Practical Doc


How can I help my resident become more self-directed?

Teaching residents or medical students to present cases in the SNAPPS format encourages them to reflect on the problem and possible solutions before quizzing you. It’s a good way to promote higher level clinical reasoning skills. SNAPPS shares many features with the One-minute Preceptor but is much more learner-driven.


  • S - summarize the case
  • - narrow the differential
  • A - analyze the differential
  • P - probe the preceptor
  • - plan management
  • S - select an issue for self directed learning

Breaking down the steps


  • Encourage the learner to present only the pertinent facts. Some of the background can be discussed with the analysis of the differential diagnoses.

Narrow differential diagnosis

  • The learner offers no more than 3 possible diagnoses

Analyze the differential

  • Reviewing the pros and cons for each diagnosis allows the student to demonstrate analytic clinical skills

Probe the preceptor

  • Not as painful as it sounds!
  • Here the student clarifies any difficult or confusing issues with the supervisor.
  • Avoid providing a mini-lecture if you want your clinic to stay on time!

Plan management

  • Developing a management plan requires an integrated clinical approach from the student or resident.
  • This is a good opportunity for the preceptor to provide some feedback.

Select a issue for self-directed learning

  • Reflecting on the case may reveal gaps in the learner’s knowledge base. This final step requires the student to plan the steps to improve later performance.
    Adapted from Wolpaw et al

Although you can coach the learner through each step of SNAPPS, it is much more effective (and efficient) to teach them the complete technique then expect them to use it in future case presentations.

Check out the accompanying video clips showing how to teach SNAPPS and demonstrating SNAPPS in action.



For more on SNAPPS visit: Teaching with patients

Wolpaw TM, Wolpaw DR, Papp KK. SNAPPS: a learner-centered model for outpatient education. Acad Med 2003;78(9):893-898

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