title: SNAPPS-Plus: an educational prescription for students to facilitate formulating and answering clinical questions.
abstract: OBJECTIVE
  To analyze the content and quality of PICO-formatted questions (Patient-Intervention-Comparison-Outcome), and subsequent answers, from students' educational prescriptions added to the final SNAPPS Select step (SNAPPS-Plus).
  
  
  METHODS
  Internal medicine clerkship students at the University of Minnesota Medical Center were instructed to use educational prescriptions to complement their bedside SNAPPS case presentations from 2006 to 2010. Educational prescriptions were collected from all eligible students and coded for topic of uncertainty, PICO conformity score, presence of answer, and quality of answer. Spearman rank-order correlation coefficient was used to compare ordinal variables, Kruskal-Wallis test to compare distribution of PICO scores between groups, and McNemar exact test to test for association between higher PICO scores and presence of an answer.
  
  
  RESULTS
  A total of 191 education prescriptions were coded from 191 eligible students, of which 190 (99%) included a question and 176 (93%, 176/190) an answer. Therapy questions constituted 59% (112/190) of the student-generated questions; 19% (37/190) were related to making a diagnosis. Three-fifths of the questions (61%, 116/190) were scored either 7 or 8 on the 8-point PICO conformity scale. The quality of answers varied, with 37% (71/190) meeting all criteria for high quality. There was a positive correlation between the PICO conformity score and the quality of the answers (Spearman rank-order correlation coefficient = 0.726; P < .001).
  
  
  CONCLUSIONS
  The SNAPPS-Plus technique was easily integrated into the inpatient clerkship structure and guaranteed that virtually every case presentation following this model had a well-formulated question and answer.
authors.affiliation: Dr. Nixon is vice chair for education, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. Dr. Wolpaw is vice dean for education, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. Dr. Schwartz is professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois. Dr. Duffy is assistant professor, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. Mr. Menk is research fellow, Biostatistical Design and Analysis Center, University of Minnesota Medical School, Minneapolis, Minnesota. Dr. Bordage is professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois.
authors.forename: James
authors.initials: J
authors.lastname: Nixon
authors.forename: Terry
authors.initials: T
authors.lastname: Wolpaw
authors.forename: Alan
authors.initials: A
authors.lastname: Schwartz
authors.forename: Briar
authors.initials: B
authors.lastname: Duffy
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Menk
authors.forename: Georges
authors.initials: G
authors.lastname: Bordage
mesh_terms: D002982:Clinical Clerkship / Q000379:methods* / Q000592:standards; D002983:Clinical Competence; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000592:standards; D008910:Minnesota; D017145:Models, Educational