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Diagnostic Reasoning Competency and Accuracy by Nurse Practitioner Students Following the Use of Structured
Patricia B Griffith1, Bette Mariani, Michelle M Kelly
1About the Authors Patricia B. Griffith, PhD, CRNP, ACNP-BC, is advanced senior lecturer, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania. Bette Mariani, PhD, RN, ANEF, FAAN, is vice dean of academic affairs and a professor, Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania. Michelle M. Kelly, PhD, CRNP, CNE, FAANP, is associate professor, Villanova University M. Louise Fitzpatrick College of Nursing. Dr. Mariani, Research Briefs editor for Nursing Education Perspectives , had no role in the review or selection of this article. This work was supported by the National League for Nursing Education Scholarship and the Pennsylvania Higher Education Nursing Schools Association Nursing Education Research funding. For more information, contact Dr. Griffith at pgriffit@nursing.upenn.edu .
Structured reflection did not significantly change diagnostic reasoning competency in nurse practitioner students. However, participants found the strategy beneficial for improving diagnostic accuracy and verification.
Area of Science:
- Medical Education
- Diagnostic Reasoning
- Cognitive Bias
Background:
- Diagnostic errors stem from reasoning flaws.
- Structured reflection enhances diagnostic accuracy in medical learners.
- Investigating structured reflection's impact on diagnostic processes is crucial.
Purpose of the Study:
- To evaluate structured reflection's effect on diagnostic reasoning competency and accuracy.
- To explore cognitive bias experiences and perceived utility of structured reflection.
- To understand how structured reflection influences diagnostic workup in simulated patient scenarios.
Main Methods:
- Mixed-methods experiment comparing nurse practitioner students with and without structured reflection.
- Assessment of diagnostic reasoning competency and accuracy.
- Exploration of cognitive bias and perceived utility through qualitative inquiry.
Main Results:
- No significant change in Diagnostic Reasoning Assessment competency scores.
- A trend towards improved diagnostic accuracy observed with structured reflection.
- Diagnostic verification emerged as a key theme, prompting diagnosis changes in both groups.
Conclusions:
- Explicit structured reflection users perceived the strategy as helpful for reasoning.
- Control participants independently adopted components of structured reflection, reporting similar benefits.
- While quantitative outcomes were unchanged, qualitative data suggests perceived value and utility of structured reflection in diagnostic processes.
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