPS4 and 2 faculty-generated case studies that documented separate patient encounters. After reading the article, students were required to read the case studies provided and apply the SNAPPS technique to present the case study patients in a Flipgrid video recording. Video recordings were limited to 2 minutes each for each presentation to encourage conciseness.
The case study provided the students with an exemplary document ensuring all necessary information to successfully address each of the 6 SNAPPS steps. Students were still required to independently identify appropriate questions for the preceptor and determine an area for self-directed learning, which allowed for critical thinking and self-awareness. It is important to note that the assignment allowed multiple attempts at the video recording before choosing which recording would be posted to be graded by faculty. This also enabled students to practice and build confidence in their ability to apply the technique.
Outcomes and Feedback
Anecdotal feedback was gathered from students and faculty following the implementation of this assignment. Feedback from students was largely positive. One student indicated that SNAPPS helped organize her thought process and contributed to increased confidence with diagnosis in the clinical setting. Another student admitted to a lack of understanding about information that was pertinent to present to the preceptor and that SNAPPS helped her form a baseline of how to present a patient. On self-reflection, one student noted the opportunity to initiate a corrective approach to her communication style, leading to her feeling more confident as she mastered her case presentation skills.
Use of the Flipgrid platform was also assessed. Faculty and students reported that Flipgrid was user-friendly and easily accessible. Users also felt the platform hosted an intuitive interface and design, which enhanced the learning experience. The ease of accessing SNAPPS videos from others in the course allowed students to view how their peers approached the SNAPPS technique. This further enabled the opportunity for self-directed learning and for students to learn from each other.
Discussion
The purpose of this assignment was to better prepare students for case presentation through introducing a structured approach. Preparing for the clinical setting can be challenging in the DL environment. Integrating the SNAPPS technique and Flipgrid platform introduced a new approach to preparing students for the basic skill of case presentation. Use of SNAPPS helped students have a better understanding of what information was pertinent to present to the preceptor, and Flipgrid allowed students to self-assess their performance with each recorded attempt. Additionally, this pedagogical approach allowed for repeated practice of the technique, which helped improve student confidence.
Conclusion
As DL education grows, educators are increasingly challenged to create new teaching and learning strategies to complement the online classroom. Faculty are called to refine and develop course work that actively engages the student and prepares them for complex clinical learning environments. Low-stakes learning environments decrease stress and increase learning opportunities for the student. Incorporating pedagogical strategies that aid in refining verbal communication skills prepares the student for the clinical learning experience on a new level. Combining the use of low-fidelity simulation with the SNAPPS technique equips students with a structured approach for case presentation so that the student enters the clinical experience well prepared and engaged.
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