Teaching Diagnostic Reasoning: A Review of Evidence-Based Interventions

Abstract

Problem/Background: The ability to accurately diagnose patients based on symptom profiles is a vital yet challenging skill that Nurse Practitioners (NPs) undertake frequently. Purpose: This integrative literature review highlights a variety of evidence based, practical educational strategies that foster the development of diagnostic reasoning. Methods: An integrative literature review was conducted in order to identify original research focusing on diagnostic reasoning educational interventions. Results: Eighteen primary sources met inclusion and exclusion criteria. Results are synthesized in terms of sample and setting, methodological features, interventions, and outcomes. Interventions broadly fit into five educational themes: testing strategies, cognitive biases, simulation programs, course formats, and instructional approaches. Discussion: Interventions are simple and can be implemented in multiple educational settings. Future research should occur in populations of NP students. Validated, easy-to-use measurement tools as well as more precise diagnostic reasoning concept development should occur.

An examination of student nurse practitioners' diagnostic reasoning skills

“…The role of the NP/APN exists in over 33 countries in the world (Maier et al, 2017). Diagnostic reasoning is critical to the role and also to patient safety (Burt & Corbridge, 2018). NP students have had experience in making intuitive judgements of a patient's response to illness as nurses but not in analytical clinical reasoning with the intent of making an appropriate diagnosis and developing a comprehensive treatment and holistic management plan.…”

“…One important component of advanced practice programme outcomes is the development of the student's diagnostic reasoning skills. Diagnostic reasoning is a critically important aspect of the NP role, though there is a paucity of literature on this topic relative to advanced nursing practice (Burt & Corbridge, 2018; Lawson, 2018). Kicklighter et al (2016) identify that this cognitive process involves clinical decision‐making based upon hypothetico‐deductive reasoning and pattern recognition.…”

Scoping review: Diagnostic reasoning as a component of clinical reasoning in the U.S. primary care nurse practitioner education

“…All but two studies were published in the past seven years. The research papers varied in design and included qualitative ( n = 2; Burt, Corbridge, et al, 2021 ; Tiffen et al, 2014 ), quantitative ( n = 6; Burt, Finnegan, et al, 2021 ; Gorton & Hayes, 2014 ; Jeffries et al, 2011 ; O'Rourke & Zerwic, 2016 ; Posey et al, 2018 ; Sweeney et al, 2017 ), mixed methods ( n = 2; Conelius et al, 2019 ; Kelley et al, 2007 ), and literature reviews ( n = 3; Burt & Corbridge, 2018 ; Gatewood & De Gagne, 2019 ; Lawson, 2018 ). Like the case reports, the research typically evaluated a teaching strategy, using convenience samples recruited from individual NP programs in which the reported innovation/intervention or study took place.…”

“…Benbenek et al ( 2016 ; Billings and Kowalski ( 2008 ); Burt and Corbridge ( 2018 ); Conelius et al ( 2019 ); Distler ( 2008 ); Durham et al ( 2014 ); Granger et al ( 2018 ); Raterink ( 2016 ); Schumaker and Bergeron ( 2016 ); Surjadi et al ( 2019 ); Tiffen et al ( 2014 ); Weber and Snow ( 2006 )…”

An international comparison of student nurse practitioner diagnostic reasoning skills

“…Diagnostic reasoning is an important competency for NPs to develop during their education program (Burt & Corbridge, 2018; Lawson, 2018; National Organization of Nurse Practitioner Faculties, 2017). There is a lack of consensus in the literature defining diagnostic reasoning with many studies using the term informally, without providing a definition (Brentnall et al, 2022; Lawson, 2018).…”