Reflecting on Diagnosis: Factors Associated with Diagnostic Reasoning in Family Nurse Practitioner Students
Open AccessDiagnostic errors are a national health crisis, with most humans likely to experience at least one in their lifetime. Educators grapple to develop interventions aimed at improving diagnosis and the complex process of diagnostic reasoning. To address this need, the dissertation study investigated factors associated with diagnostic reasoning in Family Nurse Practitioner (FNP) students. A quasi-experimental, pretest/posttest one group design was employed using the Metacognitive Diagnostic Reasoning model. Forty-one FNP students from two U.S. Masters-degree granting programs participated in a parent study intervention where 70 hours in their final semester of clinical education were replaced with screen-based simulation. Pre- and post-study measures of metacognitive awareness (Metacognitive Awareness Inventory), knowledge (Diagnostic Readiness Test), and diagnostic reasoning (i-Human Patients© simulation platform data) were collected. There was a statistically significant increase in all three variables from pre- to post-test, p < 0.001, but not a statistically significant relationship between knowledge and metacognitive awareness, r = 0.10, p = 0.54, nor metacognitive awareness and diagnostic reasoning, r = 0.05, p = 0.74. Only 6.3% of diagnostic reasoning could be explained by metacognitive awareness and knowledge, and this linear regression model was not statistically significant, F = 1.28, p = 0.29. However, with exposure to repeated patient cases through screen-based simulation, diagnostic reasoning, metacognitive awareness, and knowledge all improved. Reflecting on the current state of graduate nursing clinical education and diagnostic error, the educational significance of such an improvement is paramount.
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